IABP 2 Flashcards
Signs of Proper timing
Assisted diastolic pressure
Shape of dicrotic notch
Assisted end diastolic pressure
Assisted systolic pressure
Indications of Early Inflation
Loss of dicrotic notch
Decreased diastolic augmentation
Results of early inflation ? (6)
Regurgitation of blood into left ventricle Premature closure of aortic valve Decreased stroke volume Decreased cardiac output Increased preload Increased myocardial oxygen consumption
Indications of Late inflation ?
Widening of dicrotic notch
Results of Late Inflation (2)
Diastolic augmentation may decrease
Coronary perfusion pressure may decrease
Indications of Early Deflation?
Assisted end diastolic pressure will approach pt end diastolic pressure
Assisted systolic pressure may increase relative to pt peak systolic pressure
Results of Early Deflation ? (4)
Little or no afterload reduction Increased myocardial oxygen consumption Increased preload Retrograde coronary blood flow may occur coronary steal
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
Results of Late Deflation (6)?
No afterload reduction Afterload may be increased Prolongation of isovolumic contraction Increased myocardial oxygen demand Decreased stroke volume Decreased cardiac output
Pt Factors Affecting Response? (4)
Heart rate
Stroke volume
Mean arterial pressure
Systemic vascular resistance
Balloon Factors Affecting Response ? (6)
Balloon in sheath Balloon not unfurled Balloon position in aorta Kink in balloon catheter Balloon leak Low helium concentration
Timing Issues? (4)
Proper timing / poor augmentation
Arterial pressure monitoring site
Changing heart rate
Automatic / Manual timing control
Timing and Trigger Issues?
Electrosurgical interference
Arrhythmias
Proper Timing/ Poor Augmentation ?
Large stroke volume
Inadequate balloon volume
Improper balloon position
Balloon too small for patient
What HR is Balloon pumping most effective?
Pumping most effective if heart rate
between 80 & 100 bpm
Electrosurgical Interference ?
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
What kind of cables to use for ECG ?
Use shielded patient cables
Ectopic Beats what does the balloon do?
Balloon deflates on ectopic R wave
Let system track and respond
What happens during Tachycardia ?
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
What happens to balloon with atrial fib?
- -Severe timing problem
- -Difficult to provide effective afterload reduction
- -changing R-R interval makes it difficult to predict the next inflation point
Addtional problems that can come along with balloon pumps?
Ventricular fibrillation Cardiac arrest Pacemaker spikes --atrial --ventricular --atrio-ventricular
Evidence of adequate perfusion for weaning?
urine output >30 mls/hour
improved mental status
warm skin temperature
No evidence of congestive heart failure for weaning?
rales absent
S3 absent
Criteria for weaning?
Evidence of adequate perfusion
No evidence of congestive heart failure
No life threatening arrhythmias
Hemodynamic Criteria for weaning? (4)
HR/MAP/CI
Cardiac index >2.0 L/min/m2
HR less than 110
MAP >70 mmHg (minimal pressor)
LAP PAEDP PWAP less than 18
> 160 cm
34cc
160-182cm = cc’s?
40cc
> 182cm = cc’s
50cc
IABP Complications?
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
Keep in mind – Management during the case?
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
Keep in mind during insertion and transport of IABP?
Choosing balloon size
Alternating trigger source and EKG source
Verifying proper timing
Ensuring leg remains straight
