5.29
Impella
®
System for Use During Cardiogenic Shock
IMPLANTING AND STARTING THE IMPELLA
®
LD
CATHETER
NOTE – Proper surgical procedures and techniques are the responsibility of the
medical professional. The described procedure is furnished for information
purposes only. Each physician must evaluate the appropriateness of the procedure
based on his or her medical training and experience, the type of procedure, and
the type of systems used.
Avoid manual compression of the inlet, outlet, or sensor areas of the cannula
assembly.
Do
NOT
kink or clamp the Impella
®
Catheter with anything other than a soft jaw
vascular clamp. Do
NOT
kink or clamp the peel-away introducer.
Handle with care. The Impella
®
LD Catheter can be damaged during removal from
packaging, preparation, insertion, and removal. Do
NOT
bend, pull, or place excess
pressure on the catheter or mechanical components at any time.
An incision larger than 6 mm may allow the front plug to advance into the aorta.
The Impella
®
LD Catheter is surgically implanted when there is access to the ascending aorta
through a sternotomy or thoracotomy. Transesophageal echocardiography (TEE) is required to
guide placement.
IMPLANTATION PREPARATION
1.
Using the supplied sterile incision template for positioning (see sidebar), place a
sidebiter clamp on the aorta at least 7 cm above the valve plane.
2.
Make an incision (or punch) no larger than 6 mm at the insertion site on the ascending
aorta.
3.
Attach the Dacron
®
vascular graft (10 mm x 15 cm) to the aorta using the standard
end-to-side anastomosis.
4.
Administer heparin and achieve ACT of at least 250 seconds.
5.
When the anastomosis is complete, place a clamp at the distal end of the graft and
then release the proximal clamp at the base of the graft. Examine the suture line for
leaks and reclamp the graft at the base.
6.
Moisten the Impella
®
LD Catheter and push both silicone plugs up against the motor
housing as shown in Figure 5.33.
Use TEE for Placement
Transesophageal
echocardiography (TEE) is
required for placement of the
Impella
®
LD Catheter.
Positioning the Aortic
Incision
It is important to make the
incision in the ascending aorta
7 cm above the aortic valve so
that the Impella
®
LD Catheter
can be positioned properly.
An incision too close to the
aortic valve annulus could
result in the catheter outlet
area in the graft rather than
the aorta.
The incision must be
≤
6 mm
in length to prevent the front
silicone plug from advancing
into the aorta through the
incision.
GP IIb-IIIa Inhibitors
If the patient is receiving a
GP IIb-IIIa inhibitor, the
Impella
®
LD Catheter can be
implanted when ACT is 200
or above.
Keep ACT ≥ 250 Seconds
Maintaining ACT at or above
250 seconds will help prevent
a thrombus from entering
the catheter and causing a
sudden stop on startup.
5
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Summary of Contents for Impella 2.5
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