Yini i-Ventricular Assist Device? Injongo, Inqubo & Nemiphumela

I-ventricular assist device (VAD) iyiphampu yomshini esiza inhliziyo yakho ukuba ijikeleze igazi emzimbeni wakho wonke lapho imisipha yenhliziyo yakho iba buthaka kakhulu ukwenza lo msebenzi ngempumelelo yodwa. Cabanga ngayo njengozakwethu osekela inhliziyo yakho, ongena ukuqinisekisa ukuthi izitho zakho zithola igazi elinothile nge-oksijini elidingayo ukuze zisebenze kahle.

Le teknoloji esindisa impilo isize izinkulungwane zabantu ukuba baphile impilo egcwele, esebenzayo ngenkathi bephatha ukuhluleka kwenhliziyo okukhulu. Noma ngabe uhlola izinketho zokwelashwa wena noma othandekayo, ukuqonda ukuthi ama-VAD asebenza kanjani kungakusiza uzizwe uqiniseka kakhulu ngalesi sinqumo esibalulekile sezokwelapha.

Yini i-ventricular assist device?

I-ventricular assist device iyiphampu yomshini esebenza ngamabhethri efakwa ngokuhlinzwa ngaphakathi noma ngaphandle kwesifuba sakho ukusiza ukumpompa igazi emagumbini aphansi enhliziyo yakho (ama-ventricles) ukuya kuyo yonke eminye imizimba yakho. Le divayisi isebenza eceleni kwenhliziyo yakho yemvelo, ingayishintshi ngokuphelele.

Ama-VAD amaningi asebenzela i-ventricle yesobunxele, okuyigumbi eliyinhloko lokumpompa inhliziyo yakho elibhekele ukuthumela igazi elinothile nge-oksijini emzimbeni wakho wonke. Lokhu kubizwa ngokuthi ama-left ventricular assist devices (LVADs). Abanye abantu bangadinga ukusekelwa yi-ventricle yabo yesokudla (RVAD) noma zombili izinhlangothi (BiVAD), kuye ngesimo senhliziyo yabo esithile.

Le divayisi iqukethe izingxenye ezimbalwa ezibalulekile ezisebenza ngokubambisana. Uzoba nephampu encane, amashubhu aguquguqukayo abizwa ngokuthi ama-cannulas axhumeka enhliziyweni yakho, i-driveline ephuma esikhumbeni sakho, nesilawuli sangaphandle esinamabhethri ozowagqoka noma uwathwale nawe.

Kungani kwenziwa i-ventricular assist device?

Ama-VAD anconywa uma inhliziyo yakho iba buthaka kakhulu ngenxa yokuhluleka kwenhliziyo kanye nokunye ukwelashwa okungazange kunikeze ukuthuthuka okwanele. Udokotela wakho angase asikisele le nketho uma imithi, izinguquko zokuphila, nezinye izinqubo zingasakwazi ukugcina izimpawu zakho zilawuleka noma izitho zakho zisebenza kahle.

Le divayisi isebenza ngezinhloso ezahlukene kuye ngesimo sakho somuntu ngamunye kanye nemigomo yokwelashwa yesikhathi eside. Abanye abantu basebenzisa i-VAD njengebhuloho lokuthola ukufakelwa kwenhliziyo, libasiza ukuthi bahlale bezinzile futhi bephilile ngenkathi belinde inhliziyo yomnikeli ukuthi itholakale. Lesi sikhathi sokulinda ngezinye izikhathi singathatha izinyanga noma iminyaka.

Abanye bathola i-VAD njengokwelashwa okuyisiphelo, okusho ukuthi iba ukwelashwa unomphela lapho ukufakelwa kwenhliziyo kungafaneleki ngenxa yobudala, ezinye izimo zempilo, noma ukukhetha komuntu siqu. Abantu abaningi abakulesi simo bathola ukuthi bangakwazi ukubuyela emisebenzini abayithandayo futhi bachithe isikhathi esihle nomndeni nabangane.

Ngokuvamile, ama-VAD angasebenza njengebhuloho lokululama kubantu abanhliziyo zabo ezingase ziphole ngesikhathi nosizo. Le ndlela ngezinye izikhathi isetshenziswa ngemva kokuhlaselwa yinhliziyo, izifo ezithile, noma ngesikhathi sokululama ngemva kokuhlinzwa kwenhliziyo lapho odokotela bekholelwa ukuthi imisipha yenhliziyo ingase ithole amandla ayo.

