Abiomed Impella RP Instructions For Use & Clinical Reference Manual Download Page 37

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5 USING THE AUTOMATED IMPELLA

CONTROLLER

WITH THE IMPELLA

RP CATHETER

STARTUP .......................................................................................................5.1

Supplies Needed .............................................................................................. 5.1

Turning on the Automated Impella

Controller .................................................5.2

The Startup Screen ..........................................................................................5.3

CASE START ..................................................................................................5.4

Case Start........................................................................................................5.4

Insert Purge Cassette.......................................................................................5.5

Connect the Connector Cable ..........................................................................5.6

Enter Purge Fluid Data .....................................................................................5.8

Secure the Purge Tubing ..................................................................................5.9

Impella

RP System Configuration ...................................................................5.9

INSERTING THE IMPELLA

RP CATHETER ..................................................5.10

POSITIONING AND STARTING THE IMPELLA

RP CATHETER..................... 5.12

PERFORMANCE LEVELS ..............................................................................5.13

USE OF THE REPOSITIONING SHEATH AND THE 23 FR PEEL-AWAY
INTRODUCER ..............................................................................................5.14

PURGE CASSETTE PROCEDURES ................................................................5.15

Change Purge System .................................................................................... 5.15

Change Purge Fluid ....................................................................................... 5.16

Change Purge Cassette ................................................................................. 5.17

De-Air Purge System ...................................................................................... 5.17

TROUBLESHOOTING THE PURGE SYSTEM ..................................................5.18

Low Purge Pressure ....................................................................................... 5.18

Purge System Open ....................................................................................... 5.19

High Purge Pressure ...................................................................................... 5.19

Purge System Blocked .................................................................................... 5.19

PATIENT WEANING .....................................................................................5.20

REMOVING THE IMPELLA

RP CATHETER ..................................................5.20

Summary of Contents for Impella RP

Page 1: ...ederal law USA to provide circulatory assistance for up to 14 days in pediatric or adult patients with a body surface area 1 5 m2 who develop acute right heart failure or decompensation following left...

Page 2: ...s using the Automated Impella Controller Information contained in this document is subject to change without notice 2012 Abiomed Inc All rights reserved The ABIOMED logo and ABIOMED are registered tra...

Page 3: ...l Drive Danvers MA 01923 978 777 5410 voice 978 777 8411 fax clinical abiomed com email Abiomed Europe GmbH Neuenhofer Weg 3 52074 Aachen Germany 49 241 8860 0 voice 49 241 8860 111 fax europe abiomed...

Page 4: ...andthe23FrPeel awayIntroducer 5 14 PurgeCassetteProcedures 5 15 TroubleshootingthePurgeSystem 5 18 PatientWeaning 5 20 RemovingtheImpella RP Catheter 5 20 6 CLINICALEXPERIENCE Pivotal ClinicalStudy De...

Page 5: ...ure5 9 Entering Purge Fluid Information 5 8 Figure5 10 ConnectingthePurgeTubingtotheConnector Cable 5 9 Figure5 11 Impella RP SystemConfiguration 5 9 Figure5 12 MaximumPerformanceLevel 5 12 Figure5 13...

Page 6: ...e system and describes its major components and features Section 4 Using the Automated Impella Controller describes the controls and various screen types on the Automated Impella Controller Section 5...

Page 7: ...1 INDICATIONS CONTRAINDICATIONS AND POTENTIAL ADVERSE EVENTS INDICATIONS UNITED STATES 1 1 CONTRAINDICATIONS UNITED STATES 1 1 POTENTIAL ADVERSEEVENTS UNITEDSTATES 1 2...

Page 8: ...y artery wall that would preclude placement or correct positioning of the Impella RP device Mechanical valves severe valvular stenosis or valvular regurgitation of the tricuspid valve or pulmonary val...

Page 9: ...Bleeding Cardiac tamponade Cardiogenic shock Death Device Malfunction Hemolysis Hepatic failure Insertion site infection Perforation Phlegmasia cerulea dolens a severe form of deep venous thrombosis...

Page 10: ...2 WARNINGS AND CAUTIONS WARNINGS 2 1 CAUTIONS 2 3...

Page 11: ...nce level P0 Do NOT use saline in the purge system Do NOT use an Impella RP System if any part of the system is damaged To prevent the risk of explosion do NOT operate the Impella RP System near flamm...

Page 12: ...pment can affect medical electrical equipment The equipment or system should not be used adjacent to or stacked with other equipment If adjacent or stacked use is necessary the equipment or system sho...

