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Perf Tech 3 > 15. IABP- Exam 4 > Flashcards

15. IABP- Exam 4 Flashcards

1
Q

Cardiac ASSIST Device:

A

Patient must be ejecting blood (i.e. minimal CO)

-Simple/ Gas inside balloon is helium

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2
Q

where is the balloon placed

A

junction of the ascending and descending arch

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3
Q

Treatment for: Cardiogenic shock postmyocardial infarction - bridge to _____ therapies

A

reperfusion

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4
Q

Treatment for: Acute _______ / Unstable ______

A

myocardial ischemia

angina

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5
Q

Treatment for: Acute cardiac defects - bridge to ______ surgery

A

emergent

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6
Q

Treatment for: Bridge to ______

A

transplant

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7
Q

Treatment for: Perioperative support of ______ cardiac and general surgical patients

A

high-risk

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8
Q

Treatment for: Weaning from ________

A

cardiopulmonary bypass

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9
Q

Treatment for: Stabilize high-risk patient for ____, _____ and _____

A

PTCA, stent placement & angiography

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10
Q

Treatment for: Pharmacologically refractory ________

A

ventricular arrhythmias

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11
Q

what are the 6 absolute Contraindications

A
  • Thoracic or abdominal aortic aneurysm
  • Dissecting aortic aneurysm
  • Severe aortic insufficiency - regurgitation
  • Major coagulopathies
  • Underlying brain death
  • End-stage diseases: advanced or terminal neoplastic disease
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12
Q

what are the 2 relative Contraindications

A
  • Severe aortic or femoral atherosclerosis

- Symptomatic peripheral vascular disease

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13
Q

Balloon inflates from the ____ to the ____. As balloon expands, it displaces the _____ amount of blood pushing it toward the tip.

A

base to the tip

same

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14
Q

what are the 6 Intra-Aortic Balloon Insertion Sites and are they antegrade or retrograde

A 
Ascending Aorta- Antegrade  
Descending Aorta- Antegrade
Right Subclavian- Antegrade
Abdominal Aorta- Retrograde
Left Femoral- Retrograde
Right Femoral- Retrograde
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15
Q

Seldinger Technique: Step 1

A
  • Palpate the artery

- Insert 18G angiographic needle through skin/into artery

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16
Q

Seldinger Technique: Step 2

A
  • Stylet is removed from angiographic needle
  • Guide wire is inserted through need/to artery
  • Guide wire is advanced up to the descending aorta so the tip of the wire is above the bifurcation of the aorta
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17
Q

Seldinger Technique: Step 3

A
  • Angiographic needle is removed from artery
  • A dilator is placed on the guide wire and advanced into the artery
  • Dilator is removed and replaced with the sheath dilator assembly
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18
Q

Seldinger Technique: Step 4

A
  • Dilator portion of the sheath assembly is removed
  • The central lumen stylet from the balloon is removed
  • Balloon catheter is placed of the guide wire
  • Balloon catheter is advanced through the sheath to the artery and to its proper position in the descending aorta
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19
Q

is this a benefit for Surgical or Percutaneous (Femoral) Insertion? direct visualization

A

Surgical

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20
Q

is this a benefit for Surgical or Percutaneous (Femoral) Insertion? speed of insertion increases

A

Percutaneous

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21
Q

is this a benefit for Surgical or Percutaneous (Femoral) Insertion? less vessel trauma

A

Surgical

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22
Q

is this a benefit for Surgical or Percutaneous (Femoral) Insertion? less catheter kinking

A

Surgical

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23
Q

is this a benefit for Surgical or Percutaneous (Femoral) Insertion? can be performed throughout hospital

A

Percutaneous

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24
Q

is this a benefit for Surgical or Percutaneous (Femoral) Insertion? less bleeding