Yini inqubo yokufakwa kwedivayisi yokusiza i-ventricular?

Ukufakwa kwe-VAD kuyindlela enkulu yokuhlinzwa kwenhliziyo evame ukuthatha amahora angu-4 kuya kwangu-6 futhi idinga ukuhlelwa nokulungiswa ngokucophelela. Uzothola i-anesthesia ejwayelekile futhi uxhunywe emshinini wenhliziyo-lunga othatha umsebenzi wenhliziyo namaphaphu akho ngesikhathi senqubo.

Udkt. wakho ohlinzayo uzokwenza ukusikeka phakathi nesifuba sakho futhi axhume ngokucophelela idivayisi enhliziyweni yakho. Impompo ivamise ukubekwa esiswini sakho esiphezulu, ngaphansi nje kwe-diaphragm yakho, lapho ihlala khona kamnandi ngaphandle kokuphazamisa ukunyakaza kwakho kwansuku zonke.

Nakhu okwenzekayo ngesikhathi sokuhlinzwa, isinyathelo ngesinyathelo:

1. Udkt wenu ohlinza isifuba sakho futhi kungase kudingeke ahlukanise ezinye izicubu ezinamanxeba uma wake wahlinzwa inhliziyo ngaphambilini
2. Umshini wenhliziyo namaphaphu uthatha ukumpompa igazi ngenkathi udkt wakho esebenza
3. Ipayipi elincane (i-inflow cannula) lithungelwa ngaphakathi kwesifuba sakho sokunxele ukuze lidonse igazi lingene kudivayisi
4. Elinye ipayipi (i-outflow cannula) lixhunywe ku-aorta yakho ukuze libuyisele igazi emzimbeni wakho
5. Iphampu ibekwa esiswini sakho futhi ihlolwe ukuqinisekisa ukuthi isebenza kahle
6. I-driveline ithunelwa ngaphansi kwesikhumba sakho futhi iphume esiswini sakho
7. Isifuba sakho sivalwa futhi uyiswa esibhedlela esigxile ekunakekelweni okukhulu ukuze uqashwe

Ukwelulama esibhedlela kuvame ukuthatha amasonto ama-2 kuya kwama-3, nakuba lokhu kuhluka ngokuya ngempilo yakho yonke nokuthi ululama ngokushesha kangakanani. Uzosebenza eduze nethimba elikhethekile elihlanganisa odkt benhliziyo, odkt benhliziyo, abahlengikazi, nezinye izazi eziqonda ukunakekelwa kwe-VAD.

Ungalungela kanjani ukuhlinzwa kwakho kwedivayisi yokusiza i-ventricular?

Ukulungiselela ukuhlinzwa kwe-VAD kuhilela ukulungiselela ngokomzimba nangokomzwelo, futhi ithimba lakho lezokwelapha lizokuqondisa kuzo zonke izinyathelo ukukusiza uzizwe ulungele ngangokunokwenzeka. Uzohlinzwa izivivinyo eziningana ukuze uqiniseke ukuthi unempilo ngokwanele ukuhlinzwa nokuthi i-VAD iyona ndlela efanele esimweni sakho.

Ukulungiselela kwakho cishe kuzohlanganisa ukuhlolwa kwegazi, izifundo zokuthwebula izithombe zenhliziyo yakho nezinye izitho, kanye nokubonisana nezazi ezihlukene. Lokhu kuqokwa kusiza ithimba lakho ukuthi liqonde impilo yakho yonke futhi lihlele indlela ephephe kakhulu yokuhlinzwa kwakho.

Emasontweni ngaphambi kokuhlinzwa, gxila ekuzinakekeleni kahle ngezinyathelo ezibalulekile:

• Thatha yonke imithi oyinikiwe ngendlela eqondile, ikakhulukazi imithi yenhliziyo
• Dla ukudla okunomsoco ukuze unike umzimba wakho amandla okuphola
• Thola ukuphumula nokulala okwanele uma kungenzeka
• Hlala usebenza njengoba udokotela wakho encoma ngaphakathi kwemingcele yakho yamanje
• Gwema ukubhema futhi unciphise utshwala, ngoba lokhu kungaphazamisa ukuphola
• Zijwayeze ukuhlanzeka kwamazinyo okuhle futhi ubhekane nanoma yiziphi izinkinga zamazinyo
• Funda mayelana nokunakekelwa kwe-VAD kanye nezinguquko zokuphila okuzodingeka ukuthi uzenze

Unganqikazi ukubuza imibuzo noma ukuveza izinkathazo ngesikhathi sokuqokwa kwakho ngaphambi kokuhlinzwa. Ithimba lakho lifuna ukuthi uzizwe unolwazi futhi ukhululekile, futhi likhona ukukusekela ngalesi sinqumo esibalulekile kanye nenqubo.

