5.20
Instructions for Use & Clinical Reference Manual (US)
PATIENT WEANING
Weaning the patient from the Impella
®
RP Catheter is at the discretion of the physician. Weaning
may occur when right ventricular recovery is suspected and/or the patient is approaching the
maximum duration of use for the Impella
®
RP Catheter. It should be initiated in a step-wise
manner, such as described below.
The following weaning protocol is provided as guidance only.
1.
Initiate the weaning process by temporarily reducing the Impella
®
RP Catheter flow to
about 2 L/min.
2.
Assess right ventricular function. Small changes in right ventricular systolic function as
measured by echocardiography may be accompanied by significant improvement in
right side forward flow; therefore, it is important to evaluate both echocardiographic
evidence of improvement as well as CVP, flow rate, and overall perfusion.
3.
Record available information regarding flow rate, CVP, echo parameters, and systemic
hemodynamics.
4.
After 15–20 minutes at the reduced flow rate, if there are signs of right ventricular
recovery and no adverse effects from reduction in flow 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 at a low flow rate (<1.5 L/min) for a prolonged period,
increase ACT to at least 250 seconds.
REMOVING THE IMPELLA
®
RP CATHETER
1.
Wean the patient by following the steps in the previous section.
2.
Leave the Impella
®
RP in the pulmonary artery at P2 until ACT drops below 150
OR
Reduce the performance level to P1, pull the catheter into the inferior vena cava
(approximately 30 to 40 cm), and wait until ACT drops below 150.
3.
When ACT is below 150 seconds and patient hemodynamics remain stable, decrease
performance level to P1, pull the catheter into the inferior vena cava if it is not already
there, and stop the motor by reducing the performance level to P0.
4.
Remove the Impella
®
RP Catheter.
5.
Disconnect the connector cable from the Automated Impella
®
Controller and turn the
controller off by pressing the power switch on the side of the controller for 3 seconds.
6.
Close the blood vessel.
Signs of Right
Ventricular Recovery
As right-side support is slowly
weaned, right ventricular
recovery is indicated by
preservation of the normal
range of left-sided cardiac
output as well as by a lack of
severe elevation in CVP.