Page 13: ...NOT block the cooling vents of the Automated Impella Controller while it is operating Do NOT kink or clamp any part of the Impella RP Catheter Do NOT use the Impella RP Catheter with a damaged or kin...

Page 14: ...device failure Do NOT use the bed mount as a handle Insertion through the left femoral vein may result in repeated attempts to properly position the Impella RP which could cause excessive manipulatio...

Page 15: ...MPELLA CONTROLLER OVERVIEW 3 1 ReusableSystem Components 3 2 Single useSystem Components 3 2 System Configuration 3 2 IMPELLA RP CATHETER 3 3 Differential PressureSensor 3 4 AUTOMATEDIMPELLA CONTROLLE...

Page 16: ...e cannula to the outlet opening in the pulmonary artery Physicians and device operators monitor Impella RP Catheter function on the display screen of the Automated Impella Controller The intent of the...

Page 17: ...ollowing single use components Impella RP Catheter Purge cassette Introducer kit Connector cable SYSTEM CONFIGURATION Figure 3 2 illustrates how the Automated Impella Controller connects to the Impell...

Page 18: ...or that measures the pressure difference between the inside and outside of the cannula The pressure value is used for monitoring low during catheter operation 3 3 IMPELLA RP CATHETER The Impella RP Ca...

Page 19: ...he Impella RP Catheter to the Automated Impella Controller through a connector cable The clear sidearm is attached to the purge cassette tubing It leads to the infusion filter the pressure reservoir a...

Page 20: ...8 kg and can operate on its internal battery for at least 60 minutes when fully charged Using the controller the Impella RP System can be used by trained healthcare professionals in healthcare facili...

Page 21: ...te through the catheter to the microaxial blood pump to prevent blood from entering the motor When the purge cassette is properly installed in the Automated Impella Controller the words on it are upri...

Page 22: ...or Transmits pressure to the controller based on the purge pressure in the purge tubing a sensor in the controller measures the pressure so that it can be displayed on the screen and used by the purge...

Page 23: ...lug The white plug at the opposite end of the cable is inserted into the blue catheter plug on the front of the Automated Impella Controller Figure 3 6 White Connector Cable The introducer kit is used...

Page 24: ...dextrose in water with 50 IU mL of heparin is used as the purge fluid through the Impella RP Catheter Figure 3 9 Dextrose Solution The Automated Impella Controller cart holds the Automated Impella Con...

Page 25: ...TOMATED IMPELLA CONTROLLER FEATURES 4 1 AUTOMATED IMPELLA CONTROLLER DISPLAY 4 5 PLACEMENT SCREEN 4 8 Placement Signal Waveform 4 8 Motor Current Waveform 4 9 PURGE SCREEN 4 9 Purge Flow 4 10 Purge Pr...

Page 26: ...operating the Automated Impella Controller for the first time make sure you turn this switch on If the battery switch is not turned on the Automated Impella Controller will not be able to operate on b...

Page 27: ...ntroller is off but plugged into AC power No light controller is off and not plugged into AC power Selector knob Rotating push button turn clockwise and counterclockwise to navigate through menu items...

Page 28: ...of the Automated Impella Controller These features are described in Table 4 2 Purge Cassette Door Release Bed Mount Power Switch AC Fuses AC Plug Equipotential Ground Stud VGA RS 232 Jack Ethernet Jac...

Page 29: ...vice personnel AC fuses Electrical safety device in the event of current overload AC plug Connection point on the controller for the AC power cord Power switch Button that turns the controller on or o...

Page 30: ...low Area System Power Area Central Display Area Figure 4 3 Automated Impella Controller Display Elements Table 4 3 Automated Impella Controller Display Elements Display Element Description Alarm windo...

Page 31: ...E SYSTEM or EXIT PURGE SYSTEM Brings up the Purge System menu for changing the purge fluid purge cassette or purge system or de airing the purge system EXIT Exits the current procedure MENU MENU Bring...

Page 32: ...e purge system is stabilizing when there is no purge cassette or when the procedure has not yet started Flow area Information about Impella RP Catheter flow is displayed in the lower left corner of th...

Page 33: ...ment Signal mmHg 42 20 31 10 sec 60 20 1000 0 Figure 4 4 Placement Screen Figure 4 4 shows two time based waveform signals from different sources Placement signal waveform Motor current waveform PLACE...

Page 34: ...and shows the maximum and minimum values and the average value from the samples received You can set the time scale at the bottom of that window by pressing the DISPLAY soft button PURGE SCREEN The pu...

