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Perf Tech Final !!!!! > IABP 2 > Flashcards

IABP 2 Flashcards

1
Q

Signs of Proper timing

A

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

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2
Q

Indications of Early Inflation

A

Loss of dicrotic notch

Decreased diastolic augmentation

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3
Q

Results of early inflation ? (6)

A 
Regurgitation of blood into left ventricle
Premature closure of aortic valve
Decreased stroke volume
Decreased cardiac output
Increased preload
Increased myocardial oxygen consumption
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4
Q

Indications of Late inflation ?

A

Widening of dicrotic notch

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5
Q

Results of Late Inflation (2)

A

Diastolic augmentation may decrease

Coronary perfusion pressure may decrease

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6
Q

Indications of Early Deflation?

A

Assisted end diastolic pressure will approach pt end diastolic pressure
Assisted systolic pressure may increase relative to pt peak systolic pressure

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7
Q

Results of Early Deflation ? (4)

A 
Little or no afterload reduction
Increased myocardial oxygen consumption
Increased preload
Retrograde coronary blood flow may occur
coronary steal
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8
Q

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

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9
Q

Results of Late Deflation (6)?

A 
No afterload reduction
Afterload may be increased
Prolongation of isovolumic contraction
Increased myocardial oxygen demand
Decreased stroke volume
Decreased cardiac output
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10
Q

Pt Factors Affecting Response? (4)

A

Heart rate
Stroke volume
Mean arterial pressure
Systemic vascular resistance

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11
Q

Balloon Factors Affecting Response ? (6)

A 
Balloon in sheath
Balloon not unfurled
Balloon position in aorta
Kink in balloon catheter
Balloon leak
Low helium concentration
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12
Q

Timing Issues? (4)

A

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

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13
Q

Timing and Trigger Issues?

A

Electrosurgical interference

Arrhythmias

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14
Q

Proper Timing/ Poor Augmentation ?

A

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

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15
Q

What HR is Balloon pumping most effective?

A

Pumping most effective if heart rate

between 80 & 100 bpm

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16
Q

Electrosurgical Interference ?

A

Place return plate directly under surgical site
Placement of leads away from surgical site equidistant from surgical plate
locate in same plane
Use shielded patient cables
Limit power setting to power needed

17
Q

What kind of cables to use for ECG ?

A

Use shielded patient cables

18
Q

Ectopic Beats what does the balloon do?

A

Balloon deflates on ectopic R wave

Let system track and respond

19
Q

What happens during Tachycardia ?

A

Compromises diastolic augmentation
Major problem is electromechanical delay
—-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 HR increases
—problems occur when electromechanical delay is longer than the time from A to B

20
Q

What happens to balloon with atrial fib?

A
  • -Severe timing problem
  • -Difficult to provide effective afterload reduction
    - -changing R-R interval makes it difficult to predict the next inflation point
21
Q

Addtional problems that can come along with balloon pumps?

A 
Ventricular fibrillation
Cardiac arrest
Pacemaker spikes
--atrial
--ventricular
--atrio-ventricular
22
Q

Evidence of adequate perfusion for weaning?

A

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

23
Q

No evidence of congestive heart failure for weaning?

A

rales absent

S3 absent

24
Q

Criteria for weaning?

A

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

25
Q

Hemodynamic Criteria for weaning? (4)

HR/MAP/CI

A

Cardiac index >2.0 L/min/m2
HR less than 110
MAP >70 mmHg (minimal pressor)
LAP PAEDP PWAP less than 18

26
Q

> 160 cm

A

34cc

27
Q

160-182cm = cc’s?

A

40cc

28
Q

> 182cm = cc’s

A

50cc

29
Q

IABP Complications?

A 
Inability to advance catheter  2 to 13.5%
Inability or difficulty unwrapping balloon5 to 7%
Ischemic extremities  5 to 47%
Thrombosis of emboli  1 to 7%
Arterial perforation  2 to 6%
Bleeding  3 to 5%
Infection 2-4%
Aortic dissection 1-3%
Thrombocytopenia rare
30
Q

Keep in mind – Management during the case?

A 
Pausing for cannulation
Pausing/off for CPB
Back on for weaning from CPB
Re-zero pressure
Re-fill balloon
**Do not turn off unless the patient is anticoagulated
31
Q

Keep in mind during insertion and transport of IABP?

A

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

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