Abiomed Automated Impella Controller Manual De Usuario página 27

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 18. If,
however, the echocardiogram reveals a dense mosaic pattern of turbulence
beneath the aortic valve−Figure 19, 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 18. Correct Impella Catheter Position (Color Doppler TTE)
Figure 19. 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 CP with SmartAssist, Impella 5.0,
Impella 5.5 with SmartAssist, 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.
Automated Impella Controller with SmartAssist
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, Impella CP, Impella CP with SmartAssist,
and Impella 5.5 with SmartAssist)
• 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.
CORRECT POSITION
If the Impella Catheter is in the correct position, the placement screen
will appear as shown in Figure 20 for the Impella 2.5, Impella CP (shown
below, in Figure 20), Impella CP with SmartAssist, and Impella 5.5 with
SmartAssist, and Figure 21 for the Impella 5.0 and Impella LD. The LV
Placement Signal will be shown for the Impella CP with SmartAssist and
Impella 5.5 with SmartAssist catheters. This is not depicted in the images
below.
Figure 20. Correct Impella CP Catheter Position (similar for Impella
2.5)
Figure 21. Correct Impella 5.0 Catheter Position (similar for Impella LD)
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