IABP 1 Flashcards
Cardiac ASSIST Device: meaning what??
Patient must be ejecting blood (i.e. minimal cardiac output)
Balloon Pump is treatment for what?
- –Cardiogenic shock postmyocardial infarction -bridge to reperfusion therapies
- –Acute myocardial ischemia / Unstable angina
- –Acute cardiac defects -bridge to emergent surgery
- –Bridge to transplant
- –Perioperative support of high-risk cardiac and general surgical patients
- –Weaning from cardiopulmonary bypass
- –Stabilize high-risk patient for PTCA, stent placement & angiography
- –Pharmacologically refractory ventricular arrhythmias
Absolute balloon pump contraindications? 6
- -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
Relative Balloon pump contraindications? (2)
Severe aortic or femoral atherosclerosis
Symptomatic peripheral vascular disease
How does balloon inflate ?
Balloon inflates from the base to the tip. As balloon expands, it displaces the same amount of blood pushing it toward the tip
Seldinger Technique: Step 1
After palpating the artery, the physician inserts and 18 gauge angiographic needle through the skin and into the artery
Seldinger Technique: Step 2
The physician removes the stylet from the angiographic needle, and inserts the guide wire through the needle and into the artery. The guide-wire is inserted up into the descending aorta so the tip of the wore is above the bifurcation of the aorta
Seldinger Technique: Step 3
Physician removes the angiographic needle from the artery and then placing a dilator on the guide wire, advances the dilator into the artery. The dilator is removed and advanced with a sheath-dilator assembly
Seldinger Technique: Step 4
the dilator portion of the dilator-sheath assembly is removed. The physician removed the central lumen stylet from the balloon, places the balloon catheter over the guide wire, than advances the balloon catheter through the sheath and into the artery. The balloon is then advanced into its proper position w/in the descending aorta
Surgical benefits (vs percutaneous cannulation)
direct visualization
less vessel trauma
less catheter kinking
IABP insertion for pts with peripheral vascular disease
Surgical Risks (vs percutaneous cannulation)
bleeding infection thromboembolism increased insertion time requires surgical removal
Percutaneous Benefits (vs surgical)
speed of insertion increases
can be preformed throughout the hospital
less bleeding
decreased incidence of distal thromboembolism
decreased risk of infection
Percutaneous Risks (vs surgical)
lack of vessel visualization
potential increased vessel trauma
increased risk of thromboembolism during removal
increased chance for dissection
not applicable for pt with peripheral vascular disease
Goals of Balloon Pump Treatment (4)
Increase cardiac output
Decrease myocardial work
Decrease myocardial oxygen demand
Decrease myocardial ischemia
Balloon Counterpulsation (when is the pulse?)
Generation of a balloon pulse that is synchronized to occur opposite the cardiac cycle.
Heart creates pulse during systole.
Balloon creates pulse during diastole
Goal of Counterpulsation ?
Inflate balloon during diastole
Deflate balloon before ventricular ejection
How to accomplish counterpulsation?
To accomplish this, we need a means of synchronizing balloon inflation and deflation with the appropriate part of the patient’s cardiac cycle.
- -Trigger mechanism
- -Timing mechanism
Purpose of Trigger Logic
Synchronizes the patient’s cardiac cycle of systole and diastole with the balloon pump’s cycle of inflation and deflation
Trigger Logic
what has to be there?
—Tells pump console when the pt’s heart has entered systole
Provides starting point for timing logic
Provides mechanism to ensure that balloon
will not be inflated during systole
—Triggering information HAS to be provided by the pt
Triggering Options (3)?
—Electrocardiogram (Senses the rate at which the ECG voltage changes. Usually upstroke of R wave satisfies the criteria.)
What if the patient has a pacemaker???
pacer A
pacer V/A-V
—Pressure (Senses the rate at which the arterial blood pressure changes.)
—Internal
Optimize ECG triggering
Maximize amplitude of R wave
Do not need (or want) a diagnostic ECG
Minimize amplitude of other waves
Avoid electrical interference
How to Establish Optimal ECG Trigger? (3)
Skin preparation
Use silver-silver chloride electrodes
Consider lead placement
