Iabp

Intra aortic baloon pump

1. INTRA AORTIC BALOON PUMP PRINCY FRANCIS M II MSc (N) JMCON

2. History Dr. Adrian Kantrowitz – 1952 Augmentation of coronary blood flow by retardation of the arterial pressure pulse in animal models. 1979 : Bergman - first percutaneous insertion of IABP 1985 : First IAB model

3. definition IABP is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. IABP therapy is referred to as counter pulsation because the timing of balloon inflation in opposite to ventricular contraction

4. PURPOSe The primary goals of IABP treatment are: To increase myocardial oxygen supply and to decrease myocardial oxygen demand. Improvement of cardiac output (CO), an increase of coronary perfusion pressure.

5. INDICATION Cardiac failure. Refractory Unstable angina. Perioperative treatment of complications due to myocardial infarction. (ventricular aneurysm with ventricular dysrhythmia, acute ventricular septal defect, acute mitral valve function, cardiogenic shock) As a bridge to cardiac transplantation Preoperative, intraoperative and postoperative cardiac surgery High risk interventional cardiology procedures

6. contraindication Severe aortic insufficiency Aortic aneurysm Aortic dissection Aortic stents Bilateral femoral popliteal bypass grafts for severe PVD Irreversible brain damage Limb ischemia Thrombo embolism

7. IABP catheter Biocompatible, non thrombogenic material Catheter is 10- 20 cm long polyurethane bladder with 25- 50cc capacity.

8. IABP parts A flexible catheter -2 lumen For distal aspiration/flushing or pressure monitoring For the periodic delivery and removal of helium gas to a closed balloon. 2. A mobile console System for helium transfer Computer for control of the inflation and deflation cycle.

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10. Physiologic principle Balloon inflation – at the onset of the diastole Remains inflated throughout the diastole Increases aortic pressure, coronary blood flow , augmentation of diastolic pressure and myocardial oxygen delivery. Deflate : at the onset of systole Reduces afterload, reduce workload and decrease myocardial oxygen demand.

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12. Hemodynamic effect Aorta : Systolic pressure, diastolic pressure Left ventricle : Systolic pressure, end diastolic volume, Volume, Wall tension Heart : afterload, CO, oxygen demand Blood flow: coronary blood flow

13. IABP KIT CONTENTS Introducer needle Guide wire Vessel dilators Sheath IABP (34 or 40cc) Gas tubing 60-mL syringe Three-way stopcock

14. Balloon Sizing Sizing based on patients height Four common balloon sizes Balloon length and diameter increases with each larger size 40 cm³ balloon is most commonly used.

15. IABP INSERTION Connect to ECG Set up pressure line Select IABP balloon size IABP catheter is inserted percutaneously into femoral artery through an introducer sheath using Modified seldinger technique. Subclavian, axillary, brachial or illiac artery

16. The catheter is secured in position by suturing Outer lumen for delivery of gas and inner lumen for arterial pressure monitoring. The balloon inflates after the aortic valve closure and deflate immediately before the opening of the aortic valve. IABP timing were in relation to cardiac cycle .

17. IABP WAVEFORM dfgd

18. Trigger modes Event used by pump to identify the onset of cardiac cycle

19. ECG PATTERN: The height, width and slope of a positively or negatively deflected QRS com­plex are analysed by the IABP machine. This is the preset (default) trigger mode. ECG PEAK: The height and slope of a positively or negatively deflected QRS complex are analysed by the IABP machine. This is the trigger mode of choice in wide complex rhythms. A-FIB: The QRS complex is analysed in the same manner as in the peak mode. This is the trigger mode of choice in varying R-R intervals as in atrial fibrillation. V PACE: Ventricular signal is used as the trigger signal. This is the trigger mode of choice in 100% ventricular or AV paced rhythms. A PACE: Atrial spike is used as the trigger signal. This is the trigger mode of choice in 100% atrial paced rhythms. ARTERIAL PRESSURE: Systolic upstroke of the arterial pressure waveform as the trigger signal. This is the trigger mode of choice where ECG signals are distorted or unavailable. INTERNAL: The balloon inflates and deflates at a preset rate regardless of the patient's cardiac activity. This mode is used in situations where there is no cardiac output or ECG is unavailable.

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21. Timing errors Early inflation Late inflation Early deflation Late deflation

22. Early inflation PHYSIOLOGIC EFFECT : Potential premature closure of aortic valve Increase afterload Aortic regurgitation

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24. PHYSIOLOGIC EFFECTS : Suboptimal coronary perfusion Suboptimal afterload reduction

25. Vdvfs Physiologic effect Absent afterload reduction and may increase afterload

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31. Rounded balloon pressure waveform Loss of plateau resulting from a kink or obstruction of gas Improper catheter position IABP is too large for aorta

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33. Patient management during IABP support Check chest X ray daily Provide anticoagulation and maintain aPTT at 50 – 70 sec. Check lower limb pulses 2 hourly. Hip flexion is restricted and head of the bed should not be elevated beyond 30 degree

34. Prophylactic antibiotics Use pressure relieving mattress Never leave in standby mode for > 20 mts Daily check heamoglobin , platelet count and renal function. Wean off the IABP as early as possible Change occlusive dressing daily

35. WEANING OF IABP FZ

36. Wave forms ref

37. REMOVAL OF IABP - Discontinue heparin 1 hour prior to removal - Disconnect the IAB catheter from the IAB pump - Patient blood pressure will collapse the balloon membrane for withdrawal Withdraw the IAB catheter through the introducer sheath until resistance is met. NEVER attempt to withdraw the balloon membrane through the introducer sheath. Remove the IAB catheter and the introducer sheath as a unit - Check for adequacy of limb perfusion after hemostasis is achieved. Apply constant pressure to the insertion site for a minimum of 30 mts Check distal pulses frequently

38. COMPLICATIONS Limb Ischaemia Bleeding from site & internal Thrombosis Aortic perforation and / dissection Renal failure and bowel ischemia Neurologic complication include paraplegia Heparin induced thrombocytopenia Aortic valve rupture Infection/Sepsis Balloon leak or rupture

39. Nursing management Conduct detailed cardiovascular assessment Monitor ECG frequently Assess for adequate tissue perfusion Adopt prophylactic measures to prevent atelectasis, respiratory tract infection and aspiration. Avoid prolonged hypotension and shock, which may affect renal function. Provide psychosocial support to patient and family- minimize stress, disorientation and sleep deprivation.

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