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Perf tech 3 > Introduction to the Intra-Aortic Balloon Pump > Flashcards

Introduction to the Intra-Aortic Balloon Pump Flashcards

1
Q

Why Use the Balloon Pump?

Treatment for:

A

 Cardiogenic shock postmyocardial infarction - bridge to reperfusion therapies
 Acute myocardial ischemia / Unstable angina
 Acute cardiac defects - bridge to emergent surgery
 Bridge to transplant
 Perioperative support of high-risk cardiac and general surgical patients
 Weaning from cardiopulmonary bypass  Stabilize high-risk patient for PTCA, stent placement &
angiography
 Pharmacologically refractory ventricular arrhythmias

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2
Q

Contraindications - Absolute

A

 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

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3
Q

Contraindications - Relative

A

Severe aortic or femoral atherosclerosis Symptomatic peripheral vascular
disease

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4
Q

Seldinger Technique: Step 1

A

after palpating artery surgeon inserts a 18 gauge needle

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5
Q

Seldinger Technique: Step 2

A

removes stylet from angiographic needle and inserts guidewire through needle. wire is advanced to decending aorta so tip is above bifurcation of aorta

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6
Q

Seldinger Technique: Step 3

A

removes needle and places dilator on wire and then it is removed and replaced with sheath dilator

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7
Q

Seldinger Technique: Step 4

A

dilator portion of sheath dilator removed. removes central stylet and places ballon catheter over guidewire

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8
Q

surgical benefits

A

direct visualization, less vessel trauma, less catheter kinking, allows for IABP insertion for patients with periphereal vascular disease

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9
Q

surgical risk

A

bleeding, thromboembolism, infection, more insertion time, requires surgical removal

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10
Q

percutaneous benefits

A

speed of insertion, performed anywhere, less bleeding,less infection, decrease in distal thromboembolism

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11
Q

percutaneous risk

A

lack of visualization, increased vessel trauma, thromboembolism during removal, dissection, not applicable for periphereal vascular disease

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12
Q

Goals of Balloon Pump Treatment

A

Increase cardiac output Decrease myocardial work Decrease myocardial oxygen demand Decrease myocardial ischemia

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13
Q

Balloon Counterpulsation

A

Generation of a balloon pulse that is synchronized to occur opposite the cardiac cycle.
 Heart creates pulse during systole.  Balloon creates pulse during diastole.

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14
Q

Goal of Counterpulsation

A

 Inflate balloon during diastole

 Deflate balloon before ventricular ejection

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15
Q

To accomplish counterpulsation we need

A

a means of synchronizing balloon inflation and deflation with the appropriate part of the patient’s cardiac cycle.
– Trigger mechanism – Timing mechanism

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16
Q

To accomplish counterpulsation we need

A

a means of synchronizing balloon inflation and deflation with the appropriate part of the patient’s cardiac cycle.
– Trigger mechanism – Timing mechanism

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17
Q

Purpose of Trigger Logic

A

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

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18
Q

Trigger Logic

 Tells pump console when

A

he patient’s heart has entered systole
 Provides starting point for timing logic  Provides mechanism to ensure that balloon
will not be inflated during systole

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19
Q

Triggering information HAS to be

A

provided by the patient

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20
Q

riggering Options

 Electrocardiogram

A

(Senses the rate at which the ECG voltage changes. Usually upstroke of R wave satisfies the criteria.)
 What if the patient has a pacemaker???  pacer A  pacer V/A-V

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21
Q

triggering option Pressure

A

 Pressure (Senses the rate at which the arterial blood pressure changes.) there is an internal triggering option as well

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22
Q

Optimize ECG Triggering

A

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

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23
Q

Establishing Optimal ECG Trigger

A

Skin preparation Use silver-silver chloride electrodes Consider lead placement

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24
Q

Optimize Pressure Triggering

A

 Prevent catheter whip

 Prevent over damping of waveform

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25
Q

Purpose of Timing Logic

A

Used to set the precise inflation and deflation points.

