7.20 Instructions for Use & Clinical Reference Manual (US)Table 7.1 Guide for Managing Hemolysis in Various CircumstancesCondition Controller Indicators Clinical Indicators ManagementImpella® inlet areain close proximityto intraventricularwall• “Impella Flow Reduced” or“Suction” alarms• Lower than expected flowsImaging (see note) • Reposition the catheter by rotating or moving thecatheter into or out of the ventricle slightly. Eitheror both of these actions could help move the inletof the catheter away from the intraventricular wall.• If repositioning will be delayed, reduce the P-levelif tolerated by patient hemodynamics. Return tothe previous P-level after repositioning.• Reassess position after flow rate has returned todesired target value.Wrong pumpposition• Position alarms with higherthan expected flows• “Impella Flow Reduced”or “Suction” alarms withlower than expected flows• Pump outlet blocked alarmsImaging (see note) • Reposition the catheter by rotating or moving thecatheter into or out of the ventricle slightly. Eitheror both of these actions could help move the inletof the catheter away from the intraventricular wall.• If repositioning will be delayed, reduce the P-levelif tolerated by patient hemodynamics. Return tothe previous P-level after repositioning.• Reassess position after flow rate has returned todesired target value.Higher thanneeded flowsetting• There may be no controllerindicators• “Impella Flow Reduced” or“Suction” alarms• Normal hemodynamics• Native recovery• Reduce P-level until patient pressure starts todrop.• Slowly increase P-level.Inadequate fillingvolume• Position alarms• “Impella Flow Reduced” or“Suction” alarms• Lower than expected flows• Low CVP• Low PCWP• Low AOP• High PA pressures• Right heart failure• High urine output• Increased bleeding or chesttube drainage• Reduce the P-level if tolerated by patienthemodynamics.• Correct I and O balance.• Consider giving volume; additional volume willexpand the end systolic ventricular volume.• Reduce PA pressure.• Improve right heart function.Pre-existingpatient conditionsor other medicalproceduresN/A • Patient past medical history• Current procedures ortreatmentsNote on imaging: All imaging technology represents the anatomy in two dimensions (2D). It is not possible to assess theinteractions between the catheter and the intraventricular anatomy that occur in three dimensions (3D). Abiomed stronglyrecommends that the catheter be repositioned, even if the imaging view shows correct position.
