Abiomed Automated Impella Controller Manual De Usuario página 32

HEMOLYSIS
When blood is pumped, it is subjected to mechanical forces. Depending on the strength of the blood cells and the amount of force applied, the cells may
be damaged, allowing hemoglobin to enter the plasma. Pumping forces can be generated by a variety of medical procedures including heart lung bypass,
hemodialysis, or ventricular assist device (VAD) support. Patient conditions—including catheter position, pre-existing medical conditions, and small left
ventricular volumes—may also play a role in patient susceptibility to hemolysis.
Hemolysis should be monitored during support. Patients who develop high levels of hemolysis may show signs of decreased hemoglobin levels, dark or
blood-colored urine, and in some cases, acute renal failure. Plasma-free hemoglobin (PfHgb) is the best indicator to confirm whether a patient is exposed
to an unacceptable level of hemolysis.
Management technique may differ depending on the underlying cause of hemolysis. The following table, below, provides guidance for various
circumstances.
Table 5. Table Guide for Managing Hemolysis in Various Circumstances
Condition Controller Indicators
Impella inlet area in • "Impella Flow Reduced" or
close proximity to "Suction" alarms
intraventricular wall • Lower than expected flows
Wrong pump position • Position alarms with higher than
expected flows
• "Impella Flow Reduced" or
"Suction" alarms with lower than
expected flows
• Pump outlet blocked alarms
Higher than needed • There may be no controller
P-Level setting indicators
• "Impella Flow Reduced" or
"Suction" alarms
Inadequate filling • Position alarms
volume • "Impella Flow Reduced" or
"Suction" alarms
• Lower than expected flows
Pre-existing patient N/A
conditions or other
medical procedures
Note on imaging: All imaging technology represents the anatomy in two dimensions (2D). It is not possible to assess the interactions
between the catheter and the intraventricular anatomy that occur in three dimensions (3D). Abiomed strongly recommends that the
catheter be repositioned, even if the imaging view shows correct position.
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Clinical Indicators
Imaging (see note)
Imaging (see note)
• Normal hemodynamics
• Native recovery
• Low CVP
• Low PCWP
• Low AOP
• High PA pressures
• Right heart failure
• High urine output
• Increased bleeding or chest tube
drainage
• Patient past medical history
• Current procedures or treatments
Management
• Reposition the catheter by rotating or moving the
catheter into or out of the ventricle slightly. Either or
both of these actions could help move the inlet of the
catheter away from the intraventricular wall.
• If repositioning will be delayed, reduce the P-level
if tolerated by patient hemodynamics. Return to the
previous P-level after repositioning.
• Reassess position after flow rate has returned to
desired target value.
• Reposition the catheter by rotating or moving the
catheter into or out of the ventricle slightly. Either or
both of these actions could help move the inlet of the
catheter away from the intraventricular wall.
• If repositioning will be delayed, reduce the P-level to
P-2. Return to the previous P-level after repositioning.
• Reassess position after flow rate has returned to
desired target value.
• Reduce P-level until patient pressure starts to drop.
• Slowly increase P-level.
• Reduce the P-level if tolerated by patient
hemodynamics.
• Correct I and O balance.
• Consider giving volume; additional volume will expand
the end systolic ventricular volume.
• Reduce PA pressure.
• Improve right heart function.
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