Abiomed Impella 2.5, Instructions For Use Manual

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7.19 Impella
®
System for Use During Cardiogenic Shock
If the Impella
®
2.5 or Impella CP
®
Catheter has sudden low flows or suction at startup:
1.
Remove the catheter from the patient and ensure that ACT is 250 seconds or above.
2.
Closely inspect the inlet and outlet areas and remove any thrombus or other foreign
materials.
3.
If materials have been removed, run the Impella ® at P-8 or AUTO in a basin.
4. If flows are still above 2.2 L/min, reinsert the Impella
®
Catheter into the patient.
5.
If no material is visible or if the flows are still low, there could be a clot inside the
device. An assessment (fluoroscopic or echocardiography) of the left ventricle is
recommended to rule out left ventricular thrombus before inserting another device.
SUCTION WITH THE IMPELLA
®
5.0 OR LD CATHETER
If the “Suction” alarm occurs during support with the Impella ® 5.0 or LD Catheter, follow the
recommended actions:
1. Reduce P-level by 1 or 2 levels to reduce the effects of suction.
2.
Check the Impella
®
Catheter for correct positioning using imaging. Reposition the
catheter by rotating or moving it into or out of the ventricle slightly. Either or both of
these actions could help move the inlet of the Impella
®
Catheter away from the interior
ventricular wall.
3.
Assess patient’s fluid intake and output to confirm adequate volume status.
4.
Confirm right ventricular function by assessing CVP or right side function with
echocardiography. If CVP is not an option, check the pulmonary artery diastolic
pressure to assess the patient volume status.
5. Return the P-level to pre-alarm setting.
HEMOLYSIS
When blood is pumped, it is subjected to mechanical forces. Depending on the strength of the
blood cells and the amount of force applied, the cells may be damaged, allowing hemoglobin to
enter the plasma. Pumping forces can be generated by a variety of medical procedures including
heart lung bypass, hemodialysis, or ventricular assist device (VAD) support. Patient conditions—
including catheter position, pre-existing medical conditions, and small left ventricular volumes—
may also play a role in patient susceptibility to hemolysis.
Hemolysis should be monitored during support. Patients who develop high levels of hemolysis
may show signs of decreased hemoglobin levels, dark or blood-colored urine, and in some cases,
acute renal failure. Plasma-free hemoglobin (PfHgb) is the best indicator to confirm whether a
patient is exposed to an unacceptable level of hemolysis.
Management technique may differ depending on the underlying cause of hemolysis. Table 7.1
provides guidance for various circumstances.
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