IMPELLA
WILD CARD
BEFORE LEAVING THE CATH LAB
Values
& Monitoring
& Monitoring
MAKE THE ICU LOVE YOU
TROUBLE-
SHOOTING
SHOOTING
WHAT WOULD YOU DO?
WEAN & REMOVAL
Final Jeopardy
100
Fill in the Blank: The Impella is preload_______, afterload sensitive
What is dependent?
100
P-Level for CPR
What is P-2?
100
These are used to secure the repositioning sheath
What are forward tension sutures?
100
This pressure correlates to the pressure in the Right Atrium. 10 is the recommended number with an Impella
What is CVP? (10-12 on support)
100
This number on the catheter shaft should be documented on handoff to ICU nurse and helps monitor for device migration
What is the CM Marker on the Impella shaft?
100
14fr sheath has been removed & forward tension sutures are in place. The groin site is oozing. What is your recommendation?
What is hold pressure?
What is check angle matching?
100
You are weaning your patient from Impella CP. You notice the white LV waveform has disappeared. The white LV waveform disappears under what P level?
What is under P-4?
100
Patient has been brought to CCL for Impella removal. The ACT should be this prior to removal
What is <150 (or hospital guidelines for sheat removals)?
100
Once each team has written down their wagers based on the amount of points earned, the final clue will be revealed.
List 4 Contraindications for any of the devices in the Impella Family
200
This is the Impella RP peel-away sheath in FR
What is 23FR?
BONUS QUESTION FOR 200: THIS IS THE IMPELLA CP SHEATH SIZE
200
TRUE or FALSE: The right femoral artery is the only insertion site Abiomed recommends
What is FALSE?
BONUS QUESTION for 200: List other possible access sites
200
The position of the peel away sheath prior to peeling away for removal
What is completely out of the body? (Prevents injury to artery)
200
< 90mmHG, Tachy, sweaty, SOB, pale, weak pulse, EKG changes are all symptoms of this
What is Cardiogenic Shock?
200
This functions just like a swan catheter cover and should be checked and locked on both ends prior to D/C from CCL
What is T-Lock? (Attaches the anti-contamination sleeve) Also, ensure the Tuoy-Borst Valve is tight!
200
DAILY DOUBLE
You notice an immediate drop in Impella flows from 3.5 to 1.2/lpm. This is probably the cause
200
This number is found on the front of the console and can be called 24x7 for questions
What is the 1-800 number for the CSC?
Or your Local on call Abiomed Rep :)
200
Abiomed recommended closure
What is manual compression?
300
The abbreviation CP is the name of one of the devices in the Impella Family. CP stands for this
What is Cardiac Power?
300
This is the soft button on the AIC used to change P levels
What is Flow Control?
300
This is best practice & final step that should be performed under fluoro to reduce the chances of the device migrating forward
What is removed slack?
300
This waveform should be pulsatile as long as the Impella CP is in the correct position.
What is the green motor current?
300
Once the peel away sheath is removed and the repositioning sheath is in place, this step will help reduce the chances of oozing/bleeding at the insertion site
What is angle matching? (4x4 used to prop up the repositioning sheath)
300
When an impella is not in optimal position or there is not enough volume, this occurs
What is suction alarm?
300
This is the best screen for monitoring Impella placement and function
What is the Placement Screen?
300
This is the appropriate P-level for repositioning or pulling across the AO valve.
What is P-2 (Lowest P-level while in the LV)
400
This device delivers up to 6 L of flow in systole, directly unloads the LV and allows for patients to ambulate
What is the Impella 5.5?
400
The inlet of left sided devices is positioned here
What is the left ventricle?
400
Patient should never leave the lab in this setting on the AIC.
What is Auto Mode? (CP starts in AUTO)
BONUS QUESTION for 400: RP & 5.5 are started by doing this
400
This is the recommended ACT for maintenance with all Impella devices?
What is 160-180?
400
This is inserted to assist with detecting hemolysis, monitor end organ perfusion and can give patient relief
What is a foley catheter?
400
While moving patient to stretcher, the red placement signal on the AIC looks ventricularized with a flat motor current. What should you recommend?
What is treat your patient, turn down to P-2, call doc? (Flat-Flat FLUORO STAT)
400
The Impella CP is at P8 and flow is 2.7, the blood pressure is 120/80 (94) on high doses of Epi and Dopamine. This is recommended to increase flows.
What is reduce afterload? (What is wean drips?)
400
This action guarantees the Impella is off prior to removal? AKA not spraying blood everywhere
What is unplugging the white power impella cable from the console?
500
DAILY DOUBLE
Once you have placed your wagers on the dry erase board, the clue will be revealed.
Name at least 3 lab values that could indicate a patient is in Cardiogenic Shock
500
A Swan Ganz catheter is recommended for HF/CS patients supported by this device(s)
What is all Impella devices?
500
When dressing the groin, this portion of the catheter should be exposed for quick repositioning
What is the T-Lock/Tuohy-Borst Valve?
500
The red placement signal waveform should mimic this
What is AORTIC waveform?
500
This helps protect the groin and can help secure the catheter
What is a knee immobilizer?
500
The heart’s contractility is reduced. The patient is in sinus rhythm & has an extremely faint pulse. The motor current on the AIC is pulsatile with MAP of 70. This is the state of the LV function
What is low pulsatility?
500
Impella flows of 2.0 are lower that expected on P-8 with frequent suction alarms. Impella is in good position on fluoro. CVP is 7. This is recommended.
What is increase Preload? (What is give volume?)
500
Impella is used for support during a HRPCI. Weaning is initiated. The MAP decreases as P-levels are decreased and falls <60, LVEDP begins to rise. This is a sign of what
What is an Unsuccessful Wean? (Not ready for impella removal)
600
This fluid creates a protective umbrella-effect barrier that changes the pH of the dextrose
What is Sodium Bicarb purge solution?
600
Your patient needs to be defibrillated. This is the recommended action for impella management.
What is nothing?
600
This should be inserted with every Impella device to for a complete hemodynamic picture monitoring pressures and volume status
What is a Swan?
600
The equation: MAP x CO/451 determines this
What is Cardiac Power Output?
Bonus Question 600: What is a normal range for CPO?
600
This value can be calculated to result the most accurate CO for patients with an Impella
What is Fick score?
600
The purge tubing is kinked & the purge pressure changes, this alarm would be present
What is High Purge Pressure? (300-1100)
600
You're getting a suction alarm on the impella, doing this breaks the suction event
What is reduce the P-Level by 1 or 2?
600
Native heart takes over support as P-levels are reduced and support is weaned. The MAP remains stable after PCI. This is a sign of what
What is a Successful Wean?