Impella RP

 

Two separate and distinct anticoagulation solutions are required during Impella support:

  • Systemic anticoagulation titrated using standard techniques 

  • Anticoagulant added to the purge fluid to prevent blood entrance into the motor chamber and to maintain patency of the purge solution channel. If the amount of UFH in the purge fluid leads to undesired systemic anticoagulant effects as measured by ACT or PTT, the concentration of UFH in the purge fluid can be reduced

 

Purge Flow

  • 100mg/500mL D5 (can start at 25mg for 6hrs and then 50mg 6 hours after that if the bleeding is controlled) @ 4-20cc/hr

  • purge solution flows through the Impella in the opposite direction of the patient’s blood being drawn into the catheter

  • purge solution creates a pressure barrier that prevents blood from entering the Impella motor

  • dextrose concentration determines the viscosity and flow rate of the purge fluid

    • lower dextrose concentrations are less viscous and flow more quickly with less pressure through the purge system

    • higher (more viscous) concentrations result in a slower purge rate and greater pressure barrier

  • to date, Abiomed has recommended using a solution of 20% dextrose (D20, also called 20% glucose) with 50 IU/mL of heparin as the default purge fluid for all Impella ® Catheters.

  • Heparin in the purge solution provides additional anticoagulation protection.

  • In the event that blood migrates into the motor, the heparin will help maintain the patency of the purge pathway

  • it doesn't matter the number you start off with (everyone is different); the decline is what matters

  • range of dextrose solutions, from 5% to 40% dextrose have been evaluated and qualified

  • Typically when an Impella is started, 5% dextrose is used as the purge solution

  • longer-term care, the D5 purge solution is often replaced with a 20% solution of dextrose (D20) as recommended

  • recommended 300 mmHg of purge pressure.

  • When using a purge solution of 5% dextrose, the purge cassette can be used for 5 days or longer, depending on hospital policy

... but I would more especially commend the clinician who, in acute diseases, by which the bulk of mankind are cutoff, conducts the treatment better than others.
 
Hippocrates, 400 BC