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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
Q

is this a benefit for Surgical or Percutaneous (Femoral) Insertion? IABP insertion for patients with peripheral vascular disease

A

Surgical

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26
Q

is this a benefit for Surgical or Percutaneous (Femoral) Insertion? descreased incidence of distal thromboembolism

A

Percutaneous

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27
Q

is this a benefit for Surgical or Percutaneous (Femoral) Insertion? decreased risk of infection

A

Percutaneous

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28
Q

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

A

Surgical

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29
Q

is this a risk for Surgical or Percutaneous (Femoral) Insertion? lack of vessel visualization

A

Percutaneous

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30
Q

is this a risk for Surgical or Percutaneous (Femoral) Insertion? thromboembolism

A

Surgical

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31
Q

is this a risk for Surgical or Percutaneous (Femoral) Insertion? infection

A

Surgical

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32
Q

is this a risk for Surgical or Percutaneous (Femoral) Insertion? potential increased vessel trauma

A

Percutaneous

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33
Q

is this a risk for Surgical or Percutaneous (Femoral) Insertion? increased chance of thrombolembolism during removal

A

Percutaneous

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34
Q

is this a risk for Surgical or Percutaneous (Femoral) Insertion? increased insertion time

A

Surgical

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35
Q

is this a risk for Surgical or Percutaneous (Femoral) Insertion? increased chance for dissection

A

Percutaneous

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36
Q

is this a risk for Surgical or Percutaneous (Femoral) Insertion? requires surgical removal

A

Surgical

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37
Q

is this a risk for Surgical or Percutaneous (Femoral) Insertion? not applicable for patients with peripheral vascular disease

A

Percutaneous

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38
Q

is this a risk for Surgical or Percutaneous (Femoral) Insertion? not applicable for patients with peripheral vascular disease

A

Percutaneous

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39
Q

what are the 4 proper balloon positions

A

left subclavian
2nd intercostal space
4th intercostal space
6th intercostal space

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40
Q

name 4 Goals of Balloon Pump Treatment

A

Increase cardiac output
Decrease myocardial work
Decrease myocardial oxygen demand
Decrease myocardial ischemia

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41
Q

Balloon Counterpulsation=

A 
Generation of a balloon pulse that is
synchronized to occur opposite the
cardiac cycle.
- Heart creates pulse during systole.
- Balloon creates pulse during diastole.
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42
Q

name 2 Goals of Counterpulsation

A
  • Inflate balloon during diastole

- Deflate balloon before ventricular ejection

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43
Q

to accomplish Counterpulsation, what is needed

A

a means of synchronizing balloon inflation and deflation with the appropriate part of the patient’s cardiac cycle.

    • Trigger mechanism
    • Timing mechanism
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44
Q

Purpose of Trigger Logic=

A

Synchronizes the patient’s cardiac cycle of systole and diastole with the balloon pump’s cycle of inflation and
deflation.

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45
Q

Trigger Logic: Tells pump console when the patient’s heart has entered ______

A

systole

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46
Q

Triggering information ____ to be provided by the _____

A

HAS

patient

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47
Q

what are 3 Triggering Options

A

Electrocardiogram
Pressure
Internal

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48
Q

Triggering Options: Electrocardiogram=

A

Senses the rate at which the ECG voltage changes. Usually upstroke of R wave satisfies the criteria.

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49
Q

Triggering Options: Pressure=

A

Senses the rate at which the arterial blood pressure changes

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50
Q

how do you Optimize ECG Triggering

A
  • Maximize amplitude of R wave: Do not need (or want) a diagnostic ECG
  • Minimize amplitude of other waves
  • Avoid electrical interference
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51
Q

how do you Establishing Optimal ECG Trigger

A

Skin preparation
Use silver-silver chloride electrodes
Consider lead placement

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52
Q

how do you Optimize Pressure Triggering

A

Prevent catheter whip

Prevent over damping of waveform

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53
Q

Purpose of Timing Logic=

A

Used to set the precise inflation and deflation points.

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54
Q

Timing Logic: _____ controls for setting inflation and for setting deflation

55
Q

Timing Logic: Act as timers (_____ or _____). Affected by _____ source.