Page 35: ...RESSURE The purge pressure generated by the purge cassette is displayed in mmHg The standard scale for the purge pressure 0 1500 mmHg is displayed to the left of the purge pressure plot The maximum va...

Page 36: ...ION The Li Ion batteries must be charged for 5 hours prior to system operation in order to meet the runtime requirement of 1 hour Failure to do so will yield a shorter runtime After being unplugged th...

Page 37: ...m Configuration 5 9 INSERTING THE IMPELLA RP CATHETER 5 10 POSITIONING AND STARTING THE IMPELLA RP CATHETER 5 12 PERFORMANCE LEVELS 5 13 USE OF THE REPOSITIONING SHEATH AND THE 23 FR PEEL AWAY INTRODU...

Page 38: ...ng and improper operation do NOT block the cooling vents of the Automated Impella Controller while it is operating The Li Ion batteries must be charged for 5 hours prior to system operation in order t...

Page 39: ...automatically performs a system test when turned on A display bar shows the progress of the system test If the system test passes the system displays the startup screen see Figure 5 2 If the system t...

Page 40: ...ftware version V03_10_36 Impella Controller Start up Screen New Case Press MENU or plug in new Impella catheter for case start procedure Figure 5 2 Automated Impella Controller Startup Screen The star...

Page 41: ...heter CASE START 1 Press the MENU soft button from the startup screen Case Start is the default selection on the pop up menu that appears on the screen 2 Press the selector knob to select Case Start T...

Page 42: ...lot to the right of the purge cassette until it snaps into place The controller will automatically begin priming the purge cassette 7 Extend the purge tubing and close the purge cassette door There is...

Page 43: ...ctor Cable Socket black end Catheter Plug Figure 5 5 Inserting the Catheter Plug into the Connector Cable 6 Pull back on the connection to make sure that the plug has snapped into place 7 Snap the pla...

Page 44: ...you have not already done so disconnect and discard the Y connector with the red and yellow luers from the purge tubing 12 Connect the yellow luer on the end of the purge tubing to the yellow luer on...

Page 45: ...ose Concentration Heparin Concentration 500 ml 20 50 units ml Figure 5 9 Entering Purge Fluid Information 2 To select the default values displayed on the screen scroll to OK below the table and press...

Page 46: ...nector cable as shown in Figure 5 10 Figure 5 10 Connecting the Purge Tubing to the Connector Cable IMPELLA RP SYSTEM CONFIGURATION Figure 5 11 illustrates the correct configuration of the Impella RP...

Page 47: ...the femoral vein 2 Insert a 5 8 Fr introducer over the 0 035 inch guidewire provided to pre dilate the vessel 3 Remove the 5 8 Fr introducer over the 0 035 inch guidewire Insert the 8 Fr 12 Fr 16 Fr a...

Page 48: ...atheter The physician can focus on advancing the guidewire and if the cannula needs to be hyperextended the scrub assistant is available to assist 10 Advance the catheter through the hemostatic valve...

Page 49: ...increase the performance level icon 3 Press the selector knob to select the new performance level 4 The catheter operation icon in the lower left corner of the screen begins rotating when the Impella...

Page 50: ...ally clot Pressure bags should not be connected to the sideport of the repositioning sheath If a pressure bag is connected the sideport must have an infusion pump or flow limiting valve in place to co...

Page 51: ...evels between P1 and P6 the Impella RP operates with a regularly recurring rapid speed pulse This minimizes stasis and reduces the risk of thrombosis in the motor area These pulses produce peaks in th...

Page 52: ...e end of the purge tubing as shown in Figure 5 13 Figure 5 13 Disconnecting the Y Connector from the Purge Cassette Tubing 3 Spike the fluid bag bottle 4 Select OK to deliver a bolus to the pressure r...

Page 53: ...ect OK to deliver a bolus to the pressure reservoir so that the reservoir can maintain purge pressure during the change A progress bar shows the progress of the bolus After the bolus is delivered the...

Page 54: ...gap in the purge cassette door when you close the door 6 The system automatically primes the purge cassette A progress bar shows the progress of the priming Once the priming is complete you are promp...

Page 55: ...age 5 If the low purge pressure alarm still remains unresolved for more than 20 minutes this may be a sign of Impella RP Catheter damage Complete the following steps immediately a Open the performance...

Page 56: ...pella RP Catheter HIGH PURGE PRESSURE If the purge pressure exceeds 1100 mmHg the Automated Impella Controller displays the Purge Flow Low alarm message 1 Inspect the purge system and check the Impell...

