IABP THERAPY – Flashcards
Unlock all answers in this set
Unlock answersquestion
Goals of IABP therapy
answer
-Decrease the work of the heart -Decrease myocardial oxygen demand -Increase coronary perfusion -Improve cardiac output -Limit myocardial ischemia -Prevent cardiogenic shock and limit size of infarctions
question
IABP uses
answer
-support in acute MI with cardiogenci shock -circulatory support in post-CABG patients -support in high-risk catheterizations -In severe ischemia as a bridge to revascularization -Intractable chest pain refractory to conventional care
question
IABP therapy
answer
-Balloon inserted percutaneously in the femoral artery -Balloon sits in the descending aorta, just distal to the left subclavian artery and above the renal arteries -Balloon inflates and deflates based on patient's EKG or arterial pressure waveform -Ventricular systole, the balloon is deflated -Ventricular diastole, the balloon is inflated
question
Contraindications of IABP therapy
answer
-Aortic insufficiency -Severe Aortic disease
question
Complications of IABP therapy
answer
-Ischemia of limb distal to insertion site -Aortic dissection -Thrombocytopenia -Septicemia -Infection -Renal complications -Air/gas emboli
question
Late deflation
answer
the balloon is inflated during the beginning of ventricular systole. This increases the work load of trhe left ventricle. Very harmful for the patient.
question
Early inflation
answer
the balloon in inflated before aortic valve closure. Causes reflux of blood into the left ventricle. Decrreases cardiac output and increases SVR, Harmful.
question
Suboptimal augmentation
answer
a result of late inflation, there is minimal displacement of blood back toward the coronary arteries.
question
vacuum effect
answer
a result of early delfation. Afterload reduction is lost. This occurs because by the time the aortic valve opens, the pressures in the aorta has equalized.
question
Transport considerations- trigger mode
answer
Due to aircraft vibration, the trigger mode may need to be tghe arterial pressure line. The ECG may have too mjuch artifact to effectively trigger the balloon inflation/deflation.
question
Transport considerations- balloon purge
answer
Balloon will purge on ascent due to Boyle's Law and gas expansion with increasing altitude. Balloon will purge again on descent due to gas contraction wtih decreasing altitude.
question
Transport considerations- patient decompensation
answer
Watch for patient decompensation during balloon purges. Be prepared to treat patient.
question
Transport considerations- art line
answer
Make sure that all air is out of the art line to minimize dampening of the waveform since this may be a trigger source in the event of EKG trigger failure.
question
Transport considerations- cardiopulmonary arrest
answer
In the event of cardiopulmonary arrest in the patient, place the trigger mode on arterial pressure or on internal trigger mode.
question
Transport considerations- power failure
answer
In the event of power failure, the balloon needs to be manually pumped every 30 minutes to prevent thrombus formation on the balloon.
question
Transport considerations- balloon placement
answer
Before leaving a facility assure balloon placement by verifying the distal tip of the balloon is 2 cm below the aortic arch, and the proximal end of the balloon does not occlude the renal arteries. Get a RECENT chest film.
question
Transport considerations- balloon too low
answer
Watch urinary output and distal pulses closely in transport- renal arteries are occluded.
question
Transport considerations- balloon too high
answer
Loss of left radial pulse indicates the balloon has migrated upward covering the subclavian artery.