A

literal or % of cardiac cycle

trigger

56
Q

Timing Logic: Set ______ point first, then set ______
point. Changing inflation point will affect ______ of
deflation point

A

inflation
deflation
timing

57
Q

Timing Logic: Proper timing can ONLY be verified by

looking at the patient’s ________

A

arterial waveform

58
Q

Timing Logic: Proper timing can ONLY be verified by

looking at the patient’s ________

A

arterial waveform

59
Q

Effects of Balloon Inflation: Proximal Compartment (5)

A
  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
Q

what % of coronary BF occurs during diastole

61
Q

Effects of Balloon Inflation: Distal Compartment (3)

A
  1. Increased peripheral runoff
  2. Increased systemic perfusion
  3. Magnitude of effect depends on position of balloon tip (toward head or toward legs)
62
Q

what are 2 Effects of Balloon Deflation

A
  1. Rapid reduction in aortic pressure

2. 10 to 15 mmHg decrease in pressure (afterload)

63
Q

during Isovolumic Contraction, what % of MVO2 occurs

64
Q

what are 4 Effects of Decreased Afterload

A
  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
Q

Myocardial oxygen balance: Demand=

A

contractility
HR
LV wall tension

66
Q

Myocardial oxygen balance: Supply=

A 
mycardial O2 uptake
diastolic BP
Coronary flow
coronary resistance
LV intramural pressure
67
Q

difference btwn balloon off and on wave forms

A 
ON= O2 demand is higher than supply
OFF= O2 supply is higher than demand
68
Q

Endocardial Viability Ratio=

A

Diastolic Pressure Time Index / Time Tension Index

[which equals supply/demand]

69
Q

Trends in Hemodynamic Effects of IABP:

Ejection fraction

A

Increased (+/-)

70
Q

Trends in Hemodynamic Effects of IABP:

Systolic aortic pressure

A

Decreased (+)

71
Q

Trends in Hemodynamic Effects of IABP:

Diastolic aortic pressure

A

Increased (+ +)

72
Q

Trends in Hemodynamic Effects of IABP:

Systolic left ventricular pressure

A

Decreased (+/-)

73
Q

Trends in Hemodynamic Effects of IABP:

Diastolic left ventricular pressure

A

Decreased (+)

74
Q

Trends in Hemodynamic Effects of IABP:

Peripheral vascular resistance

A

Decreased (+/-)

75
Q

Trends in Hemodynamic Effects of IABP:

Cardiac output

A

Increased (+ +)

76
Q

Trends in Hemodynamic Effects of IABP:

Vascular impedance

A

Decreased (+)

77
Q 
Trends in Hemodynamic Effects of IABP:
Myocardial contractility (dp/dt and Vmax)
A

Decreased (+/-)

78
Q

Trends in Hemodynamic Effects of IABP:

Left ventricular stroke work index

A

Increased (+)

79
Q

Trends in Hemodynamic Effects of IABP:

Left ventricular wall tension

A

Decreased (+)

80
Q

Trends in Hemodynamic Effects of IABP:

Left ventricular diastolic volume

A

Decreased (+)

81
Q

Trends in Hemodynamic Effects of IABP:

Central venous pressure

A

Decreased (+/-)

82
Q

Trends in Hemodynamic Effects of IABP:

Pulmonary wedge pressure

A

Decreased (+)

83
Q

Trends in Hemodynamic Effects of IABP:

DPTI/TTi

A

Increased (+ +)

84
Q

Trends in Hemodynamic Effects of IABP:

Right ventricular stroke work index

A

Decreased (+)

85
Q

Trends in Hemodynamic Effects of IABP:

Heart rate

A

Decreased (+/-)

86
Q

Trends in Hemodynamic Effects of IABP:

Heart rate

A

Decreased (+/-)

87
Q

Trends in Metabolic Effects of IABP:

Coronary blood flow

A

Increased (+)

88
Q

Trends in Metabolic Effects of IABP:

Renal blood flow

A

Increased (+/-)

89
Q

Trends in Metabolic Effects of IABP:

Lactate production

A

Decreased (+)

90
Q

Trends in Metabolic Effects of IABP:

Cerebral blood flow

A

Increased (+/-)

91
Q

Trends in Metabolic Effects of IABP:

Mesenteric blood flow

A

Increased (+/-)

92
Q

Trends in Metabolic Effects of IABP:

Myocardial oxygen consumption

A

Decreased (+)

93
Q

Trends in Metabolic Effects of IABP:

Pulmonary blood flow

A

Increased (+/-)

94
Q

Trends in Metabolic Effects of IABP:

Lactate utilization

A

Increased (+)

95
Q

Trends in Metabolic Effects of IABP:

Myocardial oxygen supply

A

Increased (+)

96
Q

what are 4 Signs of Proper Timing

A

Assisted diastolic pressure
Shape of dicrotic notch
Assisted end diastolic pressure
Assisted systolic pressure

