Intra Aortic Balloon PumpingOn-Line Program Annual Review

Special Care Manual: SP I 2.0; SP - I 2.3; SP I 2.4; SP - I 6.0

ObjectivesAt 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.

Balloon InflationBalloon inflationshould occur atthe onset of diastole.

This coronary artery perfusion and O2 delivery

Balloon DeflationBalloon deflationshould occur atthe onset of systole.

This afterload and O2 consumption.

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

Aortic pressure waveform after onset of balloon inflation and deflation (Ratio 1:2) B = Unassisted end diastolic pressureC = Unassisted Systolic pressureD = Aortic diastolic pressure (Augmentation)E = Assisted end- diastolic pressureF = Assisted systolic pressureGoal: Reduce assisted end-diastolic pressure 5-15 mmHg below unassistedGoal: Drop assisted systolic pressure, maximize augmentation, MAP

Mechanical pressure waveform related to electrical cardiac cycle (EKG)

Policy StatementsA 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.

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.

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

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