A

Percutaneous

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25
is this a benefit for Surgical or Percutaneous (Femoral) Insertion? IABP insertion for patients with peripheral vascular disease
Surgical
26
is this a benefit for Surgical or Percutaneous (Femoral) Insertion? descreased incidence of distal thromboembolism
Percutaneous
27
is this a benefit for Surgical or Percutaneous (Femoral) Insertion? decreased risk of infection
Percutaneous
28
is this a risk for Surgical or Percutaneous (Femoral) Insertion? bleeding
Surgical
29
is this a risk for Surgical or Percutaneous (Femoral) Insertion? lack of vessel visualization
Percutaneous
30
is this a risk for Surgical or Percutaneous (Femoral) Insertion? thromboembolism
Surgical
31
is this a risk for Surgical or Percutaneous (Femoral) Insertion? infection
Surgical
32
is this a risk for Surgical or Percutaneous (Femoral) Insertion? potential increased vessel trauma
Percutaneous
33
is this a risk for Surgical or Percutaneous (Femoral) Insertion? increased chance of thrombolembolism during removal
Percutaneous
34
is this a risk for Surgical or Percutaneous (Femoral) Insertion? increased insertion time
Surgical
35
is this a risk for Surgical or Percutaneous (Femoral) Insertion? increased chance for dissection
Percutaneous
36
is this a risk for Surgical or Percutaneous (Femoral) Insertion? requires surgical removal
Surgical
37
is this a risk for Surgical or Percutaneous (Femoral) Insertion? not applicable for patients with peripheral vascular disease
Percutaneous
38
is this a risk for Surgical or Percutaneous (Femoral) Insertion? not applicable for patients with peripheral vascular disease
Percutaneous
39
what are the 4 proper balloon positions
left subclavian 2nd intercostal space 4th intercostal space 6th intercostal space
40
name 4 Goals of Balloon Pump Treatment
Increase cardiac output Decrease myocardial work Decrease myocardial oxygen demand Decrease myocardial ischemia
41
Balloon Counterpulsation=
``` Generation of a balloon pulse that is synchronized to occur opposite the cardiac cycle. - Heart creates pulse during systole. - Balloon creates pulse during diastole. ```
42
name 2 Goals of Counterpulsation
- Inflate balloon during diastole | - Deflate balloon before ventricular ejection
43
to accomplish Counterpulsation, what is needed
a means of synchronizing balloon inflation and deflation with the appropriate part of the patient’s cardiac cycle. - - Trigger mechanism - - Timing mechanism
44
Purpose of Trigger Logic=
Synchronizes the patient’s cardiac cycle of systole and diastole with the balloon pump’s cycle of inflation and deflation.
45
Trigger Logic: Tells pump console when the patient’s heart has entered ______
systole
46
Triggering information ____ to be provided by the _____
HAS | patient
47
what are 3 Triggering Options
Electrocardiogram Pressure Internal
48
Triggering Options: Electrocardiogram=
Senses the rate at which the ECG voltage changes. Usually upstroke of R wave satisfies the criteria.
49
Triggering Options: Pressure=
Senses the rate at which the arterial blood pressure changes
50
how do you Optimize ECG Triggering
- Maximize amplitude of R wave: Do not need (or want) a diagnostic ECG - Minimize amplitude of other waves - Avoid electrical interference
51
how do you Establishing Optimal ECG Trigger
Skin preparation Use silver-silver chloride electrodes Consider lead placement
52
how do you Optimize Pressure Triggering
Prevent catheter whip | Prevent over damping of waveform
53
Purpose of Timing Logic=
Used to set the precise inflation and deflation points.
54
Timing Logic: _____ controls for setting inflation and for setting deflation
Separate
55
Timing Logic: Act as timers (_____ or _____). Affected by _____ source.
literal or % of cardiac cycle | trigger
56
Timing Logic: Set ______ point first, then set ______ point. Changing inflation point will affect ______ of deflation point
inflation deflation timing
57
Timing Logic: Proper timing can ONLY be verified by | looking at the patient’s ________
arterial waveform
58
Timing Logic: Proper timing can ONLY be verified by | looking at the patient’s ________
arterial waveform
59
Effects of Balloon Inflation: Proximal Compartment (5)
