simple ppt

1. JOHNY WILBERT, M.SC[N]
LECTURER,
APOLLO INSTITUTE OF HOSPITAL
MANAGEMENT AND ALLIED SCIENCE

2.  The Intra-Aortic Balloon Pump (IABP) is a circulatory
assist device that is used to support the left ventricle.
 The IABP uses counterpulsation where aortic blood is
displaced with the inflation and deflation of the balloon
catheter, which is timed to the cardiac cycle.

5.  Severe aortic insufficiency
 Aortic or abdominal aneurism
 Severe peripheral vascular disease

6. The balloon catheter is inserted either percutaneously or surgically
by cutdown into the patients’ femoral artery.

7.  Connect to mains power to ensure the battery is preserved.
 Check the helium tank is open at the back of the pump.
 Ensure both an ECG and pressure trace can be obtained
from the patient on the screen of the IABP.
 The IABP can obtain a trigger, which stimulates the
pumping of the balloon.

8.  Frequency when first commencing pumping is on 1:1,
which means that for each heart beat the balloon, will
be inflated.
 To commence balloon pumping, inflation and deflation
points should be set at the midline and then once
pumping is established, timing should be reassessed.
 Connect the extension tubing to the balloon catheter
and on the balloon console at the back.

9.  Helium is used as it is easily dissolves in
blood than air and prevents the risk of air
emboli if the catheter ruptures.

10. The end of the balloon should be just distal (1-
2 cm) to the take-off of the left subclavian
artery
 Position should be confirmed by fluoroscopy
or chest x-ray

11. Trigger
Frequency
Augmentatio

12. LV contraction:
- Isovol. Contraction (b)
- maximal ejection (c)
LV relaxation:
- start of relaxation and
reduced
ejection (d)
- isovol.relaxation (e)
LV filling:
- LV filling , rapid phase (f)
- slow LV filling (g)
- atrial systole( a)

16. Inflation and deflation of the balloon
 Blood is displaced to the proximal aorta by inflation during
diastole.
 Aortic volume ( afterload) is reduced during systole through
vacuum effect created by rapid balloon deflation
 Decrease in SBP by 20 %
 Increase in aortic Diastolic Press. by 30 % ( raise coronary
blood flow)

17.  Increase in MAP
 Reduction of the HR by 20%
 Decrease in the mean PCWP by 20 %
 Elevation in the COP by 20%

23. First change from 1:1 to 1:2 augmentation
 Check the dicrotic notch
 See if augmentation starts at that point
This should produce a sharp “V” at inflation.
 Check if diastolic augmented wave is ›
systolic wave

24. Confirm if end diastolic wave following the
augmented wave is less than an non
augmented wave.
Is Deflation slope ok.

27.  Inflation of the IAB markedly after closure of the aortic
valve.
 Waveform Characteristics:
• Inflation of IAB after the dicrotic notch.
• Absence of sharp V.
• Sub optimal diastolic augmentation

30. Late deflation of the IAB during the diastolic phase.
 Waveform Characteristics:
• Assisted aortic end diastolic pressure may be equal to
the unassisted aortic end diastolic pressure.
• Rate of rise of assisted systole is prolonged.
• Diastolic augmentation may appear widened

34. Rounded balloon pressure waveform
- Loss of plateau resulting from a kink or
obstruction of shuttle gas
- Kink in the catheter tubing
- Improper IAB catheter position
- Sheath not being pulled back to allow
inflation of the IAB
- IAB is too large for the aorta
- IAB is not fully unwrapped
- H2O condensation in the external tubing

35. - due to a loose connection
- a leak in the IAB catheter
- H2O condensation in the external tubing
- a patient who is tachycardiac and febrile which causes
increased gas
diffusion through the IAB membrane

36. Anticoagulation-- maintain apTT at 50 to 70
seconds.
CXR daily – to R/O IAB migration.
 Check lower limb pulses - 2 hourly.
 Hip flexion is restricted, and the head of the
bed should not be elevated beyond 30°.

37. Never leave in standby by mode for more than 20
minutes
 Daily
 Haemoglobin (risk of bleeding or haemolysis)
 Platelet count (risk of thrombocytopenia)
 Renal function (risk of acute kidney injury
secondary to distal migration of IABP catheter)
 Wean off the IABP as early as possible as longer
duration is associated
 with higher incidence of limb complications

39. Timing of weaning:
 Patient should be stable for 12 – 24 hours
 Decrease inotropic support
 Decrease pump ratio
 From 1:1 to 1:2 or 1:3
 Decrease augmentation
 Monitor patient closely
 If patient becomes unstable, weaning should be
 Immediately discontinued

40. THANK YOU