IABP- Part 1- Exam 4 Flashcards Preview

CV Perf Tech III > IABP- Part 1- Exam 4 > Flashcards

Flashcards in IABP- Part 1- Exam 4 Deck (29):
1

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)

2

What are some relative contraindications of IABP?

Severe aortic or femoral atherosclerosis
Symptomatic peripheral vascular disease

3

Surgical: Benefits

Direct visualization
less vessel trauma
less catheter kinking
IABP insertion for patients with peripheral vascular disease

4

Percutaneous: Benefits

Speed of insertion increases
can be performed throughout hospital
less bleeding
decreased incidence of distal thromboembolism
decreased risk of infection

5

Surgical : Risks

Bleeding
Thromboembolism
Infection
Increased insertion time
requires surgical removal

6

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

7

Goals of Balloon Pump Tx

Increased cardiac output
decreased myocardial work
Decreased myocardial oxygen demand
Decrease myocardial ischemia

8

Balloon Counterpulsation

generation of a balloon pulse that is synchronized to occur opposite the cardiac cycle

9

When does the heart create a pulse in balloon counterpulsation?

During systole

10

When does balloon create a pulse in balloon counterpulsation?

During diastole

11

What is the goal of counterpulsation?

Inflate balloon during diastole
Deflate balloon before ventricular ejection

12

What is the goal of counterpulsation?

Inflate balloon during diastole
Deflate balloon before ventricular ejection

13

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

14

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

15

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

16

Where does the trigger information come from?

The patient

17

Triggering Options

EKG
Pressure
Internal

18

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

19

Triggering Options: Pressure

Sense the rate at which the arterial blood pressure changes

20

Optimize ECG Triggering

Maximize amplitude of R wave
Do not need (or want) a diagnostic ECG
Minimize amplitude of other waves
Avoid electrical interference

21

Optimize ECG Triggering

Maximize amplitude of R wave
Do not need (or want) a diagnostic ECG
Minimize amplitude of other waves
Avoid electrical interference

22

Establishing Optimal ECG Trigger

Skin prep
Use silver-silver chloride electrodes
Consider lead placement

23

Optimize Pressure Triggering

Prevent catheter whip
Prevent over damping of waveform

24

Purpose of TIming Logic

use to set the precise inflation and deflation points

25

Describe the controls for timing logic.

Separate controls for setting inflation and for setting deflation
-Act as timers (literal or % cardiac cycle; affect by trigger source)
-Set inflation point first, then set deflation point; changing inflation point will affect timing of deflation point
Proper timing can only be verified by looking at the patients arterial waveform

26

Effects of Ballon Inflation: Proximal Compartment

Increased perfusion pressure at the coronary ostia
Increased diastolic pressure in the aortic root
Coronary BF may increase
collateral coronary circulation may open
increased perfusion to head vessels

27

Effects of Balloon Inflation: Distal Compartment

Increased peripheral runoff
Increased systemic perfusion
Magnitude of effect depends on postiion of balloon tip (toward head or toward legs)

28

Effects of Ballon Deflation

Rapid reduction in aortic pressure
10-15 mmHg decrease in pressure (afterload)

29

Effects of Decreased Afterload

Cardiac work is decreased
Max tension developed by ventricle reduced
Myocardial oxygen consumption is decreased
Balance between myocardial oxygen supply and demand may be restored