This document provides information on the indications, contraindications, care, and weaning of patients using an intra-aortic balloon pump (IABP). The main indications for IABP use are refractory ventricular failure, unstable angina, failure to wean from bypass, and cardiac support for high-risk surgery. Contraindications include aortic regurgitation, aneurysms, and severe peripheral vascular disease. Care involves monitoring waveforms, pressures, leg circulation, and the insertion site. Weaning involves gradually reducing support ratios and augmentation over hours as heart function and hemodynamics stabilize. Complications can include bleeding, infection, limb ischemia, embolism, or balloon rupture.

1. JAGAAN PESAKIT IABP
SN WAN SYAHIRAH BINTI WAN ZAINUDIN

3. INDICATIONS OF IABP
• REFRACTORY VENTRICULAR FAILURE
• REFRACTORY UNSTABLE ANGINA
• FAILURE TO WEAN FROM CARDIOPULMO4NARY BYPASS
• CARDIAC SUPPORT FOR HIGH RISK OF CARDIAC SURGERY ( POOR EJECTION
FRACTION AND PROLONGED BYPASS DURATION)

4. CONTRAINDICATION
• SEVERE AORTIC REGURGITATION
• ABDOMINAL AND THORACIC AORTIC ANEURYSM
• SEVERE PERIPHERAL VASCULAR DISEASE
• AORTIC DISSECTION

5. CARE OF PATIENT ON IABP

6. INSERTION
• ASSIST IN THE INSERTION OF IAB (INTRA –AORTIC BALLOON)
• IDENTIFY IAB CATHETER TIP POSITION ON CHEST X-RAY
• DISTAL LEG PERFUSION
-COLOUR, TEMPERATURE, DORSALIS PEDIS/ POSTERIOR TIBILASIS AETERIAL
PULSATION BY PALPATION OR DOPPLER ULTRASOUND, URINE OUTPUT, PLATETET
COUNT
• NURSE PATIENT SUPONE LESS THAN 30* PROP-UP, DO NOT BEND THE LOWER
LIMB WITH IABP CATHETER

7. CARE OF PATIENT ON IABP CATHETER
• CIRCULATION CHART. USE DROPPLER ULTRASOUND
• INSERTION SITE. OBSERVE FOR SIGNS OF BLEEDING, HEMATOMA OR INFECTION
EVERY SHIFT
• MONITOR ARTERIAL WAVEFORM, INFORM DR IF THE WAVEFORM LOOKS ABNORMAL
• MAINTAIN MAP > 60mmHg AND AUGMENTED PRESSURE > 100mmHg
• NURSE PATIENT SUPINE LESS THAN 30*, PROP UP, DO NOT BEND THE LOWER LIMB
• INSTRUCT THE PATIENT NOT TO BEND THE LEG IN WHICH THE BALOON WAS
INSERTED

8. • NEVER LET THE MACHINE IN STANDBY MODE AS IT WILL CAUSE CLOT FORMATION ON
THE BALLOON SURFACE WITHIN THE AORTA ESPECIALLY WHEN NO ANTICOAGULATION
WAS STARTED
• CHECK COAGULATION PROFILE AND PLATELETES COUNT BEFORE PLAN FOR IAB
CATHETER REMOVAL
• PATENT SHOULD LIE SUPINE FOR 6 HOURS AFTER IABP REMOVAL

9. DETERMINE EFFECTIVE FUNCTION OF IABP
• ABSENT ARTERIAL WAVEFORM IN IABP MACHINE
• CHECK ALL CONNECTION : IABP TUBING AND PRESSURE TRANSDUCER
• ENSURE THAT THE PRESSURE TRANSDUCER IS PRESSURIZED TO 300mmHg , RE-
INFLATE THE PRESSURE BAG WHEN THE PRESSURE IS LOW
• RE-ZERO THE PRESSURE TRANSDUCER
• INFORM DR MAY NEED TO ASPIRATE AND FLUSH THE PRESSURE MONITORING LINE
• LOW GAS HELIUM

10. • ARRHYTHMIAS: ATRIAL FIBRILLATION – ECSTATIC WAVEFORM
• CHANGE THE TRIGGER TO PRESSURE TRIGGER
• IF THE HEART BEAT IS HIGH >120 BPM, REDUCE THE SUPPORT RATIO FROM 1:1 TO 1:2
• INFORM DOCTOR TO TREAT THE AF

11. WEANING
• CONTINUOUS EVIDENCE OF STABLE OR IMPROVED LEFT VENTRICULAR FUNCTION
• SINGLE OR DOUBLE LOW DOSE INOTROPIC SUPPORT
• STABLE HEMOYDNAMIC : MAP> 70mmHg, SYSTOLIC BLOOD PRESSURE >90mmHg
• WEAN THE SUPPORT RATIO
- FULL SUPPORT 1:1 RATIO (EVERY BEAT IS SUPPORTED)
- REDUCE 1:2 SUPPORT FOR 1-2 HOURS
- THE REDUCE 1:3 SUPPORT FOR 30 MINUTES BEFORE REMOVING IABP. LIMIT 1:3 SUPPORT FOR
LESS THAN 30 MINUTES AS IT MAY CAUSE CLOT FORMATION IN THE BALLOON SURFACE (
WITHOUT FULL ANTICOAGULATION)

12. • REDUCE FROM 100% AUGMENTATION TO 80% FOR 1-2 HOURS
• THEN 80% -50% FOR ANOTHER 1-2 HOURS
• WHEN BLOOD PRESSURE STABLE , CAN OFF THE IABP

13. CARE AFTER REMOVAL OF IABP
• APPLICATION OF PRESSURE ON PUNCTURE SITE
• DISTAL LEG PERFUSION – COLOUR, TEMPERATURE, DORSALIS PEDIS, POSTERIOR
TIBILASIS ARTERIAL PULSATION
• OBSERVATION FOR BLEEDING AT PUNCTURE SITE
• HOULY CHECK BLOOD PRESSURE AND HEART RATE
• INFORM DR IF HYPOTENSION

14. COMPICATION CAUSED BY IABP
• BLEEDING AT INSERTION SITE
• INFECTION AT INSERTION SITE
• LIMB ISCHAEMIA
• AIR EMBOLISM
• BALLOON RUPTURE
• THROMBOCYTOPENIA

15. THANK YOU