Ungazifunda kanjani imiphumela yakho yedivayisi yokusiza i-ventricular?

Ngemuva kokuthi i-VAD yakho ifakwe, uzoqala ukufunda ukuqapha izilinganiso eziningana ezibalulekile ezitshela wena nethimba lakho lezokwelapha ukuthi idivayisi isebenza kahle kangakanani. Isilawuli sakho se-VAD sibonisa imininingwane mayelana nesivinini sephampu, ukusetshenziswa kwamandla, nokugeleza, okuyizinkomba ezibalulekile zokusebenza kwedivayisi yakho.

Isivinini sephampu, esilinganiswa ngamajika ngomzuzu (RPM), ngokuvamile sisethwa phakathi kuka-2,400 no-3,200 RPM, nakuba ububanzi bakho obuqondile obuqondiwe buzomiswa udokotela wakho ngokusekelwe ezidingweni zakho ngazinye. Lesi sivinini singalungiswa ngesikhathi sokuqokwa okulandelayo ukuze kulungiswe ukuhamba kwegazi lakho kanye nokukhululeka kwezimpawu.

Ukusetshenziswa kwamandla kubonisa ukuthi idivayisi yakho isebenzisa amandla amangaki futhi ngokuvamile kusuka ku-3 kuya ku-8 watts. Ushintsho ekusetshenzisweni kwamandla ngezinye izikhathi lungabonisa izinkinga ezinjengamahlule egazi noma izinguquko ekusebenzeni kwenhliziyo yakho kanye nedivayisi.

Izilinganiso zokugeleza zilinganisa ukuthi i-VAD yakho iphampa igazi elingakanani ngomzuzu, ngokuvamile lisuka ku-3 kuya ku-6 amalitha. Ukugeleza okuphezulu ngokuvamile kusho ukujikeleza okungcono ezingxenyeni zakho zomzimba, kuyilapho ukugeleza okuphansi kungase kusikisela isidingo sokulungiswa.

Uzofunda futhi ukuqaphela imisindo ye-alamu nemiyalezo ekuxwayisa ngezimo ezidinga ukunakwa. Ama-alamu amaningi ahlobene nezinkinga zebhethri, izinkinga zokuxhumeka, noma izinguquko zesikhashana ezingaxazululwa kalula, kodwa ithimba lakho lizokufundisa ukuthi ucele usizo ngokushesha nini.

Ungaphila kanjani nensiza yakho yokusiza i-ventricular?

Ukuphila ne-VAD kudinga ukulungiswa okuthile emsebenzini wakho wansuku zonke, kodwa abantu abaningi bathola ukuthi bangabuyela emisebenzini eminingi abayithokozelayo uma sebesinde emsebenzini wokuhlinzwa. Okubalulekile ukufunda ukuhlanganisa ukunakekelwa kwensiza empilweni yakho ngenkathi uhlala usebenza futhi uhlanganyela nomndeni nabangane.

Umsebenzi wakho wansuku zonke uzohlanganisa ukuhlola imishini yakho, ukugcina indawo yakho ye-driveline ihlanzekile futhi yomile, nokuphatha amabhethri akho ukuze uqinisekise ukuthi idivayisi yakho ayilahlekelwa amandla. Uzothwala amabhethri okusekela futhi ufunde ukuwashintsha ngokushelela ukuze imisebenzi yakho ingaphazamiseki.

Ukunakekela indawo yakho yokuphuma ye-driveline kubalulekile ekuvikeleni izifo, ezingenye yezinkinga ezinzima kakhulu. Uzohlanza indawo nsuku zonke ngezinto ezikhethekile futhi ubheke izimpawu zobubomvu, ukukhipha amanzi, noma ukuba nobumnene okungase kubonise inkinga.

