Management IABP
IABP is a device that designed to increase coronary artery perfusion, decrease myocardial workload, and decrease afterload (Debra J. Lynn-McHale;2001)
Purpose for IABP
1. increase coronary artery perfusion —> diastolic fase
2. decrease myocardial workload, and decrease afterload —> sistolic fase
The IABP offers the following potential benefits
a. Better circulation
b. Lower heart rate and decreased workload of the heart
c. Improved efficiency of the heart’s pumping
d. Increased supply of oxygen to heart tissues and decreased demand for it
e. Less pressure resistance in the aorta when the heart pumps (during the systole)
f. More pressure in the aorta,
g. which reduces the backflow of blood during the relaxed part of the heartbeat (the diastole)
Indication of IABP
1. Syock Cardiogenic
2. Unstable Angina
3. Ventricle Disrhytym by ischemia
4. Profilaksis before cardiac surgery
5. Failure in CPB weaning
6. LV failure after CPB
Contraindications of IABP
A. Absolute
– Aortic insufficiency
– Dissecting aortic aneurysm
B. Relative
– End-stage Cardiomyopathy
– Severe atherosclerosis
– End-stage terminal disease
– Abdominal aortic aneurysm, not resected
– Blood dyscrasia / bleeding disorders
Ballon Description
1. IABP cath are constructed of siliconized polyurethane, that minimizes of clot formation
2. Size: – 8,9,10,12 french
- Membrane length : 9 – 10.3 inches (228-260 mm)
- Inflate diameters :15 – 18mm
DETERMINATION OF BALLOON SIZE
AGE X WEIGHT (LB) BALLOON SIZE (CC)
< 3500 20
3500 – 6000 30
> 6000 40
PHYSIOLOGIC EFFECTS
A. Diastole / Balloon Inflation:
1. Increased coronary and cerebral perfusion
2. Increased systemic perfusion
3. Increases coronary colateral circulation
B. Systole / Balloon deflation:
1. Decreased afterload
2. Decreased myocardial work and oxygen consumption
3. Increased stroke volume and cardiac output
4. Decreased LV preload
PREPARATION
1. IABP machine: – Electrodes
- Tranducer cable
2. Balloon catheter / IABP set
3. Dressing set for IABP
4. Suture kit
5. Tranducers set : – Pressure bag
- Tranducer cable
- Flush system
POST INSERTION MANAGEMENT
Assses peripheral pulses, bleeding,skin colour every 15 mnts for 1 hr post insertion, 30 mnts for 2 hrs, 1 hrs while IABP is in place
Position : – Straigh leg
- Hip plexed no more than 30°
- Head elevated no more than 15°
Monitoring hemodynamic responses
X ray
Cloting studies : Target APTT 1,5 – 2 times control ( desirable level 150- 200 )
WEANING
Indication Parameters:
1. PCWP < 18mmHg 2. C.I > 2.2
3. Systolic BP > 90 mmHg
Reduce ratio of assisted from 1:1 to 1:2 until 1:4. in 60 mnts.
If weaning time is prolonged, mode should be returned to 1:1 for 5 mnts each hour to reduce incidence of clot formation.
REMOVAL OF IABP
Make sure:
– Minimal inflation & rate
– Clotting profile is evaluated
– Anticoagulant therapi is tapered: heparin stop 4 hour before removal of the catheter
– Turn the IABP of
– Aspirate the balloon using one way valve/ 3way stopcock
– Remove the suture
– Withdrawn balloon & sheath, allowed to bleed for 3 second to permit removal of any clot
– Compression of the femoral artery for 30 mnts of longer if bleeding persists
– Evaluates peripheral pulse & patient status immediately
– Check bleeding (direct visualization) for 10 mnts, if any bleeding: direct compression for 20 mnts & applied pressure 5 pound to the groin site for 6 hours
– Assessed for bleeding every 30 mnts time 2,hourly time 8 and every 4 hrs time 6
– Head of the bed < 30° elevated
– Leg not plexed for 18 hrs
Click here to download animated IABP pressure above (more with explaining words)
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