Intra Aortic Balloon Pumping

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Intra Aortic Balloon Pumping

• On-Line Program Annual Review

Special Care Manual SP I 2.0 SP - I 2.3
SP I 2.4 SP - I 6.0
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Objectives

• At the end of the program, the learner will be
  able to
• List steps to initiate intra aortic balloon pump
  therapy using the AutoCAT2 Series IAB pump.
• Describe the aortic (arterial) pressure waveform.
• Identify assisted, unassisted and diastolic
  agumentation pressures on the IAB waveform.
• Recognize alarms and alerts and describe their
  causes.

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Balloon Inflation
Balloon inflation should occur at the onset of
diastole. This ? coronary artery perfusion
and ? O2 delivery
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Balloon Deflation
Balloon deflation should occur at the onset of
systole. This ? afterload and ? O2
consumption.
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Aortic pressure waveform prior to balloon
counterpulsation
Balloon should inflate at dicrotic notch
Reflects mechanical cardiac cycle.
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Aortic pressure waveform after onset of balloon
inflation and deflation (Ratio 12)
Goal Reduce assisted end-diastolic pressure
5-15 mmHg below unassisted
B Unassisted end diastolic
pressure C Unassisted Systolic
pressure D Aortic diastolic pressure
(Augmentation) E Assisted end-
diastolic pressure F Assisted
systolic pressure
Goal Drop assisted systolic pressure, maximize
augmentation, ? MAP
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Mechanical pressure waveform related to
electrical cardiac cycle (EKG)
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Policy Statements

• A written order for IABP therapy and informed
  consent must appear on the chart. Order must
  include frequency and volume of balloon.
• An IAB is only inserted by a physician
  credentialed to do the procedure.
• An IAB is only inserted in the CCU (N S),
  radiology department, cardiac cath lab, CTU, or
  ICU (S).
• Defibrillator and emergency drugs must be
  available at all times.
• An arterial line must be placed for proper
  waveform identification. (If fiberoptic catheter
  not in use.) The aortic arterial line may be
  used.
• Operational checkout of the console should be
  performed weekly according to manufacturers
  guidelines.

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Nursing Care (SP-I-6.0)

• Establish baseline assessment of breath sounds,
  Sa02, LOC, urine output, vital signs, peripheral
  pulses, and cardiac rhythm.
• Assess circulation of lower extremities and
  condition of insertion site q15 minutes x 1 hour,
  then hourly.
• Continuously monitor aortic pressure waveform and
  ECG rhythm. Document tracings every shift.
• Monitor and document assisted systolic, assisted
  end-diastolic, augmented diastolic and mean
  arterial pressure q 1h on Critical Care Patient
  Flowsheet or CTU Flowsheet. (This may be done by
  use of a monitor strip.)
• Unless otherwise ordered, maintain autopilot
  timing mode.
• Autopilot will automatically select best
  trigger.
• Prevent angulation of catheter
• -Do not flex affected leg at groin or
  knee use knee immobilizer as needed.
• -Elevate head-of-bed not more than 30
  degrees maintain bedrest with logrolling.
• Maintain systemic anticoagulation. Monitor PTT,
  CBC platelet count every 12 hours.

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Nursing Care (continued)

• Promote education and address psychosocial needs
• Establish and document a baseline neurovascular
  status of both lower extremities including
  presence and quality of pulses. Note
  sensitivity, color, warmth, mobility and degree
  of capillary refill.
• Monitor arterial dopplers as ordered. Document
  and notify physician of diminished findings.
• Monitor and document urinary output hourly.
  Notify physician of any significant drop in
  output.
• Monitor IAB site for evidence of bleeding,
  hematoma formation or infection.
• Monitor, document and notify physician of any
  evidence of myocardial ischemia. Obtain daily
  EKGs while the IABP device is in place.
• Promote physical comfort
• a) administer analgesics and
  sedatives as needed
• b) position for comfort turn if
  stable

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This completes IABP review Please return to
class page and complete post-test.
For further information, view video at
http//www.arrowintl.com/products/videos/ATC2-CD/
ATC2-CD_All.asp