OR and ICU Checklist Best Practices for Impella 5.5® with SmartAssist®

Kevin Ray, MS, RT(R), CV, reviews the Impella 5.5 with SmartAssist OR and ICU checklists. These checklists include steps to perform pre-insertion, during insertion, post-insertion, prior to leaving the OR, and daily in the ICU. Kevin is a Global Impella® Training Manager with Abiomed.

Pre-insertion

• Call the Clinical Support Center (CSC) or your local Abiomed representative prior to insertion
• Assess the size and condition of the axillary artery with ultrasound or CTA prior to opening the Impella 5.5 with SmartAssist kit
• Place the sidearm retainer on the purge sidearm of the Impella 5.5 with SmartAssist to support the sidearm during and after the procedure
• Straighten the entire Impella 5.5 with SmartAssist catheter prior to insertion
• Ensure the pump is primed with heparinized D5W (25 U/mL recommended)
• Prime the Impella 5.5 with SmartAssist with the motor and cannula in a vertical position
• Confirm purge fluid exits the motor/outflow while vertical
• Continue to prime the pump for a minimum of 20 minutes prior to insertion if possible

Insertion

• Torque the pump 180 degrees clockwise (holding the catheter, not the red Impella plug) after the inflow crosses the aortic valve into the LVOT
• Continue advancing into the mid LV cavity or along the septal wall until the mid-inlet is approximately 5 cm from the aortic valve annulus

Post-insertion

• Confirm proper position with TEE
• Remove excess torque from the white cable by unplugging it from the AIC at P-2 and then unwinding it and reconnecting it to the AIC

Prior to leaving OR

• Confirm that the Tuohy-Borst is locked
• Confirm three-point external fixation positioning (one by the insertion site and one on either side of the red plug) with the red Impella plug centered on the abdomen above the umbilicus area

ICU Impella 5.5 with SmartAssist daily management

• Confirm purge fluid has the proper amount of heparin
• Confirm the Tuohy-Borst valve is locked every shift change
• Chart the centimeter marker on the Impella catheter closest to the Tuohy-Borst daily
• Chart urinary output and color
• Assess volume status (target CVP ≥10 mmHg if frequent suction alarms) as well as device position and right heart function, especially if urine is pink or red
• Address alarms on the AIC console immediately
• Ensure that NO alcohol or alcohol-based cleaning solutions are used on or near the Impella purge sidearm
• Check that the external fixations are secured near Tuohy-Borst and red plug
• Confirm that the Impella sidearm retainer is on the purge sidearm
• Conduct a baseline echo to confirm Impella position in the ventricle
• Prior to ambulation, reconfirm that the Tuohy-Borst is locked and reconfirm proper pump position (inlet ~5 cm below aortic valve annulus) with echo
• Contact CSC or local team if purge flow drops to 3 mL/hr or lower to discuss advanced purge management for patient