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.
- Expose the axillary artery and apply vessel loops proximal and distal to the point of incision.
- Make an incision between the vessel loops.
- 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.
- Clamp the graft above the anastomosis.
- 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.
- Ensure ACT is at least 250 seconds.
- Release the clamp and insert a 4Fr to 5Fr diagnostic catheter into the sheath with a 0.035” guidewire and cross the aortic valve.
- Remove the 0.035” guidewire and replace it with the provided 0.018” placement guidewire, advancing it into the apex of the left ventricle.
- Remove the diagnostic catheter leaving the 0.018” guidewire in place.
- Place a soft-jaw vascular clamp on the graft above the anastomosis to maintain hemostasis during insertion.
- 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.
- Remove the dilator from the 0.018” wire.
- 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.
- Hold the catheter upright and visualize purge fluid at the base of the impeller.
- Load the Impella over the wire, ensuring that the wire exits the inner radius of the Impella catheter.
- Fully advance the cannula and motor housing into the 23Fr peel-away introducer.
- Remove the clamp from the graft and advance the Impella catheter until the inlet crosses the aortic valve.
- Remove the guidewire and press the START IMPELLA soft button on the console to initiate support.
- Select P-2 to start the device and slowly increase the P-level to the desired amount of support.
- After placement of the Impella, place a soft-jaw vascular clamp at the anastomosis.
- Remove the peel-away sheath from the graft and peel away.
- 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