IABP- Part 2- Exam 4 Flashcards Preview

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Flashcards in IABP- Part 2- Exam 4 Deck (28):
1

Results of Early Inflation

Regurgitation of blood into left ventricle

 Premature closure of aortic valve

 Decreased stroke volume

 Decreased cardiac output

 Increased preload

 Increased myocardial oxygen consumption

2

Indications of Late Inflation

Widening of dicrotic notch

3

Results of Late Inflation

 Diastolic augmentation may decrease

 Coronary perfusion pressure may decrease

4

Indications of Early Deflation

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

5

Results of Early Deflation

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

6

Indications of Late Deflation

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

7

Indications of Late Deflation

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

8

Results of Late Deflation

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

9

Patient Factors Affecting Response

 Heart rate

 Stroke volume

 Mean arterial pressure

 Systemic vascular resistance

10

Balloon Factors Affecting Response

 Balloon in sheath

 Balloon not unfurled

 Balloon position in aorta

 Kink in balloon catheter

 Balloon leak

 Low helium concentration

11

Timing Issues

 Proper timing / poor augmentation

 Arterial pressure monitoring site

 Changing heart rate

 Automatic / Manual timing control

12

Timing / Triggering Issues

 Electrosurgical interference

 Arrhythmias

13

Proper Timing / Poor Augmentation

 Large stroke volume

 Inadequate balloon volume

 Improper balloon position

 Balloon too small for patient

14

Proper Timing / Poor Augmentation

 Large stroke volume

 Inadequate balloon volume

 Improper balloon position

 Balloon too small for patient

15

Changing Heart Rate

 Pumping most effective if heart rate

between 80 & 100 bpm

 Automatic timing vs. manual timing

16

Electrosurgical Interference

 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

17

Ectopic Beats

 Balloon deflates on ectopic R wave

 Let system track and respond

18

Ectopic Beats

 Balloon deflates on ectopic R wave

 Let system track and respond

19

Tachycardia (HR > 120 bpm)

 Compromises diastolic augmentation

 Major problem is electromechanical delay

 time it takes to physically inflate the

 time from trigger (line A) to the start

 problems occur when balloon is fixedof balloon inflation (line B) decreases as heart rate increases electromechanical delay is longer than the time from A to B

20

Atrial Fibrillation

 Severe timing problem

 Difficult to provide effective afterload reduction

 changing R-R interval makes it difficult to predict the next inflation point

21

Additional Problems

 Ventricular fibrillation

 Cardiac arrest

 Pacemaker spikes

 atrial

 ventricular

 atrio-ventricular

22

Clinical Criteria for Weaning

 Evidence of adequate perfusion

 urine output >30 mls/hour

 improved mental status

 warm skin temperature

 No evidence of congestive heart failure

 rales absent

 S3 absent

 No life threatening arrhythmias

23

Hemodynamic Criteria for Weaning

 Cardiac index >2.0 L/min/m2

 MAP >70 mmHg (minimal pressor)

 PAEDP / PAWP / LAP

24

IABP Complications

 Inability to advance catheter 2 to 13.5%

 Inability or difficulty unwrapping balloon 5 to 7%

 Ischemic extremities 5 to 47%

 Thrombosis of emboli 1 to 7%

 Arterial perforation 2 to 6%

 Bleeding 3 to 5%

 Infection 2 to 4%

 Aortic dissection 1 to 3%

 Thrombocytopenia rare

25

Whats the overall complication rate?

20%

26

Choosing balloon size

 182cm = 50cc

27

Management during the case

 Pausing for cannulation

 Pausing/off for CPB

 Back on for weaning from CPB

 Re-zero pressure

 Re-fill balloon

28

Do not turn off unless the patient is ______________.

Anticoagulated