Ch. 14 IABP

Question 1

IABC

Answer 1

intra aortic balloon counterpulsation

Question 2

IABC Indications

Answer 2

• unstable angina
• acute MI
• cardiogenic shock
• with PTCA
• with catherization
• bridge to tx
• operative support

Question 3

IABC Absolute vs Relative Contraindications

Answer 3

Absolute- thoracic/ab aortic aneurysm, occluded aorta

Relative- AI, severe perph disease, disease with no end therapy

Question 4

IABC Complications

Answer 4

• limb ischemia
• thrombus
• dissection
• vasc injury
• infection
• balloon rupture
• thrombocytopenia

Question 5

IABC Preparation if not in OR

Answer 5

clean with antiseptic, locally anesthetized with lidocaine, give 5,000 units heparin

Question 6

IABC Preparation

Answer 6

1) patient received 5,000 hep
2) make sure balloon has negative pressure with 1 way valve (at the field)
3) plug in pump
4) turn on helium (check supply)
5) obtain EKG (slaving or own leads)
6) set up and prime transducer
7) connect to patient remove one way valve and connect gas line to IAB
8) ensure arterial waveform
9) purge balloon
10) start 1:2 ratio and adjust timing
11) begin 1:1

Question 7

Timing vs Trigger

Answer 7

timing- relation between IAB deflate/inflate vs heart systole/diastole
trigger= signal to inflate/deflate (EKG-best, pressure, internal rate)

Question 8

When does IAB inflate, deflate, and what are the effects

Answer 8

Inflates= at dicrotic notch (when AV closes)= incase diastole pressure, increase coronary perfusion

Deflates= just prior to systole= sudden decrease in aortic pressure (end diastolic pressure)= lower afterload (less work/O2), increase CO

Question 9

Conventional vs Real timing

Answer 9

Conventional= duration of inflation during diastole (R-R interval)- changes with arrhythmias (most common)

Real= deflation correspond to systole= uses constant intervals (doesn’t change with arrhythmias)

• pre-ejection period= delay b/w QRS and AV open
• ejection time= Ao Valve open to close

Question 10

Early vs Late Inflation

Answer 10

-Inflation at AV closure, dicrotic notch (for both timings)

Early= increase afterload, work, O2 consumption, lowers CO, early closure of AV

Late= less coronary perfusion

Question 11

Early vs Late Deflation

Answer 11

Deflation

• conventional timing= at end of diastole/isovolumetric contraction
• real timing= debates at each QRS- longer than conventional

Early= less reduction in EDP and afterload, retro grade flow into aorta
Late= heart beating against balloon= high work, O2 consumption, less CO

Question 12

Proper Placement of IAB

Answer 12

just below left subclavian and above renal arteries

Question 13

Weaning 2 Methods

Answer 13

CI > 2.2 and stop hep 4 hours prior

Method 1) Frequency Ratio Weaning**= increase ratio then stop pump

Method 2) Volume Weaning**= decease augmentation

• more physiological, but higher clot risk
• balloon volume should not <20% of total volume **