Page 57: ...rate continue the weaning process by reducing flow rate as tolerated to 0 5 L min P1 At this flow rate there will no longer be any forward flow across the right heart 5 If the patient is maintained a...

Page 58: ...cal Considerations 6 3 ACCOUNTABILITY OF COHORT 6 3 Study Population Demographics andBaselineCharacteristics 6 4 Procedural SupportandHemodynamic Characteristics 6 5 Primary Endpoint Results 6 7 Secon...

Page 59: ...st implant Secondary safety endpoint was determined by the rates of the following adverse events at 30 days or discharge whichever is longer or at induction of anesthesia for a longer term therapy inc...

Page 60: ...0 1 post PCI or post CABG General For Both Cohorts 1 Active infection two of the following WBC 12 500 positive blood culture fever 2 RA RV and or PA thrombus 3 Prosthetic valves in the right heart tri...

Page 61: ...iothoracic surgeon selected as the Physician Medical Monitor was charged with reviewing study data in order to protect the safety and well being of human subjects and the scientific integrity of the i...

Page 62: ...7 2 30 5 6 1 18 8 3 1 12 Body Surface Area m2 Mean SD N 1 94 0 22 30 2 01 0 23 18 1 85 0 18 12 Hypertension 80 0 24 30 77 8 14 18 83 3 10 12 Coronary Artery Disease 66 7 20 30 66 7 12 18 66 7 8 12 Co...

Page 63: ...76 75 24 18 222 58 103 42 12 Hemoglobin g dL 10 31 2 01 30 10 09 1 79 18 10 63 2 35 12 Hematocrit 31 40 5 84 30 30 84 5 41 18 32 24 6 58 12 Plasma Free Hemoglobin mg dL 26 22 50 90 16 12 42 11 32 11...

Page 64: ...able 6 4 All patients presented with RVF and poor hemodynamics at the time of implant despite high dose of inotropes pressors The hemodynamic profile was consistent between the two cohorts Table 6 4 S...

Page 65: ...s though numerically high 18 30 60 of patients were predominantly related to the surgical procedure with post cardiotomy surgical bleeding accounting for 83 15 18 LVAD implantation n 10 Cohort A or he...

Page 66: ...enous pressure CVP measured during the study Improvement in LVAD flow or LV pumping function The LVAD flow in Cohort A patients improved after the initiation of Impella RP from 3 96 0 16 L min to 4 62...

Page 67: ...ated to use of the large bore sheath provided with the Impella RP pump Integrity of Cardiac and Valvular Structures A comprehensive echocardiographic safety analysis on echocardiographic images acquir...

Page 68: ...the Impella RP System to provide percutaneous hemodynamic support for right heart failure had a high survival rate The 30 day survival rate in the 30 patients treated with the Impella RP System was 73...

Page 69: ...pport to reverse shock and to restore normal hemodynamic parameters and achieved an overall survival rate of 73 at 30 days or discharge whichever is longer or to a long term therapy The Impella RP dev...

Page 70: ...7 AUTOMATED IMPELLA CONTROLLER ALARMS ALARMS OVERVIEW 7 1 Alarm Levels 7 1 Alarm Display 7 2 Mute Alarm Function 7 2 ALARM MESSAGE SUMMARY 7 3...

Page 71: ...alarm than the one that was muted ALARM LEVELS Alarms are divided into three levels of severity Advisory white Serious yellow Critical red Table 6 1 Alarm Levels Category Advisory Serious Critical So...

Page 72: ...r display screen will silence the audible alarm indicator for 2 minutes for red or yellow alarms or 5 minutes for white advisory alarms When an alarm is silenced the words MUTE ALARM next to the butto...

Page 73: ...into AC power The purge system has stopped Initiate the De air Tool and follow instructions to remove the air from the system Cause There may be a mechanical or electrical problem in the Impella RP C...

Page 74: ...s 2 Decrease concentration of dextrose in the purge solution Check the purge line click on and make sure it is fully inserted Cause There is a problem with the purger unit driver Impella RP Catheter i...

Page 75: ...not responded to a de air or purge procedure screen for more than 1 minute or a transfer to standard configuration screen for more than 5 minutes There is a problem with the controller electronics The...

Page 76: ...tification only no action is required The auditory signal for the following alarm has been disabled Alarm will be listed here Controller is running on battery power Contact Abiomed Service to update I...

