Abiomed Impella RP Manual Del Usuario página 18

Use Fluoroscopy for
Placement
Impella RP ® Catheter
performance will be
compromised if correct
placement cannot be confirmed. While other
imaging techniques,
such as transesophageal
echocardiography (TEE),
can help confirm the
position of the Impella RP
®
Catheter after placement,
TEE does not allow
visualization of the entire
catheter assembly and is
inadeguate for reliably
placing the Impella RP
®
Catheter.
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11. Advance the guidewire into the Impella RP
fingers. This prevents pinching of the outlet area.
12. The scrub assistant can help stabilize the catheter by holding the catheter proximal to the
motor. This will allow the implanting physician to visualize the inner radius. The guidewire
must exit the inlet area on the inner radius of the cannula and align with the straight
black line on the catheter. The physician can focus on advancing the guidewire and, if the
cannula needs to be hyperextended, the scrub assistant is available to assist.
13. Advance the catheter through the hemostatic valve into the femoral vein and along the
placement guidewire using a fixed-wire technique. Follow the catheter under fluoroscopy,
and rotate the catheter as it enters the right ventricle to direct the cannula tip upward and
across the pulmonary valve. Position the outlet area of the cannula approximately 4 cm
past the pulmonary valve annulus. NOTE: While the entire pump is in the abdominal IVC,
calibrate the sensor by pressing the ZERO SENSOR soft button.
14. Remove the placement guidewire.
15. Confirm position with fluoroscopy.
POSITIONING AND STARTING THE IMPELLA RP
Retrograde flow will occur from the pulmonary artery back into the inferior vena
cava if the Impella RP
When the Impella RP ® is properly positioned across the pulmonary valve, but is not yet running, the
placement signal will be similar to a pulmonary arterial waveform. After starting the Impella RP
amplitude of the placement signal will increase by a factor of 2 to 2.5, depending on the selected
P-level.
1. Press the START IMPELLA soft button.
2. Turn the selector knob to increase the P-level from P-0 to P-2.
3. Press the selector knob to select the new P-level.
4. The catheter operation icon in the lower left corner of the screen begins rotating when the
Impella RP Catheter begins to operate.
®
5. Increase P-level to P-9 to confirm correct and stable placement. Evaluate the catheter
position and remove any excess slack. The catheter inlet area should be in the inferior vena
cava and the outlet area in the pulmonary artery. Verify placement with fluoroscopy.
6. After the pump is placed into the pulmonary artery and functioning properly, refer to the
Use of the Repositioning Sheath and Introducer section.
Catheter and stabilize the cannula between the
®
Catheter is set at P-level P-0.
®
CATHETER
®
, the
®
User Manual