Assessing and Maintaining the Impella® Access Site

Jo Kajewski, advanced Impella trainer, describes how to assess the Impella access site and help prevent access site bleeding. Frequently assessing the Impella access site and performing the suggested interventions can help prevent complications and improve patient outcomes.

First, evaluate which device has been placed and make sure that the peel-away sheath has been removed. It is a best practice to remove the peel-away sheath before the patient is taken to the ICU. If the peel-away sheath is left in place, the patient may experience an increased risk of bleeding, damage to the arteriotomy if the sheath cracks or breaks, limb ischemia, or clots may form within the peel-away sheath.

When assessing the femoral access site, ensure that the angle of entry was maintained. This may require placing folded gauze under the repositioning sheath hub to prevent tenting of the arteriotomy site. If there is any bleeding or oozing at the access site, be sure to maintain the entry angle while holding pressure and notify the physician.

Perform dressing changes per hospital protocol. When changing the dressing at the Impella site, make sure that you can see the centimeter marker on the catheter shaft and that the Tuohy-Borst is accessible. To maintain catheter accessibility, it is a best practice to use two Tegaderm™ dressings and cut a triangle into each of them to fit over the insertion site. Be sure to preserve the angle of entry with each dressing change.

As with any arterial line, assess distal pulses to ensure adequate perfusion to the distal extremity. If there is a loss of pulses in the distal extremity, notify the physician immediately to discuss opportunities to reestablish blood flow to the patient’s limb.

Other interventions to prevent access site bleeding include using a knee immobilizer, maintaining the head of the bed (HOB) at less than a 30-degree angle, minimizing unnecessary movement, and ensuring that the Impella catheter is not pulled during transfers or when moving the patient.

If at any time you need support, remember to reach out to your Impella Clinical Team or call the 24/7 Clinical Support Center at 1-800-422-8666 in the U.S.

Tegaderm is a filed for trademark of 3M