Management IABP

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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

 

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 degree
– Head elevated no more than 15 degree
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 off
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 degree elevated
Leg not plexed for 18 hrs

Click here to download animated IABP pressure above (more with explaining words)

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