IABP- Part 2- Exam 4

Question 1

Results of Early Inflation

Answer 1

Regurgitation of blood into left ventricle

 Premature closure of aortic valve

 Decreased stroke volume

 Decreased cardiac output

 Increased preload

 Increased myocardial oxygen consumption

Question 2

Indications of Late Inflation

Answer 2

Widening of dicrotic notch

Question 3

Results of Late Inflation

Answer 3

 Diastolic augmentation may decrease

 Coronary perfusion pressure may decrease

Question 4

Indications of Early Deflation

Answer 4

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

Question 5

Results of Early Deflation

Answer 5

 Little or no afterload reduction
 Increased myocardial oxygen consumption
 Increased preload
 Retrograde coronary blood flow may occur
 coronary steal

Question 6

Indications of Late Deflation

Answer 6

 Assisted end diastolic dip higher than unassisted end diastolic pressure
 Assisted systolic pressure may be higher than unassisted peak systolic pressure

Question 7

Indications of Late Deflation

Answer 7

 Assisted end diastolic dip higher than unassisted end diastolic pressure
 Assisted systolic pressure may be higher than unassisted peak systolic pressure

Question 8

Results of Late Deflation

Answer 8

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

Question 9

Patient Factors Affecting Response

Answer 9

 Heart rate

 Stroke volume

 Mean arterial pressure

 Systemic vascular resistance

Question 10

Balloon Factors Affecting Response

Answer 10

 Balloon in sheath

 Balloon not unfurled

 Balloon position in aorta

 Kink in balloon catheter

 Balloon leak

 Low helium concentration

Question 11

Timing Issues

Answer 11

 Proper timing / poor augmentation

 Arterial pressure monitoring site

 Changing heart rate

 Automatic / Manual timing control

Question 12

Timing / Triggering Issues

Answer 12

 Electrosurgical interference

 Arrhythmias

Question 13

Proper Timing / Poor Augmentation

Answer 13

 Large stroke volume

 Inadequate balloon volume

 Improper balloon position

 Balloon too small for patient

Question 14

Proper Timing / Poor Augmentation

Answer 14

 Large stroke volume

 Inadequate balloon volume

 Improper balloon position

 Balloon too small for patient

Question 15

Changing Heart Rate

Answer 15

 Pumping most effective if heart rate

between 80 & 100 bpm

 Automatic timing vs. manual timing

Question 16

Electrosurgical Interference

Answer 16

 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

Question 17

Ectopic Beats

Answer 17

 Balloon deflates on ectopic R wave

 Let system track and respond

Question 18

Ectopic Beats

Answer 18

 Balloon deflates on ectopic R wave

 Let system track and respond

Question 19

Tachycardia (HR > 120 bpm)

Answer 19

 Compromises diastolic augmentation

 Major problem is electromechanical delay

 time it takes to physically inflate the

 time from trigger (line A) to the start

 problems occur when balloon is fixedof balloon inflation (line B) decreases as heart rate increases electromechanical delay is longer than the time from A to B

Question 20

Atrial Fibrillation

Answer 20

 Severe timing problem

 Difficult to provide effective afterload reduction

 changing R-R interval makes it difficult to predict the next inflation point

Question 21

Additional Problems

Answer 21

 Ventricular fibrillation

 Cardiac arrest

 Pacemaker spikes

 atrial

 ventricular

 atrio-ventricular

Question 22

Clinical Criteria for Weaning

Answer 22

 Evidence of adequate perfusion

 urine output >30 mls/hour

 improved mental status

 warm skin temperature

 No evidence of congestive heart failure

 rales absent

 S3 absent

 No life threatening arrhythmias

Question 23

Hemodynamic Criteria for Weaning

Answer 23

 Cardiac index >2.0 L/min/m2

 MAP >70 mmHg (minimal pressor)

 PAEDP / PAWP / LAP

Question 24

IABP Complications

Answer 24

 Inability to advance catheter 2 to 13.5%

 Inability or difficulty unwrapping balloon 5 to 7%

 Ischemic extremities 5 to 47%

 Thrombosis of emboli 1 to 7%

 Arterial perforation 2 to 6%

 Bleeding 3 to 5%

 Infection 2 to 4%

 Aortic dissection 1 to 3%

 Thrombocytopenia rare

Question 25

Whats the overall complication rate?

Answer 25

20%

Question 26

Choosing balloon size

Answer 26

 182cm = 50cc

Question 27

Management during the case

Answer 27

 Pausing for cannulation

 Pausing/off for CPB

 Back on for weaning from CPB

 Re-zero pressure

 Re-fill balloon

Question 28

Do not turn off unless the patient is ______________.

Answer 28

Anticoagulated