IABP- Part 1- Exam 4

Question 1

What are some absolute contraindications of IABP?

Answer 1

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)

Question 2

What are some relative contraindications of IABP?

Answer 2

Severe aortic or femoral atherosclerosis

Symptomatic peripheral vascular disease

Question 3

Surgical: Benefits

Answer 3

Direct visualization
less vessel trauma
less catheter kinking
IABP insertion for patients with peripheral vascular disease

Question 4

Percutaneous: Benefits

Answer 4

Speed of insertion increases
can be performed throughout hospital
less bleeding
decreased incidence of distal thromboembolism
decreased risk of infection

Question 5

Surgical : Risks

Answer 5

Bleeding
Thromboembolism
Infection
Increased insertion time
requires surgical removal

Question 6

Percutaneous: Risks

Answer 6

Lack of vessel visualization
Potential increased vessel trauma
Increased chance of thromboembolism during removal
increased chance for dissection
not applicable for patient with peripheral vascular disease

Question 7

Goals of Balloon Pump Tx

Answer 7

Increased cardiac output
decreased myocardial work
Decreased myocardial oxygen demand
Decrease myocardial ischemia

Question 8

Balloon Counterpulsation

Answer 8

generation of a balloon pulse that is synchronized to occur opposite the cardiac cycle

Question 9

When does the heart create a pulse in balloon counterpulsation?

Answer 9

During systole

Question 10

When does balloon create a pulse in balloon counterpulsation?

Answer 10

During diastole

Question 11

What is the goal of counterpulsation?

Answer 11

Inflate balloon during diastole

Deflate balloon before ventricular ejection

Question 12

What is the goal of counterpulsation?

Answer 12

Inflate balloon during diastole

Deflate balloon before ventricular ejection

Question 13

What two factors do we need as a means of synchronizing ballon inflation and deflation with the appropriate part of the patient’s cardiac cycle?

Answer 13

Trigger mechanism

Timing mechanism

Question 14

WHat is the purpose of the trigger logic?

Answer 14

Synchronizes the patient’s cardiac cycle of systole and diastole with the balloon pump’s cycle of inflation ahd deflation

Question 15

Trigger Logic

Answer 15

Tells pump console when the patient’s heart has entered systole
Provides starting point for timing logic
Provides mechanism to ensure that the balloon will not be inflate during systole
Trigger information has to be provided by the patient

Question 16

Where does the trigger information come from?

Answer 16

The patient

Question 17

Triggering Options

Answer 17

EKG
Pressure
Internal

Question 18

Triggering Options: EKG

Answer 18

Senses the rate at which the ECG voltage changes. Usually upstroke of R wave satisfies the criteria.
-consider if the patent has a pacemaker

Question 19

Triggering Options: Pressure

Answer 19

Sense the rate at which the arterial blood pressure changes

Question 20

Optimize ECG Triggering

Answer 20

Maximize amplitude of R wave
Do not need (or want) a diagnostic ECG
Minimize amplitude of other waves
Avoid electrical interference

Question 21

Optimize ECG Triggering

Answer 21

Maximize amplitude of R wave
Do not need (or want) a diagnostic ECG
Minimize amplitude of other waves
Avoid electrical interference

Question 22

Establishing Optimal ECG Trigger

Answer 22

Skin prep
Use silver-silver chloride electrodes
Consider lead placement

Question 23

Optimize Pressure Triggering

Answer 23

Prevent catheter whip

Prevent over damping of waveform

Question 24

Purpose of TIming Logic

Answer 24

use to set the precise inflation and deflation points

Question 25

Describe the controls for timing logic.

Answer 25

Separate controls for setting inflation and for setting deflation
-Act as timers (literal or % cardiac cycle; affect by trigger source)
-Set inflation point first, then set deflation point; changing inflation point will affect timing of deflation point
Proper timing can only be verified by looking at the patients arterial waveform

Question 26

Effects of Ballon Inflation: Proximal Compartment

Answer 26

Increased perfusion pressure at the coronary ostia
Increased diastolic pressure in the aortic root
Coronary BF may increase
collateral coronary circulation may open
increased perfusion to head vessels

Question 27

Effects of Balloon Inflation: Distal Compartment

Answer 27

Increased peripheral runoff
Increased systemic perfusion
Magnitude of effect depends on postiion of balloon tip (toward head or toward legs)

Question 28

Effects of Ballon Deflation

Answer 28

Rapid reduction in aortic pressure

10-15 mmHg decrease in pressure (afterload)

Question 29

Effects of Decreased Afterload

Answer 29

Cardiac work is decreased
Max tension developed by ventricle reduced
Myocardial oxygen consumption is decreased
Balance between myocardial oxygen supply and demand may be restored