IABP Flashcards
Tip of balloon placement
Just distal to L Subclavian
Balloon inflation events
During diastole, blood shot down aorta. Shot backwards towards closed aorta valve, into coronary arteries, head and arms.
Balloon deflation events
During systole, provides empty potential in aorta, heart does not fight afterload, negative pressure can suck blood out of heart.
West zones 1, 2, 3
- More air in lung than blood, over inflation, under perfused (usually in apexes)
- 50/50 matchup
- More perfusion than air
X-Ray & IABP
Tip of balloon pump should be in 2nd or 3rd intercostal space & 2 cm below aortic arch
IABP contraindications
- aortic valve insufficiency (if valve will not close, blood will overload LV)
- Severe aortic disease
- Severe peripheral vascular disease
IABP complications
- limb ischemia (#1 complication)
- Aortic dissection
- thrombocytopenia
- infection / septicemia
- renal complications
- gas emboli - rare
Early inflation
- Inflation before aortic valve closure
- inflation during systole
- acts as a cork in aorta
- causes reflux of blood in LV
- decreases cardiac output & increases SVR
- very harmful to pt (immediate intervention needed)
Late inflation
- late phase diastole inflation
- results in sub-optimal augmentation
- minimal displacement of blood back toward coronary arteries
Early deflation
Vacuum effect and afterload reduction is lost
- pressures decrease in aorta while aortic valve still closed.
- by the time aortic valve opens, aortic pressures have equalized.
- not harmful, but does not help situation.
Late deflation
Balloon still inflated during beginning of ventricular systole..
Most harmful. Increases LV workload
-pressures are extremely high when balloon deflates (can lead to ruptures in brain and coronaries)
Proper timing waveform will exhibit
- Nice sharp V where balloon pump kicks in, level with dicrotic notch.
- IABP deflation should show a nice uniform U shape blends nicely into beginning of next arterial waveform.
Which is safer? Inward or outward waveform adjustment.
Safer to move inward
outward:
- inflation: early inflation (harmful)
- deflation: late deflation (most harmful)
Inward:
- inflation: late deflation (not helpful, but not harmful)
- deflation: early deflation (not helpful, but not harmful)
Balloon purge
On ascent about 1000 ft agl
- due to Boyles law
- will be less than 1 minute. Monitor for decompensation
Normal pump trigger
EKG
