Perf Tech 3 Test 3

Question 1

IABP Treatment

Answer 1

bridge to reperfusion therapy (after stroke/MI), acute ischemia, acute cardiac defect (bridge), bridge until transplant, perioperative, failure to wean, stabilize stent placement

Question 2

Absolute Contraindications

Answer 2

aortic aneurysm, dissecting, aortic regorge, coagulation issues, brain death, end stage diseases

Question 3

Relative Contraindications

Answer 3

atherosclerosis, peripheral vascular disease

Question 4

Insertion Sites

Answer 4

retrograde= femoral artery, abdominal aorta 
antegrade= asc or descending aorta, right subclavian

Question 5

Percutaneous Insertion (Seldinger Technique)

Answer 5

1) feel pulse, insert needle into artery
2) remove stylet and insert guide wire past bifurcation of aorta
3) remove needle and place dilator over guide wire, remove dilator and replace with sheath dilator assembly
4) remove dilator portion of sheath and insert balloon over guide wire

Question 6

Position of Balloon

Answer 6

@ aortic arch and descending aorta, 2 cm below L subclavian

• X-Ray= between 2nd intercostal space and L1 vertebra
• want 80-90% occluded

Question 7

Goals of Balloon Pump

Answer 7

1) increase CO
2) decrease work
3) decrease O2 demand
4) decrease ischemia

Question 8

Trigger and Timing Logic

Answer 8

1) trigger= starting point for timing, HAVE to have info from patient
- EKG- senses rate of ECG voltage changes
- pressure- senses rate of arterial BP changes
- internal= machine uses fixed rate
2) timing= used to set precise in/deflate points= HAVE to compare with patients native arterial waveform

Question 9

Effects of Balloon Inflation

Answer 9

proximal= increases diastolic pressure in root, increases PP in coronary, increase coronary BF, increase BF to head vessels 
distal= increase peripheral run off, increase systemic kidney perfusion (magnitude depends on direction of tip)

Question 10

Effects of Balloon Deflation

Answer 10

• rapid reaction in aortic pressure
• 10-15 mmHg decrease in after load
• valve opens with balloon deflation= so opens before normal= less isovolumetric time= decreases from the 90% it causes in O2 consumption

Question 11

Effects of Decreased Afterload

Answer 11

-decrease work
-reduced max tension
reduced O2 consumption
-balance of supply and demand may be restored
(lower demand cuz lower after load, higher supply cuz more diastolic BP and less LV pressure)

Question 12

Endocardial Viability Ratio

Answer 12

= (diastolic pressure time index)/(time tension index)

aka supply/demand

Question 13

Lactate utilization vs. production

Answer 13

utilization= aerobic
production= anaerobic

Question 14

Early Inflation

Answer 14

loss of DN, lower DP augmentation

-results= regurge blood into LV, premature A valve closure, decrease SV, CO, increase preload, O2 consumption

Question 15

Late Inflation

Answer 15

wide DN (2 humps)
results= decrease CPP, decrease DP augmentation

Question 16

Early Deflation

Answer 16

assisted EDP same level as normal, increase in assisted SP

results= no decrease in after load, increase preload, retrograde coronary BF/coronary steal, increase O2 consumption

Question 17

Late Deflation

Answer 17

increase assisted EDP higher than normal, increase assisted SP
results= no decrease in after load (may increase), prolonged isovolumetric contraction, lower SV, CO, high O2 consumption

Question 18

Patient Factors Affecting Response

Answer 18

HR, SV, Map, SVR

Question 19

Balloon Factors Affecting Response

Answer 19

sheath, not unfurled, position, kink, leak, decrease Helium

Question 20

Timing Issues

Answer 20

1) proper timing but poor augmentation- causes large SV, improper position, too small
2) hemodynamic monitoring site- measuring aorta vs femoral, delay in waveform
3) change in heart rate- most effective at 80-100 bpm
4) Automatic vs. Manual timing
5) electrical interference
6) Arrhythmias: ectopic beat (don’t touch anything), tachy, a-fib, v-fib, cardiac arrest, pacemakers

Question 21

Weaning Off Balloon Criteria

Answer 21

Clinical:
1) evidence of good perfusion (urine above 30, good mental, warm skin)
2) absence of angina
3) no congestive HF, no rales, S3
4) no life threatening arrhythmias 
Hemodynamic:
5) CI > 2.0 (normal 2.5-4)
6)Map > 70 (70-105)
7) Pawp/Lap < 18 (6-12)
8) HR < 110 (60-100)

Question 22

IABP complactions

Answer 22

overall rate= 20%
high- inability to advance cather, ischemic
low- aortic dissection, thrombocytopenia