Impella Education, Insertion, Patient Management, Surgical Applications

Impella® Skills Video: Impella 5.5® with SmartAssist® Insertion with Axillary Insertion Kit

 

This Impella skills video demonstrates insertion of the Impella 5.5 with SmartAssist using the axillary insertion kit. The axillary insertion kit includes the following components:

  • 23Fr peel-away sheath with hemostatic valve
  • 2 graft locks to facilitate fixation of a 10mm vascular graft to the sheath
  • 8Fr silicone-coated dilator

The vascular graft is not included in the kit. Abiomed recommends using a Hemashield Platinum® or Vascutek Gelweave™ graft.

The video is a simplified version of the insertion, highlighting the primary steps of the procedure.

  1. Expose the axillary artery and apply vessel loops proximal and distal to the point of incision.
  2. Make an incision between the vessel loops.
  3. Attach a 10 mm x 20 cm woven Dacron vascular graft to the artery using at least a 60-degree bevel to facilitate passage of the Impella into the graft.
  4. Clamp the graft above the anastomosis.
  5. Insert the provided 23Fr peel-away introducer into the graft and secure with one of the provided graft locks to maintain hemostasis while making the wire exchange in the ventricle.
  6. Ensure ACT is at least 250 seconds.
  7. Release the clamp and insert a 4Fr to 5Fr diagnostic catheter into the sheath with a 0.035” guidewire and cross the aortic valve.
  8. Remove the 0.035” guidewire and replace it with the provided 0.018” placement guidewire, advancing it into the apex of the left ventricle.
  9. Remove the diagnostic catheter leaving the 0.018” guidewire in place.
  10. Place a soft-jaw vascular clamp on the graft above the anastomosis to maintain hemostasis during insertion.
  11. Load the provided 8Fr silicone-coated dilator onto the 0.018” wire and advance it through the hemostatic valve several times, allowing the silicone to lubricate the valve to aid insertion of the Impella catheter.
  12. Remove the dilator from the 0.018” wire.
  13. Prior to inserting the Impella catheter over the wire, lay the catheter out straight and remove any excess torque in the catheter and white connector cable.
  14. Hold the catheter upright and visualize purge fluid at the base of the impeller.
  15. Load the Impella over the wire, ensuring that the wire exits the inner radius of the Impella catheter.
  16. Fully advance the cannula and motor housing into the 23Fr peel-away introducer.
  17. Remove the clamp from the graft and advance the Impella catheter until the inlet crosses the aortic valve.
  18. Remove the guidewire and press the START IMPELLA soft button on the console to initiate support.
  19. Select P-2 to start the device and slowly increase the P-level to the desired amount of support.
  20. After placement of the Impella, place a soft-jaw vascular clamp at the anastomosis.
  21. Remove the peel-away sheath from the graft and peel away.
  22. Trim the graft so that the skin can be closed over the graft.

 

Hemashield Platinum is a registered trademark of MAQUET Cardiovascular LLC
Gelweave is a filed for trademark of Terumo Aortic

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IMP-2109