Left Ventricular Impella 5.0/CP/2.5 Order Set Page 1 of 4
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1 Left Ventriclar Impella 5.0/CP/2.5 Order Set Page 1 of 4 See Cardiovasclar Post-Operative IC Order Set See Cardiology Interventional POST Orders 04 PATIENT WEIGHT: kg (reqired) PATIENT HEIGHT: cm (reqired) PATIENT MONITORING: Vital Signs AN Hemodynamic Monitoring 15 mintes for 1 hor, then per nit rotine AN PRN after each pmp performance level (P Level) change Measre Cff Blood Pressre opposite of implant, if axillary placement Mixed Venos Blood Gas draw every AM Monitoring AN ocmentation Gidelines Monitor pmp placement continosly sing dal signal waveforms of motor crrent AN placement signal Measre AN docment catheter depth pon admission AN every 4 hors Monitor AN docment every hor: Pmp performance (P Level) Flow (L/min) Placement Signal (mmhg) Prge Pressre ( mmHg) Motor Pmp position Prge Flid Infsion Rate (ml/hr) Power AC Battery (60 minte battery life) Maintain the appropriate anticoaglation monitoring flowsheet for heparin, argatroban, or bivalirdin ACTIVITY: Bed rest If Axillary Placement: Head of Bed elevated to 30 degrees If Femoral Placement: Head of Bed elevated to maximm of 30 degrees Nrsing Instrction Keep cannlated extremity straight Knee immobilizer PRN to maintain straight cannlated extremity Trn every 2 hors logroll only NRSING: Assessment Vasclar checks to cannlated extremity every hor Assess insertion site for bleeding, hematoma, cannla kinking or movement every hor Interventions tify M Change in nerovasclar stats of cannlated extremity Heme positive stool Hematria Platelet cont less than 50% of IC admission baseline Signs of bleeding, hematoma or cannla movement For alarms that cannot be resolved after trobleshooting with Abiomed Clinical Spport evice Performance Maintain pmp performance level at (P Level) to keep flow at or above L/min tify M if nable to maintain at or above specified flow rate decrease pmp performance (P Level) below P2 as long as the pmp is in the ventricle; te: Retrograde flow will occr across the aortic valve if the pmp is set below P2 ALAR: Nrsing Instrction Contact Abiomed Clinical Spport PRN for trobleshooting:
2 Left Ventriclar Impella 5.0/CP/2.5 Order Set Page 2 of 4 ALAR CONTINE: If Sction Alarm: Redce P Level by 2 levels, bt do not decrease below P2 Assess volme (CVP/PA) stats to ensre adeqate ventriclar filling If filling isses: Follow Impella Hypovolemia protocol for PA < mmhg or CVP < mmhg (refer to pg 4) If NO filling isses: Increase P Level to previos pre-alarm setting Reposition patient-logroll only If Occlsion Alarm: Check for kinks and resolve Assess for Catheter islocation (See Catheter islocation orders below) OTHER INTERVENTIONS: If Catheter islocation is sspected: ecrease P Level to P2 tify M STAT If Cardiac Arrest: tify M STAT ring chest compressions, decrease the P Level to P2 Follow ACLS gidelines AN defibrillate immediately, if indicated CLINICAL ECISION SPPORT If Catheter islocation is sspected or Cardiac Arrest occrs, a Transesophageal Echocardiogram (TEE) is the best method for confirming placement. te: The Impella system ES have to be stopped or nplgged to defibrillate If ACLS sccessfl: Increase P Level by 2 levels every 15 mintes ntil pre-arrest setting is achieved 04 WON CARE: Specialty Bed Transparent occlsive dressing to insertion site. Perform sterile dressing change to insertion site as needed when dressing becomes damp, loosened, or soiled. Beginning Post-op 2, perform sterile dressing change every 24 hors sing transparent occlsive dressing. o not cover catheter sleeve with tape or transparent dressing ANTICOAGLATION TREATMENT PLAN: Start Systemic Heparin Infsion AN Prge Heparin NOW Start Systemic Heparin Infsion AN Prge Heparin on / at : Start direct thrombin inhibitor (argatroban or bivalirdin) (recommended for patient with HIT) See Impella Argatroban Bivalirdin Spplemental Order Set (#) For Heparin Infsion: Baseline ACT prior to starting Heparin infsion ACT therapetic goal between sec for Heparin infsion ACT every 4 hors ntil therapetic goal is achieved AN every 4 hors after each rate change ACT every 6 hors after therapetic goal is achieved Repeat ACT in 2 hors if M orders a bols of Heparin Heparin 25,000 nits in 250mL extrose 5% Water (100 nits/ml) IV Start TOTAL Heparin prge and IV infsion at: 100 kg = 10 nits/kg/hor >100 kg = 10 ml/hr (1000 nits/hr) Max initial dose: 1000 nits/hor (TOTAL OF PRGE AN INFSION) Heparin titration orders for IV infsion If ACT less than 141 sec If ACT sec If ACT sec If ACT sec If ACT sec If ACT greater than 220 sec Increase Heparin infsion by 2 nits/kg/hor Increase Heparin infsion by 1 nit/kg/hor change ecrease Heparin infsion by 1 nit/kg/hor ecrease Heparin infsion by 2 nits/kg/hor tify M
