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Flashcards in IABP Deck (19):
1

Tip of balloon placement

Just distal to L Subclavian

2

Balloon inflation events

During diastole, blood shot down aorta. Shot backwards towards closed aorta valve, into coronary arteries, head and arms.

3

Balloon deflation events

During systole, provides empty potential in aorta, heart does not fight afterload, negative pressure can suck blood out of heart.

4

West zones 1, 2, 3

1. More air in lung than blood, over inflation, under perfused (usually in apexes)
2. 50/50 matchup
3. More perfusion than air

5

X-Ray & IABP

Tip of balloon pump should be in 2nd or 3rd intercostal space & 2 cm below aortic arch

6

IABP contraindications

-aortic valve insufficiency (if valve will not close, blood will overload LV)
-Severe aortic disease
-Severe peripheral vascular disease

7

IABP complications

-limb ischemia (#1 complication)
-Aortic dissection
-thrombocytopenia
-infection / septicemia
-renal complications
-gas emboli - rare

8

Early inflation

-Inflation before aortic valve closure
-inflation during systole
-acts as a cork in aorta
-causes reflux of blood in LV
-decreases cardiac output & increases SVR
-very harmful to pt (immediate intervention needed)

9

Late inflation

-late phase diastole inflation
-results in sub-optimal augmentation
-minimal displacement of blood back toward coronary arteries

10

Early deflation

Vacuum effect and afterload reduction is lost
-pressures decrease in aorta while aortic valve still closed.
-by the time aortic valve opens, aortic pressures have equalized.
-not harmful, but does not help situation.

11

Late deflation

Balloon still inflated during beginning of ventricular systole..
Most harmful. Increases LV workload
-pressures are extremely high when balloon deflates (can lead to ruptures in brain and coronaries)

12

Proper timing waveform will exhibit

1. Nice sharp V where balloon pump kicks in, level with dicrotic notch.
2. IABP deflation should show a nice uniform U shape blends nicely into beginning of next arterial waveform.

13

Which is safer? Inward or outward waveform adjustment.

Safer to move inward
outward:
-inflation: early inflation (harmful)
-deflation: late deflation (most harmful)

Inward:
-inflation: late deflation (not helpful, but not harmful)
-deflation: early deflation (not helpful, but not harmful)

14

Balloon purge

On ascent about 1000 ft agl
-due to Boyles law
-will be less than 1 minute. Monitor for decompensation

15

Normal pump trigger

EKG

16

Cardiopulmonary arrest considerations

Place trigger mode on arterial pressure or internal trigger mode.
-Leave pump running.
-May assist efforts

17

In the event of power failure

Balloon pump needs manual pumping q 30 minutes to prevent thrombus formation

18

Positioning the patient for balloon pump rupture

Rust colored flakes!!!
-place patient in trendelenburg position and roll so patient insertion site is high. Helium will travel and trap at insertion site. Prevents emboli

19

Goals of IABP therapy

-Decreasing afterload (decrease workload on heart)
-augment diastolic coronary perfusion
-improve cardiac output
-limits myocardial ischemia
-prevent cardiogenic shock