26
Q

Timing Logic

 Separate controls for

A

setting inflation

and for setting deflation

27
Q

you have to set

A

nflation point first, then set deflation
point  Changing inflation point will affect timing of
deflation point.

28
Q

timers act as

A

(literal or % of cardiac

cycle) (Affected by trigger source)

29
Q

Proper timing can ONLY be verified by

A

looking at the patient’s arterial waveform

30
Q

Effects of Balloon Inflation

Proximal Compartment

A

Increased perfusion pressure at the coronary ostia
 Increased diastolic pressure in the aortic root
What about coronary blood flow???

31
Q

during inflation in the pRoximal compartment coronary BF______ COLLATERAL CORONARY BF_______ AND PERFUSION TO HEAD VESSELS_______

A

INCREASES, MAY OPEN, INCREASES

32
Q

Effects of Balloon Inflation

Distal Compartment

A

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

33
Q

Effects of Balloon Deflation

A

Rapid reduction in aortic pressure

 10 to 15 mmHg decrease in pressure (afterload)

34
Q

Effects of Decreased Afterload

A

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

35
Q

HI

36
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: EJECTION FRACTION

A

TINY INCREASE

37
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping. DIASTOLIC AORTIC PRESSURE

A

SIGNIFICANT INCREASE

38
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: CO

A

SIGNIFICANT INCREASE

39
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: LEFT VENTRICULAR STROKE WORK

A

SLIGHT INCREASE

40
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: DPTI/TTi

A

SIGNIFICANT INCREASE

41
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: SYSTOLIC AORTIC PRESSURE

A

SLIGHT DECREASE

42
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: SYSTOLIC LEFT VENTRICULAR PRESSURE

A

EQUIVOCAL DECREASE

43
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: DIASTOLIC LEFT VENTRICULAR PRESSURE

A

SLIGHT DECREASE

44
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: PERIPHERAL VASCULAR RESISTANCE

A

equivocal DECREASE

45
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping VASCULAR IMPEDANCE

A

slight DECREASE

46
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: MYOCARDIAL CONTRACTILITY (dp/dt and Vmax)

A

equivocal DECREASE

47
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: Left ventricular wall tension

A

slight DECREASE

48
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: Left ventricular diastolic volume

A

slight DECREASE

49
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping:Central venous pressure

A

equivocal DECREASE

50
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: Pulmonary wedge pressure

A

slight DECREASE

51
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: Right ventricular stroke work index

A

slight DECREASE

52
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: HEART RATE

A

equivocal DECREASE

53
Q

Trends in Hemodynamic Effects of Intra-Aortic Balloon Pumping: HEART RATE

A

equivocal DECREASE

54
Q

Trends in Metabolic Effects of Intra-Aortic Balloon Pumping: coronary BF

A

SLIGHT INCREASE

55
Q

Trends in Metabolic Effects of Intra-Aortic Balloon Pumping: RBF

A

EQUIVOCAL INCREASE

56
Q

Trends in Metabolic Effects of Intra-Aortic Balloon Pumping: CBF

A

EQUIVOCAL INCREASE

57
Q

Trends in Metabolic Effects of Intra-Aortic Balloon Pumping: MESENTERIC BF

A

EQUIVOCAL INCREASE

58
Q

vTrends in Metabolic Effects of Intra-Aortic Balloon Pumping: PULMONARY BF

A

EQUIVOCAL INCREASE

59
Q

Trends in Metabolic Effects of Intra-Aortic Balloon Pumping: LACTATE UTILIZATION

A

SLIGHT INCREASE

60
Q

Trends in Metabolic Effects of Intra-Aortic Balloon Pumping: MYOCARDIAL OXYGEN SUPPLY

A

SLIGHT INCREASE

61
Q

Trends in Metabolic Effects of Intra-Aortic Balloon Pumping: MYOCARDIAL OXYGEN CONSUMPTION

A

SLIGHT DECREASE

62
Q

Trends in Metabolic Effects of Intra-Aortic Balloon Pumping: LACTATE PRODUCTION

A

SLIGHT DECREASE

Perf tech 3 (14 decks)

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