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IABP, VAD, ICD & Pacemaker Therapies

IABP, VAD, ICD & Pacemaker Therapies. Diane E. White RN CCRN PhD. Intraortic Balloon Pump Therapy. Indications: less than 30% EF, MI, sepsis, LV failure Contraindications Theory: decrease workload by decreasing afterload, thus increasing oxygen supply and decreasing demand

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IABP, VAD, ICD & Pacemaker Therapies

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  1. IABP, VAD, ICD & Pacemaker Therapies Diane E. White RN CCRN PhD

  2. Intraortic Balloon Pump Therapy • Indications: less than 30% EF, MI, sepsis, LV failure • Contraindications • Theory: decrease workload by decreasing afterload, thus increasing oxygen supply and decreasing demand • 40cc Helium Balloon • Inserted into descending thoracic aorta

  3. IABP • Timing is Essential: EKG “R” wave is used to time deflation of balloon during onset of systole. Diacrotic notch of arterial wave form is used to time inflation of balloon during diastole. • .5-1.0 Liter increase in cardiac output • Weaning the IABP • Complications • Nursing Role

  4. Ventricular Assist Devices • Indications: PCWP > 25, MAP < 60, UO < 20 cc/hr, CI < 1.8, SVR > 2100 • History: 1935 developed IABP then in 1953 the assist device was developed. First used in animals then in late 1950’s and 1960’s used in humans

  5. VAD • Types: roller pumps, centrifugal pumps, and pneumatic devices • Operation modes: fixed rate, synchronous, fill-to-empty • Implantation: need IABP, can be used in one ventricle or both • Weaning: trial every 4 hours x 2 based on parameters

  6. VAD • Complications: bleeding, disconnection, coagubility problems, emboli • Nursing Role: homodynamics, IABP, prevent infection, labs, CT drainage, anticoagulant tx, Ventilator mgt, EKG monitoring, sedation/paralytics, & psychosocial support

  7. Pacemaker Therapy • Indications • Types: Temporary (external and tranvenous), Permanent • Controls: On/off, rate control, electrical output (ma), & sensitivity control • Modes: demand & asynchronous • Nursing Role

  8. Pacemaker Therapy • Terminology: • Capture – depolarization • Threshold – minimal energy required for capture • Sensitivity – generators ability to “sense” patient's own heart beat • Failure to capture – generate initiates pulse but no response • Failure to sense – spikes fall on/near patient’s

  9. Implantable Cardioverter Defibrillator • Indications: Cardiac arrest secondary to V-Tach, or V- Fib, spontaneous VT, syncope of undetermined origin • Procedure: implanted pectoral area, 24 hour stay • Transitional care: teaching, no lifting more than 10 lbs. for 1 month, or over the head activities, 1-2 week check-up post-op

  10. ICD • Avoid certain activities alone such as boating, swimming, etc. • Security alarms, driving, machinery, magnetic fields, cellular phone use • Psychosocial Care: fear • Call within 24 hour of shock, or repeated shock • Immediate EMS if multiple shocks and/or symptomatic

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