Nawa amasu abalulekile okuphatha nsuku zonke ozowazi:

• Hlola isibonisi sakho sesilawuli ukuze uthole ukufundwa okuvamile kanye nanoma yimaphi ama-alamu
• Hlanza indawo yakho yokuphuma ye-driveline ngobuchwepheshe obungenazo inzalo
• Shintsha futhi ushaje amabhethri ngokuya ngeshejuli yakho
• Thatha imithi enqunyiwe, ikakhulukazi ama-blood thinners
• Qapha isisindo sakho bese ubika izinguquko ezinkulu
• Hlala unamanzi futhi udle ukudla okunempilo enhliziyo
• Thola ukuphumula okwanele futhi ulawule ukucindezeleka

Abantu abaningi abane-VAD bangakwazi ukubuyela emsebenzini kancane kancane, ukuhamba, nemisebenzi yokuzilibazisa ngokuhlela okufanele nokuqapha. Ithimba lakho lizokusiza ukuthi uqonde ukuthi yimiphi imisebenzi ephephile nokuthi ungayiguqula kanjani eminye ukuze ihambisane nedivayisi yakho.

Ziyini izici eziyingozi zezinkinga ze-VAD?

Ngenkathi ama-VAD eyizisetshenziswa ezisindisa impilo, njenganoma yikuphi ukungenelela okukhulu kwezokwelapha, aletha ezinye izingozi okufanele uziqonde ngaphambi kokwenza isinqumo sakho. Ithimba lakho lezokwelapha lizoxoxa ngalezi zingozi ngobuqotho nawe futhi lichaze ukuthi lisebenza kanjani ukuzinciphisa.

Ukunyuka kwamagciwane kungenye yezinkinga ezivame kakhulu, ikakhulukazi endaweni yokuphuma kwe-driveline lapho ikhebula lidlula esikhumbeni sakho. Lokhu kudala ukuvulwa okungapheli okudinga ukunakekelwa nsuku zonke ukuvimbela amagciwane ukuthi angene emzimbeni wakho.

Izinto eziningana zingakhuphula ingozi yakho yezinkinga, futhi ukuqonda lezi kusiza ithimba lakho ukuthi linikeze ukunakekelwa okungcono kakhulu:

• Ukuhlinzwa kwenhliziyo kwangaphambilini okudala izicubu ezinamanxeba
• Isifo sikashukela noma ezinye izimo ezithinta ukuphola
• Izinkinga zezinso noma zesibindi ezithinta impilo yakho yonke
• Ukudla okungenamsoco noma ukuba ngaphansi kwesisindo noma ukukhuluphala ngokweqile
• Ukunyuka kwamagciwane okusebenzayo noma yikuphi emzimbeni wakho
• Ubunzima bokulandela amashejuli emithi ayinkimbinkimbi
• Ukusekelwa komphakathi okulinganiselwe ekufundeni ukunakekelwa kwensiza
• Isifo esibi samaphaphu noma ezinye izinkinga zezitho

Ithimba lakho lihlolisisisa lezi zinto ngaphambi kokuncoma i-VAD ukuze liqinisekise ukuthi maningi amathuba okuthi uzuzwe kusuka kusisetshenziswa ngenkathi kuncishiswa izingozi ezingaba khona. Bazosebenza nawe ukuthuthukisa impilo yakho ngaphambi kokuhlinzwa noma nini lapho kungenzeka.

Ziyini izinkinga ezingaba khona zamadivayisi okusiza i-ventricular?

Ukuqonda izinkinga ezingaba khona kukusiza ukuthi wenze isinqumo esinolwazi futhi wazi ukuthi yiziphi izimpawu okufanele uzibheke ngemuva kokuthi i-VAD yakho ifakwe. Ngenkathi izinkinga zingenzeka, abantu abaningi baphila ngempumelelo ngama-VAD iminyaka ngobunakekeli obufanele nokuqapha.

Izinkinga ezivame kakhulu zihlanganisa ukopha, amahlule egazi, nokunyuka kwamagciwane, ngalinye lidinga amasu ahlukene okuvimbela nokwelashwa. Ithimba lakho lezokwelapha lizokufundisa ukuthi ungazibona kanjani izimpawu zakuqala zalezi zinkinga ukuze zixazululwe ngokushesha.

