INTRA AORTIC BALLON PUMP [IABP].ppt news

Iabp

1. INTRA AORTIC BALLON PUMP [IABP]

2. Intra aortic balloon pump counter pulsation is the simplest and most frequently used mechanical circulatory device WORKING PRINCIPLE Operation of the balloon is timed with ECG or aortic pressure wave form It inflate during diastole and deflate during systole Systole :contraction of the heart Diastole: relaxation of the heart

3. POSITIONING: By the silidinger technique Peripheral cannulation FEMORAL APPROACH : The primary access route for balloon pump is the retrograde approach to common femoral artery The sheath is placed percutaneously The balloon is passed and secured Balloon position may be checked by palpation of descending aorta in the left pleural space through sternotomy incision The catheter should be 2-3cm distal to the left subclavian artery And it should be positioned in a such way it does not occlude renal and splenic blood flow

4. INDICATIONS SUPPORT FOR : Coronary angiography Coronary angioplasty Thrombolysis High risk of interventional procedures BRIDGE DEVICE FOR Cardiac transplant Total mechanical assistance Support during ground or air transplant Post surgical myocardial dysfunction Inability to wean from CPB

5. PREOPERATIVE FOR Low EF patients Class 3 or 4 angina Repeat surgical candidates PROPYLACTIC SUPPORT FOR Anesthesia induction Non cardiac procedures

6. TIMING It defines time of balloon inflation over ECG waveform balloon inflation timing should be R-Wave Over arterial wave form balloon inflation timing at dicrotic notch TRIGGER Physiological signal that the IABP uses to identify the beginning of cardiac cycle ECG Arterial pressure Pacemaker spika Pacer Internal trigge r

7. INSERTION KIT Sheath Dilater Balloon 3-way stop cock Needle Syringe Guide wire 60ml syringe

8. IABP SIZE SELECTION It depends on patient height 50cc – 6 inch [183cm] 40cc – 5.4 inch to 6 inch [163-183 cm ] 34cc -5inch to 5.4 inch [ 152-163 cm] 25cc - <5inch [ 152 cm ]

9. PLACEMENT Tip of the IAB catheter 1-2cm distal to left subclavian artery Between 2 nd and 3 rd intercostal space MATERIALS Balloon is made up of polyurethane Helium gas is used for inflation of IABP balloon

10. COMPLICATIONS Ischemia Thrombosis Embolism Aortic dissection Bleeding Thrombocytopenia Infection Balloon leak Immobility of the balloon catheter

11. IABP WAVE FORM

12. TIMING ERRORS 1. EARLY DEFLATION Premature deflation of the intra aortic balloon during the diastolic phase Wave form characteristics Deflation of IAB is seen as a sharp drop following diastolic augmentation Sub optional diastolic augmentation Assisted aortic end diastolic pressure may be equal to or greater than unassisted aortic end diastolic pressure Assisted systolic pressure may rise

13. PHYSIOLOGICAL EFFECTS Sub – optimal coronary perfusion Potential for retrograde coronary and carotid blood flow Angina may occur as a result of retrograde coronary blood flow Sub optimal after load reduction Increased MVO2 demand

14. 2. Late deflation Deflation of IAB late in diastolic phase as aortic valve is beginning to open WAVEFORM CHARECTERISTICS Assisted aortic end diastolic pressure may be equal to the unassisted aortic end diastolic pressure Rate of risk of assisted systole prolonged Diastolic augmentation is appear wide

15. PYSIOLOGICAL CHARACTERRISTICS Afterload reduction is essentially absent Increased MVO2 consumption due to the left ventricle ejecting against a greater resistance and prolonged isovolumetric contraction phase

16. 3. EARLY INFLATION Inflation of the IAB prior to aortic valve closure WAVE CHARECTERISTCS Inflation of IAB prior to dicrotic notch Diastolic augmentation encroaches on systole PYYSIOLOGICAL EFFECTS Potential pressure closure of aortic valve Potential increased in LVEDV and LVEDP or PCWP Increased MVO2 demand

17. 4. Late inflation Inflation of the IAB after the dicrotic notch WAVE CHARECTERISTICS Inflation of IAB after dicrotic notch Absence of sharp V Suboptimal diastolic augmentation PYSIOLOGICAL EFFECTS Sub optimal coronary perfusion