Welcome to my page

Intra-aortic balloon pump

Presentation duration :
.60-90mins
Help yourself with my page
.presentation
 INTRA-AORTIC
BALLOON PUMP
Circulatory assist
mechanical device for
.the failing heart
WHAT IS I.A.B.P ?

** I.A.B.P….basically is a unique console specially

designed to :
- increase coronary artery perfusion
- increase systemic perfusion
- decrease myocardial workload
- decrease afterload

I.A.B.P THERAPY IS AN ACUTE SHORT TERM

THERAPY PROVIDES TEMPORARY MECHANICAL
CIRCULATORY ASSIST TO THE FAILING
HEART BY UTILIZINGTHE PRINCIPLE OF
COUNTERPULSATION
Counterpulsation
 WHAT IS
? COUNTERPULSATION

THE PRINCIPLE OF
COUNTERPULSATION
IS REFER TO THE
ALTERNATING INFLATION AND
DEFLATION OF THE INTRA-AORTIC
BALLOON DURING DIASTOLE AND
SYSTOLE RESPECTIVELY
 .Intra-aortic balloon pump therapy
;)The pump outside the heart(
When the heart does not have enough .1
oxygen due to blocked coronary arteries,
or other medical problems, the heart must
.work harder to provide the needed oxygen

Intra-aortic balloon pump therapy helps .2

restore the balance between the supply of
oxygen-rich blood the heart receives from
the coronary arteries, and the amount of
.oxygen the heart needs to pump
 ;This therapy involves two components
One is a thin balloon which is.1
positioned within aorta after being
.introduced through an artery

Second component of balloon pump.2

therapy is the pump itself. The pump
continually inflates and deflates the
balloon within the aorta in time with
.the heart beat
The intra-aortic balloon pump assists**
the heart during both its rest phase
.and its work phase
In the rest phase, the balloon inflates,**
increasing the supply of oxygen-rich
.blood to the coronary arteries
In the work phase, the balloon**
deflates, decreasing the workload on
.your heart
The decrease in workload results in a**
decrease in the amount of oxygen the
.heart needs to pump
 .The normal work/rest cycle of the heart

As blood is pumped, the heart is at work. **

During the work phase, the heart pumps
oxygen-rich blood into the aorta and out to the
.far reaches of the body
This task requires a large amount of oxygen. At**
the end of each work phase the heart has used
up a large portion of the oxygen it has been
.given
As chambers fill, the heart is at rest phase,**
preparing to pump more blood. During this
phase the heart muscle is able to relax. While
it is resting, it is receiving a fresh supply of
oxygen-rich blood through the coronary
.arteries
.How the intra-aortic balloon assists the heart
When the balloon deflates, the heart's workload is**
reduced. Just before the heart gets ready to work,
.the balloon within the aorta deflates
This deflation results in a drop in pressure in the**
aorta, so that when the heart pumps it doesn't have
to work against high pressure. Instead, the heart's
workload is actually reduced, and blood is pumped
.throughout the body more easily
When the balloon inflates, the heart receives more**
oxygen. When the heart is in its rest phase, and
receiving its fresh supply of blood, the balloon
.placed within the aorta is inflated by the pump
This process pushes more oxygen-rich blood through**
the coronary artery supply network and into the
heart's muscle tissue, providing the tired heart with
.extra energy for its work phase
Inflation of the balloon during diastole =**
augmentation of the aortic diastolic
pressure which increases coronary
.) blood flow ) DPTI
Deflation of the balloon occurs just prior**
to the onset of systole and reduces
impedance to left ventricular ejection
.) )TTI
This results in less myocardial work,**
decreased myocardial oxygen
consumption and increased cardiac
.output
 .PHYSIOLOGY EFFECT OF I.A.B.P