Nawa ama-complications okufanele uwazi ngawo, ahlelwe kusuka kwavame kakhulu kuya kwavamile kancane:

• Ukutheleleka kwemigqa eduze nendawo yokuphuma, okubangela ububomvu, ubuhlungu, noma ukuphuma
• Izinkinga zokuphuma igazi ngenxa yemithi yokunciphisa igazi edingekayo nge-VADs
• Amahlule egazi angakheka kudivayisi noma ahambe kwamanye amalungu omzimba
• Ukwehluleka kwenhliziyo kwesokudla uma i-ventricle yakho yesokudla ingakwazi ukuhambisana nokwanda kokugeleza kwegazi
• Isifo sohlangothi esivela emahlule egazi noma izinguquko kumaphethini okugeleza kwegazi
• Ukungasebenzi kahle kwedivayisi okudinga ukulungiswa noma ukuhlinzwa kokushintshwa
• Izinkinga zezinso ezivela ezingeni lokugeleza kwegazi noma imithi
• Ukuphuma igazi emathunjini, okungase kuvamile ngezinhlobo ezithile ze-VADs

Ama-complications angavamile kodwa abucayi afaka ukwehluleka kwedivayisi, ukutheleleka okukhulu okusabalala emzimbeni wakho wonke, kanye nama-complications ahlobene nemithi yokunciphisa igazi. Ithimba lakho likuqapha eduze ngezinkinga ezinjalo futhi linama-protocol okuzixazulula ngokushesha uma kwenzeka.

Khumbula ukuthi ngenkathi lolu hlu lungase lubonakale lukhathaza, ithimba lakho lezokwelapha linolwazi oluningi lokuphatha lezi zinkinga, futhi eziningi zingavinjelwa noma ziphathwe ngempumelelo uma zitholwe kusenesikhathi.

Kufanele ngibone nini udokotela ngezinkinga ezihlobene ne-VAD?

Ngemuva kokuthola i-VAD yakho, uzoba nama-aphoyintimenti okulandelayo njalo ukuze uqaphe idivayisi yakho nempilo yonke, kodwa kufanele futhi wazi ukuthi kufanele ufune nini ukunakekelwa kwezokwelapha ngokushesha. Ukufunda ukuqaphela izimpawu zokuxwayisa kusiza ukuqinisekisa ukuthi uthola ukunakekelwa okusheshayo uma kudingeka.

Kufanele uthinte ithimba lakho le-VAD ngokushesha uma uhlangabezana nama-alamu edivayisi angaxazululwa ngokuxazulula izinkinga eziyisisekelo, noma yiziphi izimpawu zokutheleleka eduze komugqa wakho wokushayela, noma izimpawu ezingase zibonise ama-complications afana nesifo sohlangothi noma izinkinga zenhliziyo.

Funa ukunakekelwa okuphuthumayo ngokushesha ngezimpawu zokuxwayisa ezimbi:

• Izixwayiso zedivayisi eziqhubekayo ezingeke zime noma zicishe
• Ukwahluleka okuphelele kwedivayisi noma ukulahlekelwa amandla
• Ubuhlungu obukhulu besifuba obuzumayo noma ubunzima bokuphefumula
• Izimpawu zokushaywa unhlangothi njengobuthakathaka obuzumayo, ukudideka, noma izinkinga zokukhuluma
• Ukuphuma igazi okukhulu okungami ngomfutho
• Umkhuhlane omkhulu onamakhaza noma ukuzizwa ungaphilile
• I-driveline edonswe noma elimele
• Isiyezi esikhulu esizumayo noma ukuquleka

Xhumana nethimba lakho le-VAD kungakapheli amahora angama-24 ngezimpawu ezikhathazayo kodwa ezingaphuthumi kangako: ukuphuma noma ukwanda kobubomvu endaweni yakho ye-driveline, ukukhuluphala ngaphezu kwamaphawundi ama-3 ngosuku, isicanucanu esiqhubekayo noma ukuhlanza, noma yiziphi izimpawu ezintsha ezikukhathazayo.

Unganqikazi ukushaya ucingo ngemibuzo noma izinkathazo, ikakhulu ezinyangeni zakho zokuqala ngedivayisi. Ithimba lakho lingathanda ukuzwa kuwe ngento encane kunokuthi ulinde isikhathi eside ukuze ubhekane nenkinga engaba yingozi.

Imibuzo evame ukubuzwa ngamadivayisi okusiza i-ventricular

Umbuzo 1. Ingabe idivayisi yokusiza i-ventricular ilungele ukuhluleka kwenhliziyo esigabeni sokugcina?

Yebo, ama-VAD angaba izinketho zokwelapha ezinhle kakhulu kubantu abahluleka inhliziyo esigabeni sokugcina abangathuthukiswanga ngemithi kanye nokunye ukwelashwa. Lawa madivayisi angathuthukisa kakhulu izinga lempilo, andise ukusinda, futhi akusize ukuthi ubuyele emisebenzini oyithandayo.

