Impella Education, Patient Management
Impella® Skills Video: Guidewire Reaccess
This Impella Skills video demonstrates how to use the repositioning sheath with guidewire access port on the Impella CP® or Impella CP® with SmartAssist® to insert a 0.035” guidewire to maintain access to the arteriotomy. The stylet within the access port maintains patency and should not be removed from the port until access is needed.
- Loosen and detach the anticontamination sleeve.
- Remove the stylet from the sidearm of the repositioning sheath hub.
- Aspirate the port to confirm arterial blood flow, which indicates that the tip of the sheath is inside the artery and the line is patent.
- Flush the port.
- Under fluoroscopic guidance, insert a 0.035” J-tip guidewire through the sidearm. If you encounter any difficulty advancing the guidewire, rotate the sidearm to reorient the direction of the wire exiting the sheath tip.
- Advance the guidewire into the descending aorta, above the level of the renal arteries.
- Pull the Impella catheter back across the aortic valve at P-level 1 (P-1).
- Turn the Impella off by reducing flow to P-0.
- Pull the catheter back until it reaches the distal end of the repositioning sheath.
- Remove the Impella device and repositioning sheath from the arteriotomy, leaving the wire in place.
- Immediately apply pressure to the access site to control bleeding.
- If replacing the Impella device, insert the peel-away sheath provided with the new Impella Setup & Insertion kit and follow insertion steps to insert the new device.
- If device replacement is not required, insert an appropriately sized sheath over the 0.035” guidewire, ensuring that hemostasis is maintained.