Abiomed Impella 2.5, Instructions For Use Manual

Page: 87 / 211

5.33 Impella
®
System for Use During Cardiogenic Shock
5. Wait 30 seconds for flow to reach its maximum value, then confirm correct and stable
placement. Evaluate the catheter position in the aortic arch and remove any excess
slack. The catheter should align against the lesser curvature of the aorta rather than
the greater curvature. Verify placement with fluoroscopy and with the placement signal
screen.
6.
Reposition the catheter as necessary.
7.
If the Impella
®
Catheter advances too far into the left ventricle and the controller
displays a ventricular waveform (see Figure 5.38) rather than an aortic waveform,
follow these steps to reposition the catheter.
a.
Pull the catheter back until an aortic waveform is present on the placement screen.
b.
When the aortic waveform is present, pull the catheter back an additional 4 cm.
(The distance between adjacent markings on the catheter is 1 cm.) The catheter
should now be positioned correctly.
Impella Flow
3.5
System Power
MUTE
ALARM
0 . 0
DISPLAY
0 . 0
MENU
PURGE
SYSTEM
Impella CP S/N: 123456 30 - 09 - 2012 05:30
100%
CONTROL
FLOW
A U T O
L/min
4.0 Max
________________________
3.0 Min
Purge System
Purge Pressure: 600 mmHg
Purge Flow: 20.0 ml/hr
Motor
Current
7 92/537
( 7 03)
( mA)
10 sec.
Placement
Signal
( mmHg)
90/10
( 37 )
10 sec.
160
0
1000
0
Figure 5.38 Ventricular Waveform on Placement Signal Screen
MODES OF OPERATION
AUTO
In
AUTO
, the Automated Impella
®
Controller sets the motor speed of the Impella
®
Catheter
to achieve the maximum possible flow without causing suction. After 3 hours of operation, if
you have not transferred to the standard configuration, the controller automatically switches
to P-level mode. Upon transfer from AUTO mode to P-level mode, the controller displays the
message shown in Figure 5.39 and the AUTO setting is no longer an option.
Impella Flow
3.5
System Power
MUTE
ALARM
0 . 0
Impella CP S/N: 123456 30 - 06 - 2011 05:30
100% L/min
3.0 Max
________________________
4.0 Min
Purge System
Purge Pressure: 600 mmHg
Purge Flow: 10.0 ml/hr
Placement
Signal
( mmHg)
109/8 0
( 93)
10 sec.
160
OK
0
The system has perf ormed a routine transf er to P-Lev el
mod e af ter three hours of pump operation.
Please ack nowled ge b y selecting OK .
OKOK
Figure 5.39 Transfer to P-level Mode
5. 5. Wait 30 seconds for flow to reach its maximum value, then confirm correct and stable
placement. Evaluate the catheter position in the aortic arch and remove any excess
slack. The catheter should align against the lesser curvature of the aorta rather than
the greater curvature. Verify placement with fluoroscopy and with the placement signal
screen.
Importance of Proper
Impella
®
Catheter
Placement
When the Impella
®
Catheter is
not correctly placed, there is
no effective unloading of the
ventricle. The patient may not
be benefiting from the flow
rate shown on the controller.
6. 6.
Reposition the catheter as necessary.
7. 7.
If the Impella
®
Catheter advances too far into the left ventricle and the controller
displays a ventricular waveform (see Figure 5.38) rather than an aortic waveform,
follow these steps to reposition the catheter.
a. a.
Pull the catheter back until an aortic waveform is present on the placement screen.
b. b.
When the aortic waveform is present, pull the catheter back an additional 4 cm.
(The distance between adjacent markings on the catheter is 1 cm.) The catheter
should now be positioned correctly.
Placement Monitoring
Suspended
When the Impella ® Catheter is
operating in a low flow range,
placement monitoring may be
suspended and the flow rate
in the lower left corner of the
controller display screen will
turn yellow to indicate that
Impella position is unknown.
Retrograde Flow
If the Impella ® Catheter
minimum flow is below
0.1 L/min then the controller
will increase the motor speed
to prevent retrograde flow.
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