Kubantu abaningi abahluleka inhliziyo ethuthukile, i-VAD inikeza ukusekelwa kokujikeleza okudingekayo ukuze kugcinwe izitho zisebenza kahle ngenkathi kunciphisa izimpawu ezinjengokuphefumula kanzima nokukhathala. Izifundo zibonisa ukuthi abantu abane-VAD bavame ukuzwa ukuthuthukiswa kwamandla okuzivocavoca kanye nenhlalakahle yonke uma kuqhathaniswa nokwelashwa ngemithi kuphela.

Umbuzo 2. Ingabe ukuba ne-VAD kusho ukuthi angikwazi ukuhamba noma ukusebenza?

Abantu abaningi abane-VAD bangahamba futhi bahlale bekhuthele uma sebeluleme emsebenzini wokuhlinzwa futhi bafunde ukuphatha kahle idivayisi yabo. Kuzodingeka ukuthi uhlele kusengaphambili futhi uthathe imishini eyengeziwe, kodwa abantu abaningi abathola i-VAD bahamba ngaphakathi ezweni nangamazwe ngamazwe.

Imisebenzi efana nokuhamba, ukubhukuda ezimweni ezithile, kanye nemisebenzi eminingi yokuzilibazisa ivame ukwenzeka ngezinyathelo zokuphepha ezifanele. Ithimba lakho lizokusiza ukuthi uqonde ukuthi yimiphi imisebenzi ephephile nokuthi ungayishintsha kanjani eminye ukuze ihambisane nedivayisi yakho ngenkathi uhlala usebenza futhi uhlanganyela.

Q.3 Ngingaphila isikhathi esingakanani ngedivayisi yokusiza i-ventricular?

Abantu abaningi baphila iminyaka eminingi ngama-VAD abo, futhi amazinga okusinda ayaqhubeka nokuthuthuka njengoba ubuchwepheshe buqhubeka. Abanye abantu baye baphila iminyaka engaphezu kweshumi ngamadivayisi abo, begcina izinga elihle lempilo kuyo yonke leyo minyaka.

Ukuqonda kwakho komuntu ngamunye kuncike ezintweni eziningi ezihlanganisa impilo yakho yonke, ukuthi uyinakekela kahle kangakanani idivayisi yakho, nokuthi ngabe unazo yini izinkinga. Ithimba lakho lezokwelapha lingakunikeza imininingwane ecacile ngokusekelwe esimweni sakho esithile kanye nesimo sempilo.

Q.4 Ngizokwazi yini ukuzwa i-VAD isebenza ngaphakathi emzimbeni wami?

Abantu abaningi bajwayela i-VAD yabo kungakapheli amasonto ambalwa futhi abayiboni isebenza ngesikhathi semisebenzi yansuku zonke. Ekuqaleni ungase uzwe ukudlidliza okuthile noma uzwe umsindo othule wokuhumusha, kodwa lezi zinzwa ngokuvamile ziba ngaphansi uma isikhathi sihamba.

Idivayisi yakhelwe ukuthi isebenze ngokushelela futhi ngokuqhubekayo, ngakho akufanele uzizwe ungenamahloni ukumpompa noma ukunyakaza okungajwayelekile. Abanye abantu bathola ukudlidliza okumnene kuqinisekisa ngoba kubenza bazi ukuthi idivayisi yabo isebenza kahle.

Q.5 Ingabe i-VAD ingasuswa uma inhliziyo yami ilulama?

Ezimweni ezingavamile lapho ukusebenza kwenhliziyo kuthuthuka kakhulu, ama-VAD angase asuswe ngezinye izikhathi, nakuba lokhu kwenzeka ngamaphesenti amancane nje eziguli. Leli thuba lingenzeka kakhulu kubantu abaye bahlaselwa ukuhluleka kwenhliziyo ngenxa yezimo ezingase ziphole, njengokutheleleka okuthile noma ukuhlaselwa yinhliziyo kwakamuva.

Ithimba lakho lezokwelapha liqapha ukusebenza kwenhliziyo yakho njalo futhi lizoxoxa ngethuba lokususwa kwedivayisi uma inhliziyo yakho ikhombisa ukululama okukhulu. Kodwa-ke, abantu abaningi abathola ama-VAD bazowadinga isikhathi eside, kungaba njengebhuloho lokufakelwa noma njengokwelashwa unomphela.