Impella Education, Patient Management, AMI Cardiogenic Shock, Protected PCI
Best Practices for Patients Supported with Impella® (Part 5): Impella Groin Management
In this video, Behnam Tehrani, MD, FSCAI, discusses important groin management concepts for patients supported with the Impella heart pump.
Most notably, Dr. Tehrani emphasizes the importance of removing the Impella peel-away sheath after confirming Impella position and before the patient leaves the cath lab. “Don’t leave the sheath in. Make sure you pull it back, you crack it, and you take it out.” Leaving the peel-away sheath in place can cause severe bleeding and damage to the arteriotomy site from cracking or breaking. Stasis and clot formation can occur in the dead space between the 9Fr catheter and 14Fr sheath. Leaving the peel-away sheath in the femoral artery post-procedure can lead to limb ischemia.
Other aspects of groin management Dr. Tehrani discusses include:
Do NOT raise the head of the bed to higher than a 30-degree angle.
Use a knee immobilizer as needed to maintain access site straight.
Perform dressing changes per hospital protocol, using aseptic technique.
Assess the access site for bleeding and hematoma.
Do a neurovascular exam on patients.
Have 3 people present when moving the patient, with one person solely focused on maintaining Impella catheter position.
Monitor pedal pulses.
Maintain an activated clotting time (ACT) of 160-180 or an equivalent activated partial thromboplastin time (aPPT).