PACE Exam questions and answers
graded A+
AIC states "Impella Position Unknown". Family member asks you what it means. - ANS ✔Talk to
the nurse. RN explains that it's normal because the pump has taken over for the heart.
Continue to watch and evaluate MAP.
Turn off alarm.
Transferring AIC to AIC - ANS ✔Turn on Console B.
Disconnect white cable from console A, plug it into console B.
Press the selector knob to accept the previous settings.
Disconnect the yellow leur locks and reconnect it.
Transfer purge cassette and purse solution to console B.
Purge Menu to change purge fluid bag and estimate remaining volume.
"Air in Line" - ANS ✔Purge Menu
Deair purge.
Pink urine and doc asks if it could be the Impella. - ANS ✔It's possible, however studies show
when the pump is correctly positioned and patient has appropriate volume, the incidence of
hemolysis are clinically insignificant.
Suggest sending plasma-free Hgb and UA.
Order an echo to evaluate position
"Placement Signal Lumen Blocked" - ANS ✔*Only seen in 2.5 and CP w/o SA.
Threshold for this alarm: PP <10mmHg.
,Likely clot.
Make sure pressure bag is properly inflated to 300mmHg.
Take 20cc syringe and aspirate the red connection port.
-If it clears, flush and reattach pressure bag.
-If you can't aspirate, cap off pressure port. Disable placement signal (under Menu). **Will lose
suction alarms and PS. Monitor MC.
Fellow believes the patient has HIT. - ANS ✔HIT is 50% drop in platelets after Heparin
administration.
Can we run an ELISA or SRA to confirm?
If confirmed, contact medical officer to get appropriate alternative of Angiomax or Argatroban.
"Impella Position Wrong" - ANS ✔PS: AO. MC: flat. Home Screen will show "Impella Position
Wrong" with a question mark.
Drop to P-2. Get an echo to determine where the catheter is (3 options):
entire catheter in AO.
entire catheter except pig in AO.
inlet and outlet in LV with OPP in AO.
5.0/LD - too far in/too far out.
Impella Stopped. - ANS ✔"Controller failure"? yes - replace console. No...
Restart at previous P-level.
Restart at P-2.
Wait 1 minute, reattempt at P-2.
Replace pump.
, *If you can't get the pump restarted, pull the catheter back across AoV. Treat medically PRN.
Sudden drop in flows... - ANS ✔-probably a clot.
What was the ACT? Did you flush the sheath? Reduce to P-1, pull back across AoV. Replace
pump.
Suction alarms - ANS ✔Volume = CVP?
Placement = echo?
RV failure = PAPi, echo, liver enzymes?
If pt can tolerate lower P-level, no need to escalate to RP.
How to wean patient in ICU - ANS ✔Off all pressers and tropes? Yes - great.
Decrease P-levels x2, Q2-4hr. Assuming pt is stable, MAP >60mmHg or LVEDP with SA, continue
decreasing at this rate. Be at P-2 when ready to pull. P-1 and pull back across valve. P-0 and pull
pump and sheath as one unit. Hold pressure. Pull white cable, turn off AIC.
"Low Purge Pressure" - ANS ✔- check all connections for tightness.
- change purge cassette.
- increase dextrose concentration.
- **watch motor current.
Needed but not included for 2.5 insertion - ANS ✔D5W
diagnostic catheter
J-wire
dilators
graded A+
AIC states "Impella Position Unknown". Family member asks you what it means. - ANS ✔Talk to
the nurse. RN explains that it's normal because the pump has taken over for the heart.
Continue to watch and evaluate MAP.
Turn off alarm.
Transferring AIC to AIC - ANS ✔Turn on Console B.
Disconnect white cable from console A, plug it into console B.
Press the selector knob to accept the previous settings.
Disconnect the yellow leur locks and reconnect it.
Transfer purge cassette and purse solution to console B.
Purge Menu to change purge fluid bag and estimate remaining volume.
"Air in Line" - ANS ✔Purge Menu
Deair purge.
Pink urine and doc asks if it could be the Impella. - ANS ✔It's possible, however studies show
when the pump is correctly positioned and patient has appropriate volume, the incidence of
hemolysis are clinically insignificant.
Suggest sending plasma-free Hgb and UA.
Order an echo to evaluate position
"Placement Signal Lumen Blocked" - ANS ✔*Only seen in 2.5 and CP w/o SA.
Threshold for this alarm: PP <10mmHg.
,Likely clot.
Make sure pressure bag is properly inflated to 300mmHg.
Take 20cc syringe and aspirate the red connection port.
-If it clears, flush and reattach pressure bag.
-If you can't aspirate, cap off pressure port. Disable placement signal (under Menu). **Will lose
suction alarms and PS. Monitor MC.
Fellow believes the patient has HIT. - ANS ✔HIT is 50% drop in platelets after Heparin
administration.
Can we run an ELISA or SRA to confirm?
If confirmed, contact medical officer to get appropriate alternative of Angiomax or Argatroban.
"Impella Position Wrong" - ANS ✔PS: AO. MC: flat. Home Screen will show "Impella Position
Wrong" with a question mark.
Drop to P-2. Get an echo to determine where the catheter is (3 options):
entire catheter in AO.
entire catheter except pig in AO.
inlet and outlet in LV with OPP in AO.
5.0/LD - too far in/too far out.
Impella Stopped. - ANS ✔"Controller failure"? yes - replace console. No...
Restart at previous P-level.
Restart at P-2.
Wait 1 minute, reattempt at P-2.
Replace pump.
, *If you can't get the pump restarted, pull the catheter back across AoV. Treat medically PRN.
Sudden drop in flows... - ANS ✔-probably a clot.
What was the ACT? Did you flush the sheath? Reduce to P-1, pull back across AoV. Replace
pump.
Suction alarms - ANS ✔Volume = CVP?
Placement = echo?
RV failure = PAPi, echo, liver enzymes?
If pt can tolerate lower P-level, no need to escalate to RP.
How to wean patient in ICU - ANS ✔Off all pressers and tropes? Yes - great.
Decrease P-levels x2, Q2-4hr. Assuming pt is stable, MAP >60mmHg or LVEDP with SA, continue
decreasing at this rate. Be at P-2 when ready to pull. P-1 and pull back across valve. P-0 and pull
pump and sheath as one unit. Hold pressure. Pull white cable, turn off AIC.
"Low Purge Pressure" - ANS ✔- check all connections for tightness.
- change purge cassette.
- increase dextrose concentration.
- **watch motor current.
Needed but not included for 2.5 insertion - ANS ✔D5W
diagnostic catheter
J-wire
dilators
