Algorithms, Impella Education, Patient Identification, Patient Management, AMI Cardiogenic Shock, Protected PCI
Best Practices for Patients Supported with Impella® (Part 1): Overview and Initial Management Tips
Behnam N. Tehrani, MD, FSCAI discusses best practices and troubleshooting for patients supported with the Impella heart pump in a series of 6 videos from his presentation on new frontiers in cardiogenic shock and Protected PCI. In this first video, Dr. Tehrani provides an overview for the series—which covers device management (positioning, hemolysis, and alarms), groin management, and weaning and escalation—and he describes best practices for managing patients prior to leaving the cath lab and upon arrival in the CCU. Dr. Tehrani is co-medical director of the Inova cardiogenic shock team and medical director of cardiac catheterization lab at Inova Fairfax.
Dr. Tehrani emphasizes the importance of having best practices and algorithms in place to recognize disease processes, and ensuring that adequate support is available to get patients to the cath lab, get hemodynamic assessments, and ultimately, as needed, get mechanical support with Impella. He also explains that it is important to understand how Impella works and be well-versed in groin management as well as the factors involved in deciding whether to wean or escalate support in the cardiac intensive care unit.
Dr. Tehrani provides the following tips for patient management before patients leave the cath lab or as they arrive in the CCU:
Ensure the Tuohy valve is locked. Locking the Tuohy valve helps prevent Impella migration when the patient is moved.
Document the cm position of the catheter at Tuohy valve. It is critically important for the physician who inserts Impella to document the centimeter (cm) position on the catheter and communicate that to the receiving physician as well as the techs and bedside nurses in the CCU. This information should also be documented every day in the CCU, especially when patients get echocardiograms to evaluate positioning.
Ensure slack is removed prior to leaving the cath lab. If there is slack, Impella is likely to migrate.
Obtain echo on arrival to CCU and qAM. To confirm Impella position, it is important to get an initial echocardiogram upon arrival in the CCU as well as echos every morning.
Consider using knee immobilizer. Keeping the patient’s leg in place with a knee immobilizer or other device is critically important to prevent complications.
Monitor pedal pulses. Neurovascular evaluations are vital to ensure distal perfusion before leaving the cath lab.
Have 3 professionals with the patient in the CCU. During daily turning, movement, and hygiene in the CCU, it is helpful to have 3 professionals with the patient.
The next video in this series discusses best practices for Impella positioning in the CCU.