3 Left Ventriclar Impella 5.0/CP/2.5 Order Set Page 3 of 4 NTRAVENOS FLIS: Prge Pressre Soltion 500mL extrose 20% in Water (20W) for CP/2.5 and extrose 10% in Water (10W) for 5.0 Clinical ecision Spport: The Impella atomated console will atomatically adjst the prge flow rate to maintain a prge pressre between mmHg and a prge flow rate between 2-30 ml/hor. 500mL 20W with 25 nits/ml Heparin for CP/2.5 and 10W with 25 nits/ml Heparin for 5.0 E: See Heparin Start Time Above 10W prge soltion with direct thrombin inhibitor per spplemental orders for patients with HIT 1000 ml 0.9% rmal Saline (NS) pressrized bag to be infsed via red pressre sidearm PRN for Impella 2.5 AN CP ONLY 04 Prge Pressre Maintenance Nrsing Instrctions Change prge soltion every 24 hors Change prge pressre cassette every 96 hors Complete prge flid change in less than 2 mintes to prevent damage to the catheter pmp ocment changes in prge pressre per policy AN assess trends Monitor Prge Pressres after P Level changes Prge Pressre Trobleshooting For prge pressre LESS THAN 300mmHg If prge flow rate less than 30mL/hor, assess tbing for loose connections or leaks If prge flow rate is eqal to 30mL/hor, change prge flid to 500mL extrose 40% Water (40W) AN tify M For prge pressre GREATER THAN 1100mmHg If prge flow rate is eqal to 2mL/hor, assess tbing for kinks or closed clamps If prge flow rate is greater than 2mL/hor, change prge flid to 500mL extrose 10% Water (10W) If low or high prge pressre alarms REMAIN NRESOLVE after trobleshooting tify Abiomed Clinical Spport If prge pressre remains less than 300mmHg or greater than 1100mmHg tify M and Perfsionist LABORATORY BMP, CBC, ABG,, PT/INR, PTT pon admission AN every AM while on device ABG, Potassim, PRN for hemodynamic instability Mixed Venos Blood Gas every AM while on device ABG every 6 hors for first 24 hors post device implantation RAIOLOGY Portable Chest X-Ray STAT pon admission AN every AM Indication: Confirm Impella position in LV logroll only CONSLTS Conslt WOCN Reason: Low Braden Score (High Risk)
4 [Patient Identifier] Left Ventriclar Impella Hypovolemic Protocol Page 4 If Sction Alarm Assess Volme: Per M orders (see pg 2) PA < OR CVP < Yes HgB > 7 HgB < 7 0.9% NS 250ml bols X 1 Transfse 1 nit of PRBC If Sction Alarm persists and PA or CVP less than above parameters If Sction Alarm persists and PA or CVP less than above parameters Recheck HgB Repeat 0.9% NS 250ml bols X 1 Recheck HgB HgB < 7 Yes 0.9% NS 250ml bols X 1 Transfse 1 nit of PRBC. If Sction Alarm persists IFY M o not exceed 750mL of Crystalloids or 2 nits PRBC withot notifying M RN Signing Off Order: ate: Time:
5 Fll-dose Heparin Flowsheet for Left Ventriclar Impella Keep in MAR section of the Chart (not to be sed when only the prge heparin is being administered) Complete when fll-dose heparin initiated: Patient weight (kg): Affix Patient Label Total dose of heparin initially ordered (prge + standard IV infsion) = 10 nits/kg/hr = nits/hr (max 1000 nits/hr) Prge Heparin Infsion = crrent prge rate ( ml/hr) * 25 nits/ml = nits/hr Begin Heparin IV infsion (100 nits/ml) at nits/hr = nits/kg/hr Signatre ate/time Complete following each ACT measrement: ACT information Goal = sec Heparin dosing information ate/ Time of ACT ACT Vale (sec) IV IV Rate (ml/hr) IV Baseline Prge Total Change needed Change made at On Hold ntil Baseline change or New IV New IV Rate (ml/hr) ACT* de at Signatre * Time of repeat ACT is from the time that the infsion rate is changed Origin ate: 11/12; 10/14 ; 8/15 *1242*
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