Intra Aortic Balloon Pumping

1. 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

2. 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.

3. Balloon Inflation Balloon inflation should occur at the onset of diastole. This ↑ coronary artery perfusion and ↑ O2 delivery

4. Balloon Deflation Balloon deflation should occur at the onset of systole. This ↓ afterload and ↓O2 consumption.

9. Aortic pressure waveform prior to balloon counterpulsation Balloon should inflate at dicrotic notch Reflects mechanical cardiac cycle.

10. Aortic pressure waveform after onset of balloon inflation and deflation (Ratio 1:2) 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

11. Mechanical pressure waveform related to electrical cardiac cycle (EKG)

14. 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 manufacturer’s guidelines.

15. 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.

16. 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

17. 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