: AUGMENTATION
augmentation of the diastole pressure -
: INCREASE IN
coronary perfusion -
mean arterial pressure -
cardiac output -
myocardial oxygen supply -
: DECREASE in
Aortic End-Diastolic pressure -
heart rate -
afterload -
systemic vascular resistance -
left ventricular End-Diastolic pressure -
myocardial oxygen consumption -
 ;Increased ;Decreased
Aortic diastolic Aortic systolic pressure
pressure LVEDP
MAP Myocardial O2
Early transmitral flow consumption
Ejection fraction Lactate production
)cardiac output ( Afterload
Coronary perfusion Heart rate
Cerebral & renal Systemic vascular
perfusion resistance
Myocardial O2 supply
Diastolic coronary flow
 Cases that may consider by expert requiring IABP
: therapy
Unstable angina
Altered mental status
Heart rate > 110bpm
Dysarrthmias
SBP < 90mmHg
MAP < 70mmHg with Vasopressor support
Cardiac index < 2.4
PAWP > 18mmHg
Decreased SVO2
Inadequate peripheral perfusion
Urine output < 0.5ml/kg/hour
 Indication and
contraindication
 ; INDICATON
Refractory unstable angina.1
Cardiogenic shock / septic shock.2
Refractory left ventricular failure.3
Impending infarction.4
Complication of M.I.5
Cardiac contusion.6
;Prophylactic support.7
coronary angiography /angioplasty -
thrombolysis -
high risk intervention procedure -
; Bridging device.8
cardiac transplant -
total mechanical assistance -
 : CONTRAINDICATION
: ABSULUTE ***
aortic valve insuffiency -
dissection of the aneurysm to the -
aortic *
thoracic *

: RELATIVE ***
endstage cardiomyopathies -
atherosclerosis -
endstage terminal disease -
) abdominal aortic aneurysm ) not resected -
peripheral vascular disease -
 CONTRAINDICATION

:Mechanical defects***
valvular disease / insufficiency -
ruptured papillary muscle -
ventricular septal defect -
left ventricular aneurysm -

: Surgical indication***
post surgery myocardial dysfunction -
inability to wean from C.P.B -
prophylactic support -
Set up of IABP
Insertion of IAB
catheter
Malaysia : Bed side CVICU staff
SFH : Cath lab staff
Assist in insertion of IAB
either bedside or in CVL
Technician set up IABP machine
Equipment require pre
: insertion
IABP console
)Helium gas tank)240psi
ECG & Arterial pressure monitoring set
IAB catheter set & insertion kits
Skin prep requirement
.Sterile dressing , drapes & gown
Glove,cap,mask or goggle
) Suture ) cutting needle / silk
Scalper blade
Local anesthesia LA 1%/2%
way stopcock connection 2/3
10/20/50ml leurlock plug syringes
50ml slip tip syringe
Heparinised saline
Hemodynamic transducer monitoring kits
Medication as per doctors order
sedation/analgesic -
Inotrops -
)IVF)NSS/D5NS etc .17
 Fluoroscopy
Portable CXR
Emergency trolley
Lead and apron
Special stretcher
 Prepare patient :
explanation to pt’s and
family
Validate Consent
 Ensure pt’s hooked on monitor*
*assist doctor :
- invasive procedure
*indwelling catheter
Ventilated cases lease with RT
Responsible as a nursing
provider in IABP
management and care
Establish ECG input to the IABP console**
Obtain ECG configuration with optimal**
R‘ wave amplitude‘
Or – indirect ECG input can be obtained**
via bedside ECG to IABP console
: Setting a trigger**
R‘ wave‘ -
QRS complex -
arterial pressure waveform -
may be used as a trigger for balloon inflation and(
)deflation
NB:Pt‘s with PPM-set trigger to reject the pacemaker
artifact
.Obtained base data and investigation prior procedure**
Ensure patient‘s condition allow to proceed with the**
insertion of IAB catheter
Notify doctor if any abnormality from the data**
collection prior insertion and obtain written order
.for IAB insertion
Insertion of IAB catheter team :
- doctor
- scrub nurse
-circulating nurse
-technician
Catheter insertion approach :
*percutaneously ) common )
* cut down
* via transthoracic placement
))during cardiac surgery
 )Pre-insertion consideration:)IAB KITs
Prior insertion of IAB catheter keep the IAB**
cath in its package until absolutely ready to
insert the balloon and to completely drawn the
vacuum before the insertion, to ensure balloon
.clear the sheath
**)Complete IABP console)OK function test**
ready set of pressure transducer -
correct ECG & related cables -
)helium tank)240psi -
Complete prep trolley for IAB insertion **
.Prior to removal of IAB from tray.1
connect the one way valve to the male luer on the -
. short drive line tube attached to the IAB
Slowly aspirate a full syringe of air.2
make sure the one way valve remain connected to -
IAB until the balloon is properly positioned in
. the patient
Remove the cath from the tray, keeping it in line with.3
the IAB membrane
grasp the cath close to the tray & pull it straight -
. out
keep the cath level with the tray -
DO NOT LIFT or BEND the cath during removal -
)Remove stylet from central lumen )if applicable -
Flush the central lumen with Heparinised saline solution.4
 For sheath insertion only :
* Remove Peel-Away hemostsasis
device prior to IAB catheter
insertion.
.* Push tabs to break,then peel away
 :IAB sizing recommendation
30cc 40cc 50cc
Height < 162cm 162-182cm >182cm
”0’6< ”0’6-”4’5 ”4’5 >

