test 3 part 2

Question 1

Balloon timing: Inflation

Answer 1

dicrotic notch

Question 2

Signs of Proper Timing

Answer 2

 Assisted diastolic pressure
 Shape of dicrotic notch
 Assisted end diastolic pressure
 Assisted systolic pressure

Question 3

Indications of Early Inflation

Answer 3

 Loss of dicrotic notch

 Decreased diastolic augmentation

Question 4

Results of Early Inflation

Answer 4

 Regurgitation of blood into left ventricle
 Premature closure of aortic valve
 Decreased stroke volume
 Decreased cardiac output
 Increased preload
 Increased myocardial oxygen consumption

Question 5

Indications of Late Inflation

Answer 5

 Widening of dicrotic

notch (two humps)

Question 6

Results of Late Inflation

Answer 6

 Diastolic augmentation may decrease

 Coronary perfusion pressure may decrease

Question 7

Indications of Early Deflation

Answer 7

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

Question 8

Results of Early Deflation

Answer 8

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

Question 9

Indications of Late Deflation

Answer 9

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

Question 10

Results of Late Deflation

Answer 10

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

Question 11

Patient Factors Affecting Response

Answer 11

 Heart rate
 Stroke volume
 Mean arterial pressure
 Systemic vascular resistance

Question 12

Balloon Factors Affecting Response

Answer 12

 Balloon in sheath
 Balloon not unfurled
 Balloon position in aorta
 Kink in balloon catheter
 Balloon leak
 Low helium concentration

Question 13

Timing Issues

Answer 13

 Proper timing / poor augmentation
 Arterial pressure monitoring site
 Changing heart rate
 Automatic / Manual timing control
 Electrosurgical interference
 Arrhythmias

Question 14

Timing Issues: Proper Timing / Poor Augmentation

Answer 14

 Large stroke volume
 Inadequate balloon volume
 Improper balloon position
 Balloon too small for patient

Question 15

Timing Issues: Hemodynamic Monitoring Site

Answer 15

• there is a delay in the reading the farther out you get away from the aortic root

Question 16

Timing Issues: Changing Heart Rate

Answer 16

 Pumping most effective if heart rate
between 80 & 100 bpm
 Automatic timing vs. manual timing

Question 17

Timing Issues: Electrosurgical Interference

Answer 17

 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 18

Timing Issues: 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 balloon is fixed
 time from trigger (line A) to the start of balloon inflation (line B) decreases as heart rate increases
 problems occur when 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

Question 22

Clinical Criteria for Weaning

Answer 22

 Evidence of adequate perfusion
         urine output >30 mls/hour
         improved mental status
         warm skin temperature
 Absence of angina
 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 (normal = 2.5 to 5)
 MAP >70 mmHg (minimal pressor) (normal = 80 to 105)
 PAEDP / PAWP / LAP <18 mmHg (normal = 6 to 12)
 Heart rate <110 bpm (normal = 80 to 100)
 no complex ventricular arrhythmias

Question 24

Most common IABP Complications

Answer 24

 Inability to advance catheter

 Ischemic extremities

Question 25

Less common IABP Complications

Answer 25

 Inability or difficulty unwrapping balloon
 Thrombosis or emboli 
 Arterial perforation 
 Bleeding
 Infection
 Aortic dissection
 Thrombocytopenia (rare)

Question 26

Rate of IABP complications

Answer 26

• 20% complication rate

Question 27

Other Complications

Answer 27

 Hemolysis
 Cardiac arrhythmias
 Renal failure
 Ineffective cardiac assist
 Malposition
 Catheter leak
 Balloon entrapment

Question 28

What will you need to do for using the IABP

Answer 28

 Gathering necessary supplies
         IABP console
         IABP balloon
         Pressure transducer/pressure tubing
         EKG cables
 Choosing balloon size
 Connecting balloon to console
 Priming and zeroing transducer
 Alternating trigger source and EKG source
 Verifying proper timing

Question 29

Management of IABP during the case

Answer 29

 Pausing for cannulation
 Pausing/Internal for CPB
 Back on for weaning from CPB
         Re-zero pressure
         Re-fill balloon
**Do not turn off unless the patient is anticoagulated!

Question 30

Transport for IABP

Answer 30

 Alternating trigger source and EKG source
 Verifying battery life
 Verifying helium tank level
 Verifying proper timing
 Ensuring leg remains straight