Abiomed
WILL GO TO P LEVELS IN 3 HOURS
AUTO MODE
10 x 20 mm
Abiomed recommends a _____________ hemashield platinum or vascutex graft for the impella axillary 5.0?
2-3 mls
Blue Purge Pressure Reservoir holds how many mls?
Allows the device to be turn off, but maintains purge fluid delivery, thus keep the AIC from alarming
Explain why Surgical Mode would be used?
8-12 normal > means left ventricle failure or tampnade < means hypovolemia LVEDP (VENTRICULAR PRELOAD) IS INCREASED PWP IS ALSO INCREASED
PWP
True
T/F - Only the 5.0 & LD have dual pressure sensors?
True
T/F - The 5.0 LD is the only impella with a ruler in the kit?
True
T/F- The faster the impeller rotates inside the cannula, the higher the flow produced by the Impella catheter?
26 lbs
The AIC WT is?
1 hour
The AIC battery life is?
23 fr
The Axillary 5.0 kit has a ______ peel away sheath?
Prevents blood from entering the catheter motor
The Impella System requires a purge system to:
3.5 mm
The cath inlet area is ___________below the aortic valve?
Automated Impella Controller (AIC)
The function of the _____________ is to provide an interface for monitoring and controlling the Imella cath, purge fluid to the cath, and backup power.
60-70
The impella 5.0 should be at _________ degree angle to facilitate passage of the catheter?
17 mm
The length of the LD from tip to cath is ______?
7 mm
The recommended vessel DM for the 5.0 is ______ ?
True
True or False - 5.0 LD has the impella Sponge plugs attached to the 9fr Catheter
True
True or False - The 5.0's have electrical sensor not fluid fill sensors.
True
True or False- the Impella 5.0 LD does not have a pigtail ?
1. Note placement waveform has shifted up/down on display. 2. Flow does not match the current performance level setting
Under what circumstances would you want to zero the differential pressure sensor?
2.5 = 1010
WHAT IS THE MOTOR THRESHOLD LEVEL
3.5 = 1130
WHAT IS THE MOTOR THRESHOLD LEVEL
5.0 = 1190
WHAT IS THE MOTOR THRESHOLD LEVEL
Mural Thombus in LT Ventricle Mechanical Aortic valve Aortic valve stenosis 0.6cm or less Aortic valve insufficiency graded > 2+ Access PAD
What are the Impella 2.5 contraindications?
1. < HH levels 2. Dark or blood urine 3. Acute Renal Failure
What are the s/s of hemolysis?
21 fr / 9 fr
What is the 5.0 pump and catheter size?
> 250
What is the ACT for Cath Lab?
160-180
What is the ACT range for the ICU?
2 - 30 ml/hr
What is the AIC normal purge flow rate?
300-1100 mmHG
What is the AIC normal range of the purge pressure
14 fr
What is the FR size for Impella CP
12 fr
What is the FR size for the Impella 2.5
Parasternal long axis
What is the best view position for (Transthoracic echo) TTE?
Long axis
What is the best view position for TEE?
.018
What is the guide wire for the Impella 5.0
4.0-8.0 L/min and 2.5-4.0
What is the normal CO and CI
15-25/8-15 above normal means left heart failure
What is the normal PA pressure
800-1400
What is the normal SVR
10 normal is 2-8 < hypovolemia and shock > vasodilation right side failure needs diuresis
What is the recommended CVP in ICU?
> 60
What is the recommended MAP in ICU?
93-99 cm
What is the working length of the Impella Cath
Cook 14fr / 13cm Cook 14fr / 30cm
What other sheaths can be used for the Imella 2.5?
Cook 14fr / 30cm
What other sheaths can be used for the Imella CP
BS Platinum Plus .014 BS V-18 .018
What other wires can be used for the Impella 2.5?
Reduce flow rate (P-level), Correct I/O (VOL) and improve RT heart function
What steps to take of hemolysis and low CVP,PCWP,AOP
Reduced output suction alarms elevated CVP signs of liver failure elevated pulmonary pressures (normal is 8-12 mmhg)
What the s/s of right heart failure in patients supported by the impella ?
1. Consider alternative hospital protocol. 2. Suggest contacting MEDICAL AFFAIRS for protocol
What to do if Physician decides that it is in the best interest of the patient to operate the system without heparin?
1. Whether the controller is connected to AC power. 2. Remaining battery capacity 3. Mean calculated Impella flow 4. Current purge flow 5. Calculated Impella Cath flow during systole and diastole
Which of the following types of information can you find along the BOTTOM of each screen on the AIC?
ELISA and Serotoin
HIT (heparin induce thrombocytopenia) should be verified by a positive______________ test and __________ release test?
Clinically significant hemolysis is plasma free hemoglobin greater than 40mg/dl x 2 in a 24 hour period.
Hemolysis
In the presence of adequate volume, and placement that appears in good position using a 2D echo, unresolved hemolysis requires that you continue to reposition the Impella. The rational being this is a 2D image and you cannot tell if the Impella is under Mitral apparatus.
Hemolysis
CONTRACTILITY PRELOAD- DEPENDENT AFTERLOAD- SENISTIVE
IMELLA IS PERFORMANCE IS DEPENDENT ON
First Button: MUTE ALARM Second Button ; FLOW CONTROL Third Button; DISPLAY Fourth Button ; PURGE SYSTEM Fifth Button ; MENU
Identify the buttons on the AIC ??
Dense mosaic pattern of turbulence appears above the aortic valve near the outlet area of the catheter
Describe what correct impella catheter position look like when color Doppler is added to echo?
1. Turn AIC on Hold For 3 Sec or till light alluminates 2. Press MENU and select CASE START and Press Select knob 3. Open Cassette Door by pressing the left release bottom. 4. Spike D5W bag, and insert cassette and slide purge pressure transmitter and close door 5. Plug in the red transducer plug in and snap the plastic clip to the connector cable. 7. once prime, connect red to red and yellow to yellow and make sure the conections are hand tight. 8. connect the connector cable to the connector plug on the AIC. 9. squeeze the white flush valve, and enter the purge data.
AIC Start up
Boost will return to P8 after 5 minutes
BOOST
COXMAPX.0022 IMPELLA . O.7 WATTS NORMAL IS 1-1.5
CPO CALULATION
Dense mosaic pattern beneath the aortic valve indicates that the outlet area of the catheter
Describe what incorrect impella catheter position look like when color Doppler is added to echo?
1. Low value of placement signal reduced below zero 2. Motor current normal 3. Home screen "wrong position"
Describe what you will see if the 5.0 catheter outlet area on or near aortic valve?
1. Placement signal Dampened or Flat; increased flow rate 2. Home screen "wrong position"
Describe what you will see if the 5.0 is in the ventricle or fully in aorta?
1. inadequate blood volume. 2. incorrect position within the LT Ventricle 3. RT heart failure
Describe why a suction alarm may occur?
Pulsatile placement signal Pulsatile motor current Home screen 'OK" position
Describe how the correct 5.0 AIC appears
1. Limits the amount of support 2. Decrease in arterial pressure and CO 3. Damage RBC's, leading to hemolysis
Describe the physiologic effects of prolong suction alarms?
INCREASED AFTERLOAD @ P-2/P-4 TO VENT THE LT VENTRICLE
ECMO RESULT IN