IABP/Pacemakers Flashcards
When would you remove a post op pacemaker sutures.
Patients are usually seen for staple removal within 7-10 days post insertion.
How long should a post op pacemaker patient wear a sling?
Patients should wear a sling for appox 2 week to prevent the leads from dislodging. Patients can raise their arm to shoulder level after 2 weeks and overhead after 4 weeks.
When do you perform the first pacemaker interrogation?
The first interrogation is usually preformed at 90 days, Medicare won’t reimburse for this procedure prior to that date. If a patient calls and has a problem (lightheadedness, dizziness etc) you would want to interrogate to see if they had an arrhythmia. The trending will show if they have had times where the heart rate has been elevated or low as well. Histograms are created for you to view and can then be attached to the patients chart.
How often after 90 days should you interrogate a PM?
Pacemakers should be interrogated usually in the office every 6 months, at the very least yearly to check battery life. Many protocols tell you every 3 months, but offices using these protocols usually have the patients use telephone where a limited interrogation can be preformed. The patients place wrist bands on their wrists that are connected to the phone unit and then a hand held phone is placed in the cradle of the unit and the interrogtion can be preformed with the assistance of someone from their cardiologist office who directs them thru the procedure via the telephone.
What about Biventricular pacing?
Biventricular pacing is becoming more and more common place and you may see it while in your clinical rotations.
Also, of course remember in the diagnosis of other co-morbidities, use of an MRI can have a profound effect upon pacemaker functioning and should not be considered.
When were IABP first introduced?
1960-for patients with cardogenic shock
What does an IABP do?
Decreases oxygen consumption and increases coronary artery perfusion.
Indications for a IABP:
- Severe mitral valve regurg
- AMI
- Refractory vent. arrhythmias due to ischemia
- before/after heart surgery
- severe ventriculoseptal defect
- Low cardiac output states
- Preinfarction angina refractory to pharmacological therapy
Absolute contraindications to IABP:
Aortic Aneurysm
Aortic insufficiency
Bypass grafting from aorta to peripheral vessels
Relative contraindications to IABP:
- Atherosclerosis
- Bleeding disorder
- History of embolic event
- Ethical considerations
What are the therapeutic effects of IABP?
- Increases coronary perfusion
- Reduces afterload
- Improves perfusion to vital organs.
How does IABP work?.
Inflates during diastole which displaces blood backwards, which increases perfusion to the coronary arteries, and also displaces blood forward, which increases perfusion to vital organs. Deflates just before systole, which reduces pressure in the aorta, decreases afterload, and reduces myocardial oxygen demand.
What would you want to frequently monitor with IABP therapy?
Vital signs, hemodynamics
How can you assure accurate timing with the IABP?
- R wave on ECG
- Upstroke (diacrotic notch of the arterial line tracing)
- Pacer spike
Complications?
Embolus Balloon Rupture Arterial occlusion Destruction of RBCs Inability to wean patient from pump