97
Q

what are 2 Indications of Early Inflation

A

Loss of dicrotic notch

Decreased diastolic augmentation

98
Q

what are 6 Results of Early Inflation

A 
Regurgitation of blood into left ventricle
Premature closure of aortic valve
Decreased stroke volume
Decreased cardiac output
Increased preload
Increased myocardial oxygen consumption
99
Q

what is the Indications of Late Inflation

A

Widening of dicrotic notch

100
Q

what are 2 Results of Late Inflation

A

Diastolic augmentation may decrease

Coronary perfusion pressure may decrease

101
Q

what are 2 Results of Late Inflation

A

Diastolic augmentation may decrease

Coronary perfusion pressure may decrease

102
Q

what are 2 Indications of Early Deflation

A
  • Assisted end diastolic pressure will approach patient end diastolic pressure
  • Assisted systolic pressure may increase relative to patient peak systolic pressure
103
Q

what are 4 Results of Early Deflation

A
  • Little or no afterload reduction
  • Increased myocardial oxygen consumption
  • Increased preload
  • Retrograde coronary blood flow may occur=coronary steal
104
Q

what are 2 Indications of Late Deflation

A
  • Assisted end diastolic dip higher than unassisted end diastolic pressure
  • Assisted systolic pressure may be higher than unassisted peak systolic pressure
105
Q

what are 6 Results of Late Deflation

A 
No afterload reduction
Afterload may be increased
Prolongation of isovolumic contraction
Increased myocardial oxygen demand
Decreased stroke volume
Decreased cardiac output
106
Q

what are 4 Patient Factors Affecting Response

A

Heart rate
Stroke volume
Mean arterial pressure
Systemic vascular resistance

107
Q

what are 6 Balloon Factors Affecting Response

A 
Balloon in sheath
Balloon not unfurled
Balloon position in aorta
Kink in balloon catheter
Balloon leak
Low helium concentration
108
Q

what are 4 Timing Issues

A

Proper timing / poor augmentation
Arterial pressure monitoring site
Changing heart rate
Automatic / Manual timing control

109
Q

what are 2 Timing / Triggering Issues

A

Electrosurgical interference

Arrhythmias

110
Q

what are 4 Proper Timing / Poor Augmentation

A

Large stroke volume
Inadequate balloon volume
Improper balloon position
Balloon too small for patient

111
Q

you are Pumping most effective if heart rate between =?

A

80 & 100 bpm

112
Q

how do you avoid Electrosurgical Interference

A

Place return plate directly under surgical site
Placement of leads
Use shielded patient cables
Limit power setting to power needed

113
Q

how do you place the leads

A

away from surgical site
equidistant from surgical plate
locate in same plane

114
Q

Ectopic Beats=

A

Balloon deflates on ectopic R wave

Let system track and respond

115
Q

what Compromises diastolic augmentation

A

Tachycardia (HR > 120 bpm)

116
Q

with Tachycardia (HR > 120 bpm), the main problem is?

A

electromechanical delay

117
Q

describe the electromechanical delay from tachycardia

A
  • 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
Q

what causes a severe timing problem

A

Atrial Fibrillation

119
Q

describe the timing problem from Atrial Fibrillation

A

Difficult to provide effective afterload reduction

-changing R-R interval makes it difficult to predict the next inflation point

120
Q

what are 3 Additional Problems

A

Ventricular fibrillation
Cardiac arrest
Pacemaker spikes( atrial, ventricular, atrio-ventricular)

121
Q

what are 3 Clinical Criteria for Weaning

A

Evidence of adequate perfusion
No evidence of congestive heart failure
No life threatening arrhythmias

122
Q

describe the 3 criteria for Evidence of adequate perfusion

A

urine output >30 mls/hour
improved mental status
warm skin temperature

123
Q

describe the 2 criteria for No evidence of congestive heart failure

A

rales absent

S3 absent

124
Q

what are the 4 Hemodynamic Criteria for Weaning

A

Cardiac index >2.0 L/min/m2
MAP >70 mmHg (minimal pressor)
PAEDP / PAWP / LAP

125
Q

IABP Complications (9) and % occurrence

A 
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
Q

IABP Overall Complication rate

127
Q

of all the IABP complication, what has the highest rate

A

Ischemic extremities 5 to 47%

128
Q

Keep in mind…Insertion and transport (4)

A

Choosing balloon size
Alternating trigger source and EKG source
Verifying proper timing
Ensuring leg remains straight

129
Q

a balloon size of

130
Q

a balloon size of 160-182cm = ____ml

131
Q

a balloon size of >182 = ____ml

132
Q

Keep in mind…Management during the case (3)

A

Pausing for cannulation
Pausing/off for CPB
Back on for weaning from CPB (Re-zero pressure/ Re-fill balloon)

133
Q

Do not turn off unless the patient is _______

A

anticoagulated

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