Impella vs IABP

[Lreiersen]

Hi fellow nurses!

I have a question about impellas.

I am relatively new to the CCU and critical care in general. I certainly have my work cut out for me as far as learning goes. But there is one concept that I am really struggling to learn. I had my first impella the other night, and boy are the confusing. I understand the relative concept. I understand that it assists in moving blood into the aorta and increases CO in patients with cardiogenic shock. So I have two questions.

1)Why impella vs IABP. I asked the perfusionist working with me, and he gave me an answer that was way over my head.

2) does anyone happen to have a policy or procedure from their hospital developed for an impella?? Like we keep ours on heparin gtts with a tight PTT window from 45-55, but we do not have an impella order sheet or procedure list, we are essentially relying on the physicians to order all necessary things.

I would greatly appreciate any comments or help on this one. THANKS!!!!

[RNpatterson]

The IABP only offloads the heart by about 15% which is often all is needed. The impella tends to offer more assistance and the newest model has the ability to offer full cardiac assistance.

Balloon pumps are often used to assist in the recovery of cardiogenic shock or to optimize a pt's condition before a risky cardiac surgery since studies show a decrease in morbidity and mortality when a patient goes into surgery in their "peak" condition.

Impellas are often used as a cardiac assist device in the cath lab and if a patient requires a little extra cardiac assistance for a day or two after the cath, it is easily left in place. Balloon pumps wouldn't be utilized during a cath given that it would be hard to thread anything up to the heart with that pesky balloon getting in the way with every heart beat.

Of course these are not exclusive uses for these devices but certainly common uses. Perhaps someone can add on if I missed anything pertinent but for now I hope this helps.

[StayLost, BSN, RN]

The last post is a great explanation.

When the Impella first came out, we were told by the reps that in the future it would replace the IABP, which is NOT true. There are many times that the IABP is indicated (ie incr perfusion of the coronary artaries).

Physicians were more reluctant to place it because:

1) it's a new technology and the older doc's are set in their ways.

2) The older Impella model was NOT user-friendly.

3) Unlike the IABP, the Impella line can easily migrate, causing the the tip of the catheter to move out of the LV. It required a bedside ECHO and a physician at the bedside to make sure that it was placed correctly, so it was constantly a worry. In fact, we would minimize repositioning for fear that the line would get tugged on.

3) That Impella line is about $35,000

The new model's interface is MUCH easier to understand. It basically can sense it's placement and will tell you if it's not in the right place. And since it rolled out last year, our physicians are using it much more because the outcomes have been good.