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