**Introduction/Hypothesis**
The Impella (Abiomed, Danvers, MA) is a temporary mechanical circulatory support device utilized for ventricular support in patients with cardiogenic shock or advanced heart failure undergoing high risk interventions. The purge cassette is a critical Impella device component preventing blood from flowing back into the motor. We present the case of a an Impella 5.5 Purge cassette tubing leak successfully corrected with use of a 20 Gauge needle at the bedside.

**Methods (e.g. case series, trial or case report)**
A 60-year-old female with longstanding dilated cardiomyopathy (left ventricular ejection fraction 15%) presented in cardiogenic shock with multi-organ dysfunction despite dual inotropic therapy (INTERMACS 2). A transaxillary Impella 5.5 was implanted via right axillary artery cutdown as a bridge to decision for durable support. Ten days post implantation, the purge casette tubing began spontaneously leaking adjacent to the Impella catheter connection site.

**Results**
It was noted that the purge tubing connection site was cracked and leaking prompting device alarms. Due to lack of an available backup purge cassette and connector cable, the leak was bypassed at the bedside via a 20 Gauge needle, successfully preserving device functionality. Ultimately, the patient was deemed not to be a candidate for advanced durable support and Impella support was weaned and the patient transferred to comfort cares.

**Conclusion**
The purge casette is a critical device component which prevents blood from flowing into the motor. Purge fluid typically is comprised of D5W with either heparin or bicarbonate, with bicarbonate potentially contributing to increased risk of component malfunction. A back-up purge cassette and tubing should be readily available in cases of possible component malfunction; if unavailable, needle repair may be a temporary solution to avoid catastrophic device failure.



A Novel Bedside Solution to an Impella Purge Cassette Leak