Abiomed Impella Manuel D'utilisation page 26

LOW NATIVE HEART PULSATILITY−IMPELLA 5.0,
IMPELLA LD
When a patient has poor native ventricular function, the placement signal
may remain pulsatile; however, the amplitude will be dampened and both
the minimum and maximum values will be greater than zero because the
aortic valve does not open and the Impella 5.0 or Impella LD Catheter
raises the aortic blood pressure above the ventricular pressure during
systole.
In a situation of low native heart pulsatility, the Automated Impella
Controller may not be able to determine the catheter position. You may see
the following indication on the home screen:
Impella Position Unknown
Notice that the flow rate is displayed in yellow in the lower-left corner of
the screen, indicating that the patient may not be getting the benefit of
the displayed flow rate.
Actions to take:
1.
Assess cardiac function.
2. If needed, confirm catheter position with echocardiography.
IMPELLA 5.0 OR IMPELLA LD CATHETER OUTLET AREA
ON OR NEAR AORTIC VALVE
If the Impella 5.0 or Impella LD Catheter outlet area is on or near the aortic
valve, the catheter may be too deep in the ventricle. The following alarm
appears:
Impella Outflow Blocked
In this situation, the Impella Outflow Blocked warning appears as shown
below.
Impella 5.0 Catheter Outlet Area on or near Aortic Valve (similar for
Impella LD)
Actions to take:
1.
Assess and adjust Impella 5.0 or Impella LD Catheter position
under fluoroscopic or echocardiographic guidance, if available.
2.
If fluoroscopic or echocardiographic guidance is not available,
reduce the P-level to P-2 and gently pull the catheter back 2 cm to
see if the condition resolves.
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IMPELLA STOPPED
If the Impella Catheter has stopped suddenly:
1.
Try to restart the catheter at P-8.
2.
If the Impella does not restart at P-8, try to restart at P-2.
3.
If the Impella does not restart or stops again, wait 1 minute and
try to restart again.
4.
If the Impella restarts, wean down to P-2 as the patient can
tolerate. Under these circumstances, catheter function is not
reliable and the Impella may stop again.
5.
If the Impella does not restart, remove the Impella from the
ventricle as soon as possible to avoid aortic insufficiency.
SUCTION
Suction may occur if the blood volume available for the Impella Catheter
is inadequate or restricted. Suction limits the amount of support that the
Impella Catheter can provide to the patient and results in a decrease in
arterial pressure and cardiac output. It can damage blood cells, leading to
hemolysis. It may also be an indicator of right heart failure.
SUCTION WITH IMPELLA 2.5 OR IMPELLA CP
If the Automated Impella Controller detects suction while running in
AUTO mode, it automatically reduces motor speed to lower the flow rate
to resolve the suction and displays the "Impella Flow Reduced" advisory
alarm. If the suction is cleared, the controller returns the flow rate to the
desired setting. If suction is still detected at the lowest motor speed, the
controller displays the "Suction" alarm.
If the Suction or Impella Flow Reduced alarm occurs during Impella
support, follow these recommended actions:
1.
Ensure patient has adequate volume.
2. Reduce P-Level by one or two P-levels.
3.
Check the Impella Catheter for correct positioning using imaging.
Reposition the catheter by rotating or moving it into or out of the
ventricle slightly. Either or both of these actions could help move
the inlet of the Impella Catheter away from the interior ventricular
wall.
4. Evaluate right ventricular function by assessing invasive
hemodynamics and/or echocardiography.
5. Return P-level to pre-alarm setting.
If the Impella 2.5 or Impella CP has sudden low flows or suction
at startup:
a) Remove the catheter from the patient and ensure that ACT is
250 seconds or above.
b) Closely inspect the inlet and outlet areas and remove any
thrombus or other foreign materials.
c) Replace catheter.
SUCTION WITH IMPELLA 5.0 OR IMPELLA LD
CATHETER
If the Suction alarm occurs during support with the Impella 5.0 or
Impella LD Catheter, follow the recommended actions:
1.
Reduce P-level by 1 or 2 levels to reduce the effects of suction.
2. Assess patient's fluid intake and output to confirm adequate
volume status.
3.
Check the Impella Catheter for correct positioning using imaging.
Reposition the catheter by rotating or moving it into or out of the
ventricle slightly. Either or both of these actions could help move
the inlet of the Impella Catheter away from the interior ventricular
wall.
4.
Confirm right ventricular function by assessing CVP or right side
function with echocardiography. If CVP is not an option, check the
pulmonary artery diastolic pressure to assess the patient volume
status.
5. Return the P-level to pre-alarm setting.
User Manual