1. Increased perfusion pressure at the coronary ostia 2. Increased diastolic pressure in the aortic root 3. Coronary blood flow may increase 4. Collateral coronary circulation may open 5. Increased perfusion to head vessels
60
what % of coronary BF occurs during diastole
90%
61
Effects of Balloon Inflation: Distal Compartment (3)
1. Increased peripheral runoff 2. Increased systemic perfusion 3. Magnitude of effect depends on position of balloon tip (toward head or toward legs)
62
what are 2 Effects of Balloon Deflation
1. Rapid reduction in aortic pressure | 2. 10 to 15 mmHg decrease in pressure (afterload)
63
during Isovolumic Contraction, what % of MVO2 occurs
90%
64
what are 4 Effects of Decreased Afterload
1. Cardiac work is decreased 2. Maximum tension developed by ventricle reduced 3. Myocardial oxygen consumption is decreased 4. Balance between myocardial oxygen supply and demand may be restored
65
Myocardial oxygen balance: Demand=
contractility HR LV wall tension
66
Myocardial oxygen balance: Supply=
``` mycardial O2 uptake diastolic BP Coronary flow coronary resistance LV intramural pressure ```
67
difference btwn balloon off and on wave forms
``` ON= O2 demand is higher than supply OFF= O2 supply is higher than demand ```
68
Endocardial Viability Ratio=
Diastolic Pressure Time Index / Time Tension Index | [which equals supply/demand]
69
Trends in Hemodynamic Effects of IABP: | Ejection fraction
Increased (+/-)
70
Trends in Hemodynamic Effects of IABP: | Systolic aortic pressure
Decreased (+)
71
Trends in Hemodynamic Effects of IABP: | Diastolic aortic pressure
Increased (+ +)
72
Trends in Hemodynamic Effects of IABP: | Systolic left ventricular pressure
Decreased (+/-)
73
Trends in Hemodynamic Effects of IABP: | Diastolic left ventricular pressure
Decreased (+)
74
Trends in Hemodynamic Effects of IABP: | Peripheral vascular resistance
Decreased (+/-)
75
Trends in Hemodynamic Effects of IABP: | Cardiac output
Increased (+ +)
76
Trends in Hemodynamic Effects of IABP: | Vascular impedance
Decreased (+)
77
``` Trends in Hemodynamic Effects of IABP: Myocardial contractility (dp/dt and Vmax) ```
Decreased (+/-)
78
Trends in Hemodynamic Effects of IABP: | Left ventricular stroke work index
Increased (+)
79
Trends in Hemodynamic Effects of IABP: | Left ventricular wall tension
Decreased (+)
80
Trends in Hemodynamic Effects of IABP: | Left ventricular diastolic volume
Decreased (+)
81
Trends in Hemodynamic Effects of IABP: | Central venous pressure
Decreased (+/-)
82
Trends in Hemodynamic Effects of IABP: | Pulmonary wedge pressure
Decreased (+)
83
Trends in Hemodynamic Effects of IABP: | DPTI/TTi
Increased (+ +)
84
Trends in Hemodynamic Effects of IABP: | Right ventricular stroke work index
Decreased (+)
85
Trends in Hemodynamic Effects of IABP: | Heart rate
Decreased (+/-)
86
Trends in Hemodynamic Effects of IABP: | Heart rate
Decreased (+/-)
87
Trends in Metabolic Effects of IABP: | Coronary blood flow
Increased (+)
88
Trends in Metabolic Effects of IABP: | Renal blood flow
Increased (+/-)
89
Trends in Metabolic Effects of IABP: | Lactate production
Decreased (+)
90
Trends in Metabolic Effects of IABP: | Cerebral blood flow
Increased (+/-)
91
Trends in Metabolic Effects of IABP: | Mesenteric blood flow
Increased (+/-)
92
Trends in Metabolic Effects of IABP: | Myocardial oxygen consumption
Decreased (+)
93
Trends in Metabolic Effects of IABP: | Pulmonary blood flow
Increased (+/-)
94
Trends in Metabolic Effects of IABP: | Lactate utilization
Increased (+)
95
Trends in Metabolic Effects of IABP: | Myocardial oxygen supply
Increased (+)
96
what are 4 Signs of Proper Timing
Assisted diastolic pressure Shape of dicrotic notch Assisted end diastolic pressure Assisted systolic pressure
97
what are 2 Indications of Early Inflation
Loss of dicrotic notch | Decreased diastolic augmentation
98
what are 6 Results of Early Inflation
``` Regurgitation of blood into left ventricle Premature closure of aortic valve Decreased stroke volume Decreased cardiac output Increased preload Increased myocardial oxygen consumption ```
99
what is the Indications of Late Inflation
Widening of dicrotic notch
100
what are 2 Results of Late Inflation
Diastolic augmentation may decrease | Coronary perfusion pressure may decrease
101
what are 2 Results of Late Inflation
Diastolic augmentation may decrease | Coronary perfusion pressure may decrease
102
