Axillary Access, Impella Education, Surgical Applications

Impella 5.5® with SmartAssist® Best Practices: OR and ICU Checklists

 

Bessie Sycip, an advanced surgical consultant with Abiomed, presents OR and ICU best practice checklists for set up, insertion and management of patients supported with Impella 5.5® with SmartAssist®.

OR pre-insertion checklist

After reminding the OR staff to contact the local Abiomed team or clinical support center prior to inserting the Impella 5.5 with SmartAssist, Bessie reviews the logistics of left and right axillary insertion. She highlights the importance of assessing the size of the axillary artery using ultrasound or CTA, explaining that for axillary insertion, the axillary artery should be approximately 7 mm in diameter. For direct aortic insertion, she reviews the use of the incision template for proper graft placement, noting that the graft should be anastomosed to the ascending aorta at least 7 cm above the aortic valve to ensure that the outlet of the device does not sit in the graft.

OR insertion checklist

Best practices for inserting Impella 5.5 in the OR start with straightening the white connector cable before connecting it to the Automated Impella Controller (AIC). They also include priming the pump with heparinized D5W (25 U/mL) or sodium bicarbonate (25 or 50 mEq/L) for approximately 15 minutes prior to insertion and holding the Impella 5.5 in a vertical position to confirm that purge fluid is exiting the outlet of the device. Bessie discusses that process of backloading the Impella on the 0.018” guidewire, recommendations for device orientation as it is inserted in either the left or right axillary artery or directly into the aorta and confirming position with transesophageal echocardiography (TEE).

“The next step is critical,” she emphasizes. “Once the device is in good position, clamp over the graft over the catheter shaft with soft soft inserts to hold the pump in place in order to proceed with closure.” She then highlights starting the pump at P2 as quickly as feasible, securing the blue suture hub to the skin, confirming optimal position, removing the yellow pin from the catheter lock unit and completing 3-point external fixation before leaving the OR.

ICU checklist

The best practices checklist for general ICU management includes verifying the purge solution, confirming that the yellow pin has been removed at the catheter lock unit, documenting the centimeter marking on the Impella catheter at least once per shift, charting the patient’s urinary output and color, documenting hemodynamics, assessing right heart function and evaluating device position.

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