Abiomed Impella Manuel D'utilisation page 24

COLOR DOPPLER ECHOCARDIOGRAPHY
When moving a patient supported with an Impella Catheter, it is important
to monitor catheter migration. Adding color Doppler to an echo is
another way to verify catheter position. If the Impella Catheter is correctly
positioned, a dense mosaic pattern of turbulence will appear above the
aortic valve near the outlet area of the catheter−as shown in Figure 11. If,
however, the echocardiogram reveals a dense mosaic pattern of turbulence
beneath the aortic valve−Figure 12, this likely indicates that the outlet area
of the catheter is in the wrong position, that is, the catheter is too far into
the ventricle or entangled in papillary muscle.
Note: If using transesophageal echocardiography [TEE], look for
the mosaic patterns in the same locations relative to the aortic
valve and Impella Catheter outlet area.
Figure 11. Correct Impella Catheter Position (Color Doppler TTE)
Figure 12. Incorrect Impella Catheter Position (Color Doppler TTE)
POST-INSERTION POSITIONING (PIP) CHECKLIST
Completing the steps shown in the following post-insertion positioning
checklist can help to ensure proper position of the Impella Catheter
following insertion. Pay particular attention to positioning after the patient
is moved from the operating room or catheterization laboratory.
1.
Remove slack in the Impella Catheter by increasing P-level to AUTO
or P-8 (or P-9 for the Impella 5.0 or Impella LD) and align the
catheter against the lesser curvature of the aorta (rather than the
greater curvature).
2.
Use fluoroscopy to verify that the slack has been removed.
3. Verify that the Impella Catheter inlet area is optimally positioned
3.5 cm below the aortic valve.
4. Return to previous P-level.
5.
Secure the Impella Catheter at a firm external fixation point in the
groin area.
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UNDERSTANDING & MANAGING IMPELLA
CATHETER POSITION ALARMS
The AIC continuously monitors the catheter based on the placement signal
and the motor current.
• Placement signal:
Is the signal characteristic of aortic or ventricular pressure ?
(for Impella 2.5 or Impella CP)
• Is it pulsatile or flattened ? (for Impella 5.0 or Impella LD)?
• Motor current:
Is the signal "pulsatile" or "flattened"?
If the system alarms with one of the positioning alarms described in this
section, echocardiography imaging is the best method for confirming
position. You can also use TEE, TTE, or fluoroscopy. If the Impella Catheter
is either partly, (just the pigtail) or completely, in the ventricle, reposition
the catheter under imaging guidance. If the Impella Catheter is completely
out of the ventricle, do not attempt to reposition the catheter across the
valve without a guidewire. The following describes possible placement
conditions and the associated signal characteristics and alarm messages,
as well as actions to take for each. Note: When using Impella CP with
SmartAssist or Impella 5.5 with SmartAssist with a non-optical AIC
placement monitoring is not available. Monitor pump position with imaging
CORRECT POSITION
If the Impella Catheter is in the correct position, the placement screen will
appear as shown in the first image below for the Impella 2.5 and Impella
CP, and in the second image for the Impella 5.0 and Impella LD.
Correct Impella CP Catheter Position (similar for Impella 2.5)
Correct Impella 5.0 Catheter Position (similar for Impella LD)
User Manual