Introduction to the Intra-Aortic Balloon Pump Flashcards
(62 cards)
Why Use the Balloon Pump?
Treatment for:
Cardiogenic shock postmyocardial infarction - bridge to reperfusion therapies
Acute myocardial ischemia / Unstable angina
Acute cardiac defects - bridge to emergent surgery
Bridge to transplant
Perioperative support of high-risk cardiac and general surgical patients
Weaning from cardiopulmonary bypass Stabilize high-risk patient for PTCA, stent placement &
angiography
Pharmacologically refractory ventricular arrhythmias
Contraindications - Absolute
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
Contraindications - Relative
Severe aortic or femoral atherosclerosis Symptomatic peripheral vascular
disease
Seldinger Technique: Step 1
after palpating artery surgeon inserts a 18 gauge needle
Seldinger Technique: Step 2
removes stylet from angiographic needle and inserts guidewire through needle. wire is advanced to decending aorta so tip is above bifurcation of aorta
Seldinger Technique: Step 3
removes needle and places dilator on wire and then it is removed and replaced with sheath dilator
Seldinger Technique: Step 4
dilator portion of sheath dilator removed. removes central stylet and places ballon catheter over guidewire
surgical benefits
direct visualization, less vessel trauma, less catheter kinking, allows for IABP insertion for patients with periphereal vascular disease
surgical risk
bleeding, thromboembolism, infection, more insertion time, requires surgical removal
percutaneous benefits
speed of insertion, performed anywhere, less bleeding,less infection, decrease in distal thromboembolism
percutaneous risk
lack of visualization, increased vessel trauma, thromboembolism during removal, dissection, not applicable for periphereal vascular disease
Goals of Balloon Pump Treatment
Increase cardiac output Decrease myocardial work Decrease myocardial oxygen demand Decrease myocardial ischemia
Balloon Counterpulsation
Generation of a balloon pulse that is synchronized to occur opposite the cardiac cycle.
Heart creates pulse during systole. Balloon creates pulse during diastole.
Goal of Counterpulsation
Inflate balloon during diastole
Deflate balloon before ventricular ejection
To accomplish counterpulsation we need
a means of synchronizing balloon inflation and deflation with the appropriate part of the patient’s cardiac cycle.
– Trigger mechanism – Timing mechanism
To accomplish counterpulsation we need
a means of synchronizing balloon inflation and deflation with the appropriate part of the patient’s cardiac cycle.
– Trigger mechanism – Timing mechanism
Purpose of Trigger Logic
Synchronizes the patient’s cardiac cycle of systole and diastole with the balloon pump’s cycle of inflation and deflation.
Trigger Logic
Tells pump console when
he patient’s heart has entered systole
Provides starting point for timing logic Provides mechanism to ensure that balloon
will not be inflated during systole
Triggering information HAS to be
provided by the patient
riggering Options
Electrocardiogram
(Senses the rate at which the ECG voltage changes. Usually upstroke of R wave satisfies the criteria.)
What if the patient has a pacemaker??? pacer A pacer V/A-V
triggering option Pressure
Pressure (Senses the rate at which the arterial blood pressure changes.) there is an internal triggering option as well
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 preparation Use silver-silver chloride electrodes Consider lead placement
Optimize Pressure Triggering
Prevent catheter whip
Prevent over damping of waveform
