IABP Therapy Flashcards
What does IABP do
A cylindrical balloon sits in the aorta and counter-pulsates. It actively deflates in systole increasing forward blood flow by reducing after load and actively inflates in diastole increasing blood flow to the coronary arteries.
Mounted on a catheter and sits in the descending/thoracic aorta. Inserted into the right or left femoral artery.
Main goals: Increase coronary artery perfusion and reduce afterload.
Indications for IABP therapy
> Cardiac failure after a cardiac surgical procedure
Mitral regurgitation
Preoperative treatment of complications due to MI
failed PTCA (Cardiac Stent)
*it’s all about myocardial oxygen demand and supply
Goals of IABP therapy
> Decreases the work of the heart
Decreases myocardial oxygen demand
Decreases afterload
Increase coronary perfusion
Improve cardiac output (Q)
Decrease or limit myocardial ischemia
Prevent cardiogenic shock or limit the event
Contraindications of IABP therapy
> Severe aortic insufficiency
Aortic aneurysmtest tip
Aortic dissectiontest tip
Limb ischemia
Thromboembolism
Augmentation pressure
This pressure should be looked at as the highest pressure in the heart similar to systolic pressure. What is normal systolic? That is the goal. Too much augmentation pressure will be counterproductive. This is often a result of too much chemical balloon.
This is how much helium actually goes into the balloon
Mean
The Mean is a calculated pressure by the IABP and should be looked at in the same manner as a MAP. This is how you titrate the chemical balloon.
What is the goal of a normal MAP? 65-90 mmHg
Diastolic dip
This is the true reflection of afterload reduction.
The goal should be to a minimum of 5-10 mmHg.
Unassisted versus assisted diastolic pressure
You want to see a decrease in assisted diastolic pressure from the previous unassisted diastolic pressure (diastolic dip)
Unassisted versus assisted systolic pressure
You want to see a decrease in the assisted systolic pressure from the previous unassisted systolic pressure
Pressures that you need to monitor with IABP therapy
Augmentation pressure
Mean pressure
Diastolic dip
Unassisted/assisted diastolic pressure
Unassisted/assisted systolic pressure
Why is Helium used in IABP therapy?
> Used for IABP balloon, inflation
Helium will diffuse into the bloodstream and not cause issues
Helium is a small molecule, decreased risk for emboli, and it moves very quickly
IABP transport considerations
1-IABP balloon size
2-patient presentation history
3-circulation assessment/ check all extremities
4-what is the urine output per hour?
5-is the patient balloon dependent? I put the IABP consul in standby. Can the patient handle it?
Effects of IABP balloon inflation
1-increased coronary perfusion pressure
2-increased systemic perfusion pressure
3-increased O2 supply to both coronary and peripheral tissue
4-increased baroreceptor response
5-decreased sympathetic stimulation, causing decreased heart rate, decreased SVR and increased left ventricular function
The effects of balloon deflation in IABP therapy
1-after load reduction, and therefore a reduction in myocardial oxygen consumption
2-reduction in peak systolic pressure, therefore reduction in LV work
3-increased cardiac output(Q)
4-improved ejection fraction
5- ejection fraction is normally 50 to 70%
Triggering in IABP balloon pump therapy
A trigger is necessary to signal balloon pump to begin.
Trigger signal tells the computer another cardiac cycle has begun
Triggers include ECG, arterial, waveform, internal pressure or pacer.
ECG is most common and most reliable trigger. Should be a 5-lead and should be taped down for extra security
2ndary trigger is the arterial pressure and will automatically be used if the ECG fails.