Impella

From Bay Area Structural Heart Wiki

Note Note: Good article on Single access and sheaths: Impella Single Access

Daniels single access Impella/PCI

Equipment

  • 7F Destination
  • 2 Percloses
  • Micropuncture
  • 18G Cook need to stick Impella diaphragm for Destination advancement

Hui single access Impella - DRAFT

Double stick Impella sheath

Equipment

  • Micropuncture
  • 6/7 Short slender sheath
  • 7fr. Guide

Hybrid OR 5.5 Impella via Subclavian conduit

Note Note: Change location of supplies to Cath Lab 1!

Equipment

  • Pack
  • Cath Lab to-go cart
  • ECMO cart
  • JR4
  • 6F *Cordis* Angled Pigtail
  • AL1
  • .035 exchange
  • Straight stiff glide
  • .025 exchange - if removing IABP
  • Perclose - if removing IABP/ECMO
  • 500ml bag heparinized saline
  • D5W 1000ml (with 12,500 U of heparin and/or bicarb, confirm with surgeon)

Sheridan -

  1. 6F Angled Pig
  2. 6F 260 J

Spies -

  1. 6F JR4 with .035 J

Romick -

  1. 6F JR4 with .035 J
  2. Pigtail with .035 J

Daniels -

  1. AL1 with .035 J
  2. AL1 with Straight Stiff Glide

Room Setup and Procedure

  • Enter an order for CCL in EPIC
  • Open x-ray and McKesson using entered order.
  • DO NOT CHARGE FOR THE PROCEDURE. This is OR's procedure.
  • CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!
  • Free-Text note that McKesson is open for billing and equipment only, not procedural charting. See Anesthesia and OR nurses notes.
  • Put input 4in1 B on V-integration 2 for TTE on the fluoro screen.
  • Always prep for femoral access in the event of emergent ECMO.
  • Place drape over legs after surgical draping to cover abdomen.
  • Put OR light camera in place to see the surgical site to monitor progress from control room.
  • Ask OR for 1 pack Ray-Tec sponges for wipes.
  • Do the thing (Insert 5.0 Impella)
    • Pass off sheath and clamps to surgeon. Once sheath is inserted in the conduit, JR4 and J wire advanced for valve crossing. IMPELLA wire retained in LV. Impella advanced under fluoro and echo guidance. Save image. Surgeon/ Interventionist discuss whether to removed additional support or leave in place. Surgeon closes.
  • Remove the other thing (ECMO / Balloon pump / Impella)
  • Document times and doses in McKesson and log book.
  • Reminder::: CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!
  • Close x-ray and archive to EMIM_CATH
  • Capture charges for McKesson
  • Print device usage.
  • Sticker goes in room 14 log book for tracking OR lab 1 log book, NEVER both.


Axillary Impella/IABP - DRAFT

If left subclavian is occluded or otherwise inaccessible procedure is aborted. IABP should not be inserted through right subclavian per CT surgery.

Equipment

  • Micropuncture
  • Probe Cover
  • 4/5F slender radial sheath
  • Amplatz extra stiff 260cm wire (on standby for Spies)
  • .035 150cm J wire
  • 5Fr pigtail catheter
  • 5Fr JR4 diagnostic catheter (on standby for Spies)
  • IABP kit
  • 8Fr 23cm safesheath (ep)(Romick) / 8fr x 23 brite-tip sheath (Spies)
  • Perclose
  • TR band
  • Biopatch
  • 0-Ethibond suture
  • Tournaquick (carrot top)
  • 3 Port Manifold

Procedure

  • Prep left side neck and chest (ear to nipple and shoulder to midline).
    • Note: The access site is not an absolute (may become axillary or subclavicular) hence the large site prep.
  • Prep left radial.
  • Left radial accessed and 4/5f slender sheath inserted.
  • Pigtail advanced and angiogram performed. Pigtail left in place and used as reference for subclavian access.
  • Subclavian accessed with ultrasound and fluoro guidance using micropuncture kit and radial sheath inserted.
  • Pigtail catheter removed.
  • J wire and JR4 inserted and directed to descending aorta if unable to be directed to abdominal aorta
  • Catheter and sheath removed, 8f dilator inserted, and perclose advanced for pre-closure.
  • Amplatz wire advanced, perclose removed, 8f sheath advanced.
  • IABP inserted.
  • Sheath peeled away. (Romick)
  • IABP secured with suture and site dressed.
  • Radial sheath removed and TR band applied.