BSA < 1.8m2 > 1.8m2

TRIGGERING
To achieve optimal effect of counterpulsation,**
inflation and deflation need to be correctly
.timed to the patient’s cardiac cycle
This is accomplished by either using the patient’s**
ECG signal, the patient’s arterial waveform or an
.intrinsic pump rate
The most common method of triggering the IAB is**
from the R wave of the patient’s ECG signal.
Mainly balloon inflation is set automatically to
start in the middle of the T wave and to deflate
.prior to the ending QRS complex
Tachyarrhythmias, cardiac pacemaker function**
and poor ECG signals may cause difficulties in
obtaining synchronization when the ECG mode is
.used
In such cases the arterial waveform for
triggering may be used
 TIMING and WEANING
It is important that the inflation of the.1
IAB occurs at the beginning of diastole,
noted on the dicrotic notch on the
.arterial waveform
Deflation of the balloon should occur.2
immediately prior to the arterial
.upstroke
Balloon synchronization starts usually at a.3
.beat ratio of 1:2
This ratio facilitates comparison between.4
the patient’s own ventricular beats and
augmented beats to determine ideal IABP
.timing
Errors in timing of the IABP may result in.5
different waveform characteristics and a
various number of physiologic effects
 ;Weaning consideration
If the patient‘s cardiac performance**
improves
weaning from the IABP may begin by**
gradually decreasing the balloon
augmentation ratio )from 1:1 to 1:2 to
1:4 to 1:8( under control of
. hemodynamic stability
After appropriate observation at 1:8**
counterpulsation the balloon pump is
.removed
Consider discontinue heparin therapy 4-**
.6hours before IAB cath removal
 IABP support maybe
discontinued if the
patient clinical picture
:present the following
Absent of low cardiac output syndrome
)Urine output > 30ml/hr )>0.5ml/kg/hr
Minimal inotopics support
HR < 100bpm
Absence of lethal/unstable Dysarrthmias
MAP >70mmHg
PAWP < 18mmHg
CI > 2.4
Spo2 60-80%
Capillary refill < 2sec
.Angina free .7
Removal of balloon
catheter
Done without an operative approach
Can be done quickly & safely
Explained procedure to patient
Prep area & requirement
Disconnect the balloon from the console permitting
the IAB cath to vent to atmosphere
pt BP will collapse, the balloon membrane for)
)withdrawal
Remove all dressing & suture prior to attempt to
.withdrawn the IAB cath
Post removal, continue observe hemodynamic
status, check distal pulses & assess if risk of
.complication
Secure hemostasis
direct firm pressure at site 30-45min -
beside pressure at site,firm digital -
pressure to the femoral artery
immediately above insertion site
then apply pressure dressing -
.apply sand bag pressure for at lease 4-6hr -
.Notify doctor for risk of complication
Clinical factor increase IABP complication;
* peripheral vascular disease
* old age
* female gender
* Diabetic cases
* Hypertension
* prolonged support
* large cath size > 9.5fr
* body surface area < 1.8m2
* cardiac index < 2.2L/min/m2
Management for IABP
trouble shooting
 Theory of IABP
Refer to lecture theory for
IABP