Impella Procedures

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

Equipment

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

Hybrid OR 5.5 Impella via Subclavian conduit

Note: Change location of supplies to Cath Lab 1!

Open

• Pack
• Cath Lab to-go cart
• ECMO cart
• .025 exchange - if removing IABP
• Perclose - if removing IABP/ECMO
• 500ml bag heparinized saline
• D5W 1000ml (bicarb 25 mEq, confirm with surgeon)

Standby

• JR4
• 6F *Cordis* Angled Pigtail
• AL1
• .035 exchange
• Straight stiff glide

Sheridan

• Open
  • 6F Angled Pig
  • 6F 260 J
• Standby
  • 6F AL1
  • 6F JR4
  • Glide Advantage
  • Straight stiff glidewire

• Spies -
  • 6F JR4 with .035 J

• Romick -
  • 6F JR4 with .035 J
  • Pigtail with .035 J

• Daniels -
  • AL1 with .035 J
  • AL1 with Straight Stiff Glide

Room Setup and Procedure

• Enter an order for CCL in EPIC
• Open x-ray using entered order.
• DO NOT CHARGE FOR THE PROCEDURE. This is OR's procedure.
• CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!
• 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 Cupid and log book.
• Reminder::: CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!
• Close x-ray and archive to ACUTE
• Capture charges for Cupid
• 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.