Abiomed Impella 2.5 Manual Del Usuario página 9

2. To select the default values displayed on the screen, press
the ACCEPT soft button. This will select those values and
automatically advance to the next screen. Note: The default purge
fluid values will be the purge fluid values from the last Case Start
performed on the Automated Impella Controller.
3.
To change the purge fluid information, press the EDIT soft button,
scroll to the appropriate item and push the selector knob to select
it or use the white arrow soft buttons. Then scroll through the
values and push the selector knob or press SELECT to make a new
selection. Press the DONE button to finish editing. The controller
will use the default values if no other selections are made.
• Purge fluid can be set to 50 mL, 100 mL, 250 mL, 500 mL, or
1000 mL.
• Glucose concentration can be set to 5%, 10% or 20%.
• Heparin concentration can be set to 0 IU/ml, 5 IU/ml, 6.25 IU/ml,
10 IU/ml, 12.5 IU/ml, 20 IU/ml, 25 IU/ml, 40 IU/ml, 50 IU/ml.
INSERTING THE IMPELLA CATHETER
(WIRED INSERTION METHOD)
NOTE – Proper surgical procedures and techniques are the
responsibility of the medical professional. The described
procedure is furnished for information purposes only. Each
physician must evaluate the appropriateness of the procedure
based on his or her medical training and experience, the type of
procedure, and the type of systems used.
If the Impella Catheter is used in the OR as part of open heart surgery,
manipulation may be performed only at the access site. Direct manipulation
of the catheter assembly through the aorta or ventricle may result in serious
damage to the Impella Catheter and serious injury to the patient.
When using a pigtail diagnostic catheter with side holes, ensure that the
guidewire exits the end of the catheter and not the side hole. To do so,
magnify the area one to two times as the guidewire begins to exit the pigtail.
During placement of the Impella Catheter, take care to avoid damage to the
inlet area while holding the catheter and loading the placement guidewire.
1.
Confirm purge fluid is exiting the Impella Catheter
2. Obtain access to the femoral artery.
3.
Insert a 5–8 Fr dilator over the 0.035 guidewire (provided) to pre-
dilate the vessel.
4.
Remove the 5–8 Fr dilator over the 0.035 guidewire. Predilate the
artery with the appropriate dilator prior to inserting the sheath.
While inserting the introducer, hold the shaft of the introducer to
slide it into the artery.
Impella 2.5 ® and Impella CP ® Circulatory Support Systems
5.
Administer heparin. When the ACT is greater than or equal to 250
seconds, remove the dilator.
6.
Prior to catheter insertion, flush the introducer
7. Insert a diagnostic catheter (Abiomed recommends a 6 Fr AL1 or
Multipurpose without side holes or 4–5 Fr pigtail with or without
side holes) over a 0.035 inch diagnostic guidewire into the
introducer and advance it into the left ventricle.
8.
Remove the 0.035 inch diagnostic guidewire, leaving the
diagnostic catheter in the ventricle. Form a curve or bend on
the end of the 0.018 inch, 260 cm placement guidewire. Place
the shaping tool just distal to the weld separating the shaping
ribbon from the body of the placement guidewire. Bend the
shaping ribbon against the tool, using minimal force. Do NOT use
a shaping tool with a sharp tip or edge. Do NOT pull the shaping
tool along the length of the shaping ribbon as this could strip the
coil off the guidewire and cause it to unfurl and separate. Inspect
the coil and guidewire for damage after shaping and before using.
9. Advance the placement guidewire into the apex of the left
ventricle.
10. Remove the diagnostic catheter.
To backload the catheter using the EasyGuide lumen
11. Slide the repositioning sheath towards the red pump plug prior to
insertion.
12. Insert the placement guidewire into the red EasyGuide lumen at
the tip of the pigtail.
(Once you remove the EasyGuide lumen from the Impella
Catheter, do not attempt to reinsert it. If the catheter
does not have a red EasyGuide lumen, follow the
procedure outlined in Step 13.)
a. Advance the guidewire until it exits the red lumen near the
label.
b. Remove the EasyGuide lumen by gently pulling the label
while holding the Impella Catheter.
c. If you suspect that a portion of the red lumen remains in
the catheter, do NOT use the Impella Catheter. Measure
red lumen length using catheter markings (intact length is
between 21.5 cm and 22.5 cm).
d. Skip to Step 14 if the catheter is successfully backloaded on
the guidewire.
7