Patient Management, Surgical Applications
Patient Management Topics for Impella 5.5® with SmartAssist®
Also known as “the surgeon’s heart pump,” the Impella 5.5® with SmartAssist® heart pump is designed for ease of insertion, long duration support, and ease of patient management. It provides forward flow with maximum unloading, enabling heart recovery. In this video, Jessica Page, Abiomed advanced Impella® trainer, provides a tip-to-toe overview of the device and discusses several key patient management topics.
ICU Patient Check-In Assessment and Procedures
Jessica walks through the best practice of completing an assessment when a patient is transferred to the ICU with an Impella 5.5 in place. This includes assessing the Tuohy-Borst, sidearm retainer, external fixation, and volume status as well as performing a baseline echo to verify that the mid-inlet of the Impella 5.5 is approximately 5 cm from the aortic valve annulus.
External Fixation and Preventing Impella Device Migration
External fixation is important for decreasing the potential for Impella 5.5 catheter movement. Jessica explains the 4 points of external fixation: tightening the Tuohy-Borst, securing 3-point fixations, attaching the purge sidearm retainer, and clipping the purge sidearm to the white cable. She shows examples of good and poor external fixation positioning and emphasizes the importance of not cleaning the purge sidearm with alcohol-based products. She also reviews steps for preventing inward migration of the Impella 5.5 into the ventricle when operating at high flow rates.
Position Monitoring and Alarms
Correctly positioning the Impella 5.5 across the aortic valve is key to ensuring that patients receive the benefits of Impella support. An aortic tracing on the placement signal and a pulsatile motor current indicate correct position on the Impella 5.5; however, the placement signal waveform can be flat during full unloading or pulsatile with lower support. The AIC continually monitors the placement signal and motor current signal and with the optical sensor on the Impella 5.5, can issue “Impella Position in Aorta” and “Impella Position in Ventricle” alarms.
Other patient management topics discussed in this video include:
- Adjusting the LV placement signal
- Entering cardiac output
- Recognizing and resolving diastolic suction and continuous suction
- Identifying full forward flow for a heart that is recovering and for a heart that is completely at rest
- Handling a “Purge System Blocked” alarm
- Best practices for purge management
- General patient considerations
- SmartAssist guidance for successful weaning