Impella and VADs Flashcards
(18 cards)
What side of the heart does impella help
Left
*unless it’s an RP
What should ACT be in someone with an Impella
160-180 seconds
What are patient considerations with Impella devices
Do not raise the bed over 30
Monitor distal pulses
Check for bleeding/hematoma
Keep leg straight
What should preload be with impella
<10
What are some reasons that can cause inadequate preload
Diuretics
Bleeding
CVVH
Right heart dysfunction
ECMO
What should MAP be on impella
60-80
How do you monitor after load on Impella
By monitoring MAP and SVR
What are some reasons for high after load
Pressers
VA Ecmo
Physiologic effects
What is the range of impella flow
P0- P9
How to tell if the impella is in proper position based on the monitor
Will show a pulsatile motor current
What are some trouble shooting strategies when there is suctioning present with impella
Reduce P by 1-2 levels
Assess volume status (add if cvp <10)
Confirm RV function
Assess position
What causes suctioning with impella
Inadequate LV filling
Incorrect position in LV
RV failure
How to recognize and fix diastolic suction
-negative diastolic pressure
- normal systolic
- low diastolic flow
Check filling/volume status
What is the purpose of the purge system with impella
To prevent blood from entering the device
What type of fluid is used for the purge system in impella
D5W and heparin
What does it mean if a PAPi is less than.9
There is RV dysfunction
What is the correct positioning for an impella RP
Outlet at/above the bifurcation of right/left PA branch
Inlet in the IVC at the level of the diaphragm or apex of the heart
How to calculate the cardiac output when impella RP is in use
FICK for accurate reading
