Placing a Mattress Suture During Explant of Impella RP® with SmartAssist® 

This Impella® skills video demonstrates how to place a mattress suture during explant of Impella RP with SmartAssist in the ICU.

1. Remove the original mattress suture.
2. Using a 0 or 2-0 silk on a CT-1 needle, place a new mattress suture approximately 1 cm lateral to the repositioning sheath and approximately 1 cm deep on both sides of the repositioning sheath. Do not tie down the new mattress suture until after pump removal.
3. Apply manual compression to control bleeding and remove the repositioning sheath and the Impella RP catheter as one long unit. It is not recommended to pull the Impella RP catheter all the way back to the repositioning sheath as this could potentially dislodge any clot on the sheath. 
4. Allow for venous bleed back of approximately 15-20 mL and hold manual compression.
5. Tighten the new mattress suture and maintain manual compression for 10-15 minutes or until hemostasis is achieved.