what are 2 Indications of Early Deflation
- Assisted end diastolic pressure will approach patient end diastolic pressure - Assisted systolic pressure may increase relative to patient peak systolic pressure
103
what are 4 Results of Early Deflation
- Little or no afterload reduction - Increased myocardial oxygen consumption - Increased preload - Retrograde coronary blood flow may occur=coronary steal
104
what are 2 Indications of Late Deflation
- Assisted end diastolic dip higher than unassisted end diastolic pressure - Assisted systolic pressure may be higher than unassisted peak systolic pressure
105
what are 6 Results of Late Deflation
``` No afterload reduction Afterload may be increased Prolongation of isovolumic contraction Increased myocardial oxygen demand Decreased stroke volume Decreased cardiac output ```
106
what are 4 Patient Factors Affecting Response
Heart rate Stroke volume Mean arterial pressure Systemic vascular resistance
107
what are 6 Balloon Factors Affecting Response
``` Balloon in sheath Balloon not unfurled Balloon position in aorta Kink in balloon catheter Balloon leak Low helium concentration ```
108
what are 4 Timing Issues
Proper timing / poor augmentation Arterial pressure monitoring site Changing heart rate Automatic / Manual timing control
109
what are 2 Timing / Triggering Issues
Electrosurgical interference | Arrhythmias
110
what are 4 Proper Timing / Poor Augmentation
Large stroke volume Inadequate balloon volume Improper balloon position Balloon too small for patient
111
you are Pumping most effective if heart rate between =?
80 & 100 bpm
112
how do you avoid Electrosurgical Interference
Place return plate directly under surgical site Placement of leads Use shielded patient cables Limit power setting to power needed
113
how do you place the leads
away from surgical site equidistant from surgical plate locate in same plane
114
Ectopic Beats=
Balloon deflates on ectopic R wave | Let system track and respond
115
what Compromises diastolic augmentation
Tachycardia (HR > 120 bpm)
116
with Tachycardia (HR > 120 bpm), the main problem is?
electromechanical delay
117
describe the electromechanical delay from tachycardia
- time it takes to physically inflate the balloon is fixed - time from trigger (line A) to the start of balloon inflation (line B) decreases as heart rate increases - problems occur when electromechanical delay is longer than the time from A to B
118
what causes a severe timing problem
Atrial Fibrillation
119
describe the timing problem from Atrial Fibrillation
Difficult to provide effective afterload reduction | -changing R-R interval makes it difficult to predict the next inflation point
120
what are 3 Additional Problems
Ventricular fibrillation Cardiac arrest Pacemaker spikes( atrial, ventricular, atrio-ventricular)
121
what are 3 Clinical Criteria for Weaning
Evidence of adequate perfusion No evidence of congestive heart failure No life threatening arrhythmias
122
describe the 3 criteria for Evidence of adequate perfusion
urine output >30 mls/hour improved mental status warm skin temperature
123
describe the 2 criteria for No evidence of congestive heart failure
rales absent | S3 absent
124
what are the 4 Hemodynamic Criteria for Weaning
Cardiac index >2.0 L/min/m2 MAP >70 mmHg (minimal pressor) PAEDP / PAWP / LAP
125
IABP Complications (9) and % occurrence
``` Inability to advance catheter 2 to 13.5% Inability or difficulty unwrapping balloon 5 to 7% Ischemic extremities 5 to 47% Thrombosis of emboli 1 to 7% Arterial perforation 2 to 6% Bleeding 3 to 5% Infection 2 to 4% Aortic dissection 1 to 3% Thrombocytopenia rare ```
126
IABP Overall Complication rate
20%
127
of all the IABP complication, what has the highest rate
Ischemic extremities 5 to 47%
128
Keep in mind…Insertion and transport (4)
Choosing balloon size Alternating trigger source and EKG source Verifying proper timing Ensuring leg remains straight
129
a balloon size of
34ml
130
a balloon size of 160-182cm = ____ml
40ml
131
a balloon size of >182 = ____ml
50ml
132
Keep in mind…Management during the case (3)
Pausing for cannulation Pausing/off for CPB Back on for weaning from CPB (Re-zero pressure/ Re-fill balloon)
133
Do not turn off unless the patient is _______
anticoagulated

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