2024 Q1 Critical Care Transport Update Webinar

Jena Billig, BSN, RN, CCRN, CFRCN, an Impella critical care transport trainer, presents this first quarterly critical care transport update webinar. The session opens with a patient vignette video and then Jena discusses two featured topics:

• Understanding the Impella purge system and heparin-free purge solution
• Transport considerations for second generation Impella 5.5® with SmartAssist®

Impella purge system and heparin-free purge

Jena reviews the purpose and components of the Impella purge system. She explains that the purge solution is typically 5% dextrose in water (D5W), which has a viscosity that helps prevent blood from entering the Impella motor housing, with either added heparin (25 U/mL) or sodium bicarbonate (25 mEq/L).

Jena highlights tips and tricks related to the purge system and patient transport, and she discusses how sodium bicarbonate provides a heparin-free option for Impella purge solution She dispels the myth that heparin is added to the purge solution for its anticoagulation properties, explaining that it is added to raise the pH of the purge solution. Using sodium bicarbonate, instead of heparin, has the added benefits of eliminating the need to calculate how much heparin the patient is receiving in the purge system, and improving pump motor durability by raising pH even higher, further helping to prevent blood proteins from sticking to the motor gap.

Transporting patients with Gen 2 Impella 5.5® with SmartAssist®

Jena briefly compares Impella CP® with SmartAssist® and Impella 5.5 with SmartAssist with regard to flow and insertion. She explains that while most transport situations involve transporting patients supported with an Impella CP to a tertiary care facility, patients supported with Impella 5.5 may be transported for reasons such as transplant/durable LVAD evaluation.

Jena describes purge-related enhancements and repositioning unit enhancements of the second generation Impella 5.5 with SmartAssist. “The relocated purge sidearm,” she emphasizes, “is basically the biggest jump for joy ever in the transport world.” In addition to no longer having “140 nautical miles of purge tubing” to manage, the second generation Impella 5.5 has a modular purge cassette with less tubing and sodium bicarb compatible luer. Jena also spends time discussing the new catheter lock unit and 3-point external fixation best practices for transporting patients supported with the Impella 5.5 with SmartAssist.