Abiomed Impella RP Manual Del Usuario página 21

8. Secure the repositioning sheath by suturing it to the skin using the yellow eyelet on the
sheath.
9. Attach the anticontamination sleeve to the yellow section of the repositioning sheath. Lock
the anchoring ring in place by turning it clockwise. Secure the catheter shaft in place by
tightening the connected anchoring ring.
10. Carefully extend the anticontamination sleeve to maximum length and secure the end
closest to the blue Impella plug by tightening the anchoring ring.
11. Reposition the catheter as necessary.
To prevent contamination and subsequent infections, always use sterile technique on the insertion
site. Follow institutional protocols for prophylaxis of infection for patients on ventricular assist
devices and indwelling lines, as well as protocols for surveillance of such patients. If device-related
infection occurs, consider each patient's clinical circumstances when deciding whether to continue
Impella support.
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PATIENT WEANING
Weaning the patient from the Impella RP
may occur when right ventricular recovery is suspected and/or the patient is approaching the
maximum duration of use for the Impella RP
such as described below.
The following weaning protocol is provided as guidance only.
1. Initiate the weaning process by temporarily reducing the Impella RP
about 2 L/min.
2. Assess right ventricular function. Small changes in right ventricular systolic function as
measured by echocardiography may be accompanied by significant improvement in right
side forward flow; therefore, it is important to evaluate both echocardiographic evidence
of improvement as well as CVP, flow rate, and overall perfusion.
3. Record available information regarding flow rate, CVP, echo parameters, and systemic
hemodynamics.
4. After 15–20 minutes at the reduced flow rate, if there are signs of right ventricular
recovery and no adverse effects from reduction in flow rate, continue the weaning process
by reducing flow rate as tolerated to 0.5 L/min (P1). At this flow rate there will no longer
be any forward flow across the right heart.
5. If the patient is maintained at a low flow rate (<1.5 L/min) for a prolonged period, increase
ACT to at least 250 seconds.
Impella RP ® with the Automated Impella
Catheter is at the discretion of the physician. Weaning
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Catheter. It should be initiated in a step-wise manner,
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® Controller
Catheter flow to
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Signs of Right
Ventricular Recovery
As right-side support
is slowly weaned, right
ventricular recovery is
indicated by preservation
of the normal range of
left-sided cardiac output as
well as by a lack of severe
elevation in CVP.
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