IABP- Part 1- Exam 4 Flashcards
(29 cards)
What are some absolute contraindications of IABP?
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)
What are some relative contraindications of IABP?
Severe aortic or femoral atherosclerosis
Symptomatic peripheral vascular disease
Surgical: Benefits
Direct visualization
less vessel trauma
less catheter kinking
IABP insertion for patients with peripheral vascular disease
Percutaneous: Benefits
Speed of insertion increases can be performed throughout hospital less bleeding decreased incidence of distal thromboembolism decreased risk of infection
Surgical : Risks
Bleeding Thromboembolism Infection Increased insertion time requires surgical removal
Percutaneous: Risks
Lack of vessel visualization
Potential increased vessel trauma
Increased chance of thromboembolism during removal
increased chance for dissection
not applicable for patient with peripheral vascular disease
Goals of Balloon Pump Tx
Increased cardiac output
decreased myocardial work
Decreased myocardial oxygen demand
Decrease myocardial ischemia
Balloon Counterpulsation
generation of a balloon pulse that is synchronized to occur opposite the cardiac cycle
When does the heart create a pulse in balloon counterpulsation?
During systole
When does balloon create a pulse in balloon counterpulsation?
During diastole
What is the goal of counterpulsation?
Inflate balloon during diastole
Deflate balloon before ventricular ejection
What is the goal of counterpulsation?
Inflate balloon during diastole
Deflate balloon before ventricular ejection
What two factors do we need as a means of synchronizing ballon inflation and deflation with the appropriate part of the patient’s cardiac cycle?
Trigger mechanism
Timing mechanism
WHat is the purpose of the trigger logic?
Synchronizes the patient’s cardiac cycle of systole and diastole with the balloon pump’s cycle of inflation ahd deflation
Trigger Logic
Tells pump console when the patient’s heart has entered systole
Provides starting point for timing logic
Provides mechanism to ensure that the balloon will not be inflate during systole
Trigger information has to be provided by the patient
Where does the trigger information come from?
The patient
Triggering Options
EKG
Pressure
Internal
Triggering Options: EKG
Senses the rate at which the ECG voltage changes. Usually upstroke of R wave satisfies the criteria.
-consider if the patent has a pacemaker
Triggering Options: Pressure
Sense the rate at which the arterial blood pressure changes
Optimize ECG Triggering
Maximize amplitude of R wave
Do not need (or want) a diagnostic ECG
Minimize amplitude of other waves
Avoid electrical interference
Optimize ECG Triggering
Maximize amplitude of R wave
Do not need (or want) a diagnostic ECG
Minimize amplitude of other waves
Avoid electrical interference
Establishing Optimal ECG Trigger
Skin prep
Use silver-silver chloride electrodes
Consider lead placement
Optimize Pressure Triggering
Prevent catheter whip
Prevent over damping of waveform
Purpose of TIming Logic
use to set the precise inflation and deflation points
