The Internet belongs to everyone. Let’s keep it that way.

Protect Net Neutrality
Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

IABP

No description
by

Kori Martinez

on 18 April 2017

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of IABP

Deflation
Occurs at the start of Systole
Removes volume from the aorta reducing aortic pressure
Reduces afterload (resistance) which improves stroke volume
reduces myocardial consumptions
Reduces preload
Kori Martinez RN, CCRN, CFRN
April 2015

Objectives
Myocardial Supply VS Demand
Transport Considerations
Describe the Cardiac Cycle and myocardial supply vs demand
List indications for IABP
Recognize the contraindications and necessities of transport
Recognize potential side effects and/or complications related to the IABP
Review appropriate timing errors and troubleshooting
What is the Intra Aortic Balloon Pump?
IABP INDICATIONS
•Support for High Risk PTCA or Failed PTCA
•Cardiogenic Shock
•Support for High Risk CABG
•Failure to wean from CBP
•Unstable / Refractory Angina
•Refractory LV Failure
•Mechanical Complications of AMI
•Intractable Ventricular Arrhythmias
•Support for High Risk Surgery
•Decompensated Systolic Heart Failure (bridge)
Synchronized Counter pulsation Therapy
Balloon is situated in the descended aorta
Inflation
Occurs during Diastole
Proximal and distal displacement of blood
Increases Coronary blood flow
Improves blood flow to the coeliac, renal and mesenteric vessels
The Cardiac Cycle
CO= HR X SV
STROKE VOLUME
PRELOAD
CONTRACTILITY
AFTERLOAD
Preload refers to the amount of stretch on the ventricular myocardium prior to contraction.

"Filling Pressure"

CVP 2-6mmHg
The resistance of the ventricle during ejection

SVR 900-1200 dyne*sec/cm5
The ability of the myocardium to contract
CONTRAINDICATIONS
Aortic Regurgitation
Aortic Dissection
Aortic Stent
Chronic End-Stage Heart Disease
AAA
Severe Peripheral Vascular Disease
Inflation and Deflation
TIMING and TRIGGERS
IABP FREQUENCY
2002
2007
2012
1997
TRIGGERS
TRIGGERS
EKG
Pattern
Peak
Afib
AP
Pacer
Internal
TIMING
Rules for Timing
Indication for the IABP and reason for Transport (MI)
Type of IABP
Arrow Vs Datascope
Patient status
stability, vital signs, respiratory distress, vasoactive medications
Verify that the ground ambulance has an inverter
Make sure you have ALL the proper equipment
Report and Preparation
Call for report
Type of IABP
Mode
Trigger
Frequency
Augmentation
Insertion site and condition
Most patients will be on a heparin drip
A transport bag should accompany all IABP transports with auxiliary supplies.
Check your helium and assure you have a back up tank
Must have a 60cc syringe for emergencies
Get securing device and straps for aircraft
Arrival at the Facility
Obtain a strip from the transferring facility
Turn on the IABP and match patients current settings
Open Helium tank by turning left and check for adequate level
Attach IABP leads and use tape to secure leads to prevent displacement
Find appropriate pressure cable and attach to transport IABP and pressure bag. Proceed to zero the A-line
Place facilities IABP on STANDBY and place helium tubing on transport IABP. (hold for 2 seconds)
Fill Balloon (hold for 2 seconds)
Press START
Assess augmentation and vital signs. Look at your patient!!!
Do not turn off facility IABP unless transport IABP is functioning properly
Continue to reassess the Patient and measurement of the catheter
Transport Care
Augmented diastolic pressure > Unassisted systolic pressure
Assisted systolic pressure < Unassisted systolic pressure
Assisted End diastolic pressure< Unassisted end diastolic pressure
Assess and reassess your patient
Load the Patient head first into the aircraft but a keep an eye on the vital signs during take off due to increased preload.
Balloon will purge on ascent due to Boyle's Law and gas expansion with increasing altitude. Balloon will purge again on descent due to gas contraction with decreasing altitude.
When loading and unloading the IABP, make sure there is NO TENSION on the catheter to prevent dislodgement
Bedrest and Logroll
HOB never more than 30degrees
Do not allow patient to flex knee
Keep the IABP plugged in at ALL times possible
30min when low battery light comes on
New fully charged battery provides 135 mins of portable operations
GOOD COMMUNICATION is a MUST!!!!
Possible Complications
Documentation
Document q 5-15min
Vital signs
IABP settings
Site condition
Neurovascular checks
Pulses
Narrative
Document and assess waveform and timing in a 1:2 frequency
At the facility, in transport, and at the accepting facility
With any changes in the patients vital signs or status
With changes in augmentation
EMERGENCY SITUATION
A-fib: R wave deflate
Cardiac arrest
Pull out EKG cable and start CPR
Pump failure/catheter displacement
Place pump on STANDBY
Use 60cc syringe and inflate/deflate balloon Q 3-5min
50-100mL/beat
INFLATION – Just prior to the dicrotic notch
Find the dicrotic notch on the assisted systole waveform
Draw a horizontal line across the strip
Look at the balloon inflation preceding the assisted systole
The balloon should inflate on this line
Inflation assessment
The IABP will be inflating above the horizontal line
Early Inflation
DEFLATION
Find the ST segment on the rhythm strip
One baby box from the J point
Draw a vertical line down from the rhythm strip to the IABP waveform
The balloon should deflate at this line
Deflation Assessment
Late deflation
Early deflation
Diacritic notch exposed. A “gap” between the dicrotic notch and IABP inflation: No sharp V.
Late Inflation
Semi-Auto or Manual Modes
ECG detected
ECG activity exist while in internal trigger
Irregular Press trigger
Deflation late or arrhythmias
Verify Proper Timing
Auto Mode
Maintenance required
Maintenance required
Poor signal quality
Both ECG and pressure signals poor – in ECG trigger
Unable to update timing
Waveform quality poor
All Modes
Augmentation below limit set
AD has dropped: Check patient
Low helium
40He below 24-fill reserve
Low battery
< 30 min operating time
Maintenance required Code#
System maintenance may be required
Prolonged time in standby
Standby for at least 10 min
ALERTS
CATHETER ALARMS
Battery in use
System test ok
R-Wave deflat
Function unavailable in AUTO operation mode
Slow gas loss alarm is off
Auto R-Wave deflate
R-Trac (in IABP deflation indicator
IAB not filled
Manual fill IAB
Autofilling
Verify proper timing
Leak testing safety disk
Gas loss and catheter alarms disabled
Automatic operation mode is disabled
STATUS / PROMPTS
Troubleshooting
Semi-Auto or Manual Mode
No Trigger
Valid trigger does not exist or is lost
No Pressure Trigger
Valid pressure trigger does not exist or is lost
Check Pacer Timing
Pt not 100% paced, trigger interval varies or AV pacer rate > 125 bpm
Trigger Interference
Electrical interference while in pacer trigger source
Auto Mode
No Trigger
Valid ECG and arterial pressure do not exist or are lost
Poor Signal Persists
Both ECG and arterial pressure signal quality have been poor for a sustained period
TRIGGER ALARMS
Intra Aortic Balloon Pump
Once the IABP is turned on, the PV loop indicates lower pressure and increased stroke volume. Simply turning the pump on increases cardiac output as much as 18%-22% within just 3 beats when accurately timed. This direct patient benefit is evident in the PV loop shown here.
30cc Balloon- White: 4'10"-5'4"
40cc Balloon- Blue: 5'4"-6'0"
50cc Baloon- Orange: >6'0"
Full transcript