Impella Education, Insertion, Surgical Applications
Impella® Skills Video: Impella 5.5® with SmartAssist® Insertion Using the Silicone Plug Technique
This Impella® skills video demonstrates insertion of the Impella 5.5® with SmartAssist® using the silicone plug technique. The video is a simplified version of the technique, 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 axillary artery using at least a 60-degree bevel to facilitate passage of the Impella into the graft.
- Clamp the graft above the anastomosis.
- Insert a 6Fr to 8Fr sheath into the graft and secure with heavy suture or umbilical tape to maintain hemostasis while making the wire exchange in the left ventricle.
- Remove the clamp and insert a 4Fr to 5Fr diagnostic catheter—pigtail, AL1, or Multipurpose—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.
- Form a curve or bend in the guidewire before advancing it into the apex of the left ventricle.
- Remove the diagnostic catheter leaving the 0.018” guidewire in place.
- Clamp the graft over the wire above the anastomosis to maintain hemostasis during insertion.
- Remove the vascular sheath.
- Attach one silicone plug to the distal portion of the Impella catheter shaft just proximal to the motor housing.
- Prior to inserting the Impella 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 0.018” guidewire, ensuring that the wire exits the inner radius of the catheter.
- Fully advance the cannula, motor housing, and silicone plug into the graft.
- Wrap heavy suture or umbilical tape around the graft and silicone plug ensuring that the catheter can still move within the silicone plug.
- Ensure the 0.018” placement guidewire remains outside of the silicone plug.
- Loosen the vessel loops or unclamp the graft.
- Advance the Impella 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 Impella 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 silicone plug and trim the graft so that the skin can be closed over the graft.