Page 77: ...NICATIONSCOMMISSION FCC NOTICE 8 5 ELECTROMAGNETIC COMPATIBILITY 8 5 TRANSPORT BETWEEN HOSPITALS 8 10 Guidelines forPatient Transport 8 10 Important TransportConsiderations 8 11 FAA Advisory 8 10 TRAN...

Page 78: ...ith inlet and outlet and pigtail at the tip Pressure present in the Impella RP Catheter and in the infusion line Impella purge cassette used for rinsing the Impella RP Catheter Reverse flow through th...

Page 79: ...le Use by date eg use before June 1 2016 Do not reuse Sterilized using ethylene oxide Electric scrap must be disposed of separately Must not be disposed of as domestic waste Protective Earth ON OFF Al...

Page 80: ...351 mm 13 8 in 443 mm 17 4 in 236 mm 9 3 in 508 mm 20 0 in 559 mm 22 0 in 406 mm 15 0 in 11 8 kg 26 1 lbs 13 6 kg 30 lbs 100 230 V AC nominal 47 63 Hz 1 1 A 14 4 V DC nominal lithium ion 120 VA 2 Amp...

Page 81: ...Safety Requirements for Medical Electrical Equipment IEC 60601 1 4 2000 Edition 1 1 Consolidated Edition Medical Electrical Equipment Part 1 4 General Requirements for Safety Collateral Standard Progr...

Page 82: ...ot expressly approved by Abiomed Inc could void the user s authority to operate this device Impella RP with the Automated Impella Controller 8 5 IEC 60601 1 Class I degree of protection CF defibrillat...

Page 83: ...on is required Monitor Impella RP Catheter flow and patient hemodynamics to confirm normal operation The condition will resolve itself once the Automated Impella Controller is no longer exposed to the...

Page 84: ...synthetic the relative humidity should be at least 30 Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or...

Page 85: ...saffectedbyabsorptionand reflectionfromstructures objects andpeople a Fieldstrengthsfromfixedtransmitters suchasbasestationsforradio cellular cordless telephonesandlandmobileradios amateurradio AMandF...

Page 86: ...01 0 04 0 06 0 12 0 1 0 11 0 19 0 38 1 0 35 0 6 1 2 10 1 11 1 9 3 8 100 3 5 6 0 12 For transmitters rated at a maximum output power not listed above the recommended separation distance d in meters m...

Page 87: ...ring transport Steps should be taken to eliminate or minimize any aspect of the transport that might adversely affect these factors The Automated Impella Controller is designed to operate for 60 minut...

Page 88: ...nd passed the EMC EMI tests as specified in IEC 60601 1 2 General requirements for safety Collateral standard Electromagnetic compatibility Requirements and tests The Automated Impella Controller does...

Page 89: ...la Controller Patient Environment For some Automated Impella Controller alarms there is a short delay between the triggered event and the audible annunciation and visual display of the alarm ALARM DEL...

Page 90: ...use US Up to 14 days Dimensions of Impella RP Catheter Length of invasive portion without catheter Approx 238 mm Diameter Max 7 6 mm Classification per DIN EN 60601 1 Protection class I degree of pro...

Page 91: ...al surface to prevent falling Connect the AC power cord to an AC outlet The battery may be destroyed if the Automated Impella Controller is stored with a depleted battery CLEANING Clean the Automated...

Page 92: ...APPENDIX A AUTOMATED IMPELLA CONTROLLER MENU STRUCTURE A 1 Overview A 1 MUTE ALARM A 1 FLOW CONTROL A 1 DISPLAY A 2 PURGE SYSTEM A 2 MENU A 3 APPENDICES...

Page 93: ...on mutes silences active alarms It does not open another menu When you press MUTE ALARM a bell icon with an X through it replaces the words MUTE ALARM in the upper right of the display screen If no al...

Page 94: ...ers the motor current waveform and adjusts the range accordingly Infusion opens the infusion history screen The infusion history screen which is discussed in section 4 of this manual shows the volume...

Page 95: ...able Enable Reverse Flow Control Disable Enable Automatic Zero Disable Enable P Level Suction Control Disable Enable Audio Impella Sensor Failure Allows you to enable or disable audio for the Impella...

Page 96: ...INDEX TO BE DEVELOPED...

Page 97: ...Facsimile 978 777 8411 Email clinical abiomed com Abiomed Europe GmbH Neuenhofer Weg 3 52074 Aachen Germany Voice 49 241 8860 0 Facsimile 49 241 8860 111 Email europe abiomed com Clinical support 24...

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