Short Term Mechanical Circulatory Support Flashcards
Mechanical Circulatory Support (MCS) Devices
- Goals of MCS: to dcr myocardial workload, maintain adequate perfusion to vital organs, reduce pulm congestion, augment coronary perfusion, provide circulatory support during procedures, and limit infarction size
-
Pt populations with short term MCS
> acute decompensated right failure
> bridge for long term options
> destination therapy
Intra-Aortic Balloon Pump (IABP)
Synchronized inflation during diastole and deflation during systole (counterpulsation) to reduce mocardial ozygen demand and incr myocardial oxygen supply
Intra-Aortic Balloon Pump (IABP) - Indications for Use
-
Acute CHF
> low BPs
> low output - Cardiogenic shock
-
Any low cardiac output state
> need to reduce afterload
Intra-Aortic Balloon Pump (IABP) - Contraindications
- Aortic aneurysm
- Significant aortic valve insufficiency
- Severe peripheral vascular disease
Intra-Aortic Balloon Pump (IABP) - Physiologic Effects: Increased
- Coronary blood flow
- Cardiac output
- Urine output
- Improved mentation
Intra-Aortic Balloon Pump (IABP) - Physiologic Effects: Decreased
- Signs of myocardial ischemia: angina, ST segment changes, ventrocular dysrhythmias
- Afterload
- Preload
- Myocardial oxygen demand
- Pulmonary congestion
- Heart rate
Intra-Aortic Balloon Pump (IABP) - Nursing Management
- Maintain timing of IABP
-
Assess for complications r/t IABP
> bleeding, balloon rupture/leak, dissect aorta, Heparin induce thrombo, occluded subclavian or kidneys (cold arm) -
Physical assessment
> resolution of low cardiac output state: urine output, blood flow - Assess IABP counsel for helium leak
- Notify physician of comps
Impella
A nonpulsatile axial flow pump tht draws blood from LV and ejects it proximally into asceding aorta
Impella - Placement
In cath lab, percutaneous approach
Impella - Contraindications
Mechanical aortic valve
Impella - Nursing Management
- Care must be taken to prevent catheter dislodgement, which could lead to systemic desaturation or device malfunction
- These pts can ambulate
> IABP pts cannot
Impella - Complications
- Thrombocytopenia
- Punctured septum
- Air embolism
- Blood clots
- Damage to RBCs; hemolyze
Which Short Term Mechanical Device - a pt w/ acute exac of chf w/ hypotension
IABP and/or impella
Which Short Term Mechanical Device - pt w/ a mechanical heart valve
IABP
Which Short Term Mechanical Device - pt w/ an aortic aneurysm
Impella
Which Short Term Mechanical Device - pt who presents w/ an acute MI who continues to be hypotensive after dopaminee started
IABP or impella
Which Short Term Mechanical Device - a pt w/ severe peripheral artery disease
Impella
