The level of the transducer is at the phlebostatic axis that is confirmed using the spirit level and is changed as per patient position. Cardiovascular assessment is performed hourly or more frequently if haemodynamic status deteriorates. Education plays a pivotal part in nursing care. Our intensive care unit during a typical procedure to insert an intra-aortic balloon pump 125-131. In addition the full blood count and anti-coagulation screen is observed for a decrease in haemoglobin and platelet count or evidence that the patient is receiving too high dose of anticoagulant. IABs are generally measured by the volume of gas they contain, with sizes ranging from 2.5 mL for infants to 50 mL for large adults. Nurs Mirror Midwives J. Aside from gathering the equipment specific to IABP insertion, nursing care involves preparing the patient, eg. Weaning and removal In 2013, the American College of Cardiology and American Heart Association downgraded the strength of the recommendation for IABP use in cardiogenic shock after acute myocardial infarction, citing conflicting data on its usefulness. May 2012; British Journal of Cardiac Nursing 7(5):222-229; DOI: 10.12968/bjca.2012.7.5.222. 15. Frequency of monitoring depends on patient’s clinical condition and as acuity determines. Table 1 lists the many indications for IABP therapy. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. 49. Nursing care involves care of the pump as well as assessing patient from a cardiovascular and haemodynamic perspective . Reid MB. For an average patient, the intra-aortic balloon (IAB) is 20 to 25 cm long. Post removal the patient is kept on bed rest with the leg kept straight as per local guidelines. The insertion site dressing should be transparent which enables visual inspection of the site. and Cottrell D. Nursing care of patients receiving Intra-aortic Balloon Counterpulsation. Today. Balloon size generally depends on the patient's height and aortic diameter. Nursing care of patients during intraaortic balloon pumping, Deflation occurs at the end of diastole just before systole, which results in aortic blood being displaced down toward the mesenteric and renal arteries, increasing perfusion to these organs, and thus reducing the afterload (the pressure in the aorta that the heart has to pump against) (see Figure 1). It reflects severe left-sided heart failure. Diastole is recognised as the pres. Since then it has assumed a pivotal role in the treatment of those with heart failure and myocardial ischaemia and, according to Reid and Cottrell,1 is the most widely used mechanical support. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Explore. Caring for patients with intraaortic balloon pumps (IABPs) is a unique nursing challenge in the cardiovascular recovery and intensive care units. The intra-aortic balloon pump: a nursing care study. 12. The net result of inflation and deflation is increased coronary and cerebral perfusion and reduced myocardial workload respectively. What is intra-aortic balloon pump? 14. References . J Am Coll Cardiol 2001; 38(5): 1456, Woods S, Sivarajan Froelicher ES, Underhill Motzer SA. •The balloon pressure waveform must be assessed to verify that the inflation/deflation process is occurring correctly, that the catheter is not kinked or leaking, and that optimal counterpulsation is occurring (for details, see Nursing Practice & Skill … Intra-aortic Balloon Pump: Assessing the Pressure Waveform ). intra-aortic balloon pump explanation free. Intra-aortic balloon pump therapy is widely used for patients with left ventricular dysfunction, despite recent controversy regarding its benefit. Although it was originally designed to support patients in cardiogenic shock the indications have expanded because of continued research. Prior to insertion of the IABP a baseline assessment is performed incorporating lower and upper limb perfusion. An intra-aortic balloon pump (IABP) is a device that supports the heart in pumping a sufficient amount of blood around the body. Patient position is an important consideration if the IABP is to be effective. The goal of IABP therapy is to improve myocardial oxygen supply and reduce myocardial oxygen demand. 13. Once the patient’s condition has stabilised the IABP is considered for removal. Reid and Cottrell1 list the following as risk factors: female gender, pre-existing peripheral arterial disease, older age, diabetes mellitus, smoker, hypertension and obesity. Reid MB, Cottrell D. Nursing Care of Patients receiving intra-aortic balloon counterpulsation. Now, 40 years after the its introduction in the clinical practice, the intra-aortic balloon pump (IABP) is the most widely used temporary cardiac assist device It was used in clinical pratice initially in 1967 for the treatment of cardiogenic shock Other indications include septic shock, cardiac support for non-cardiac related surgery and support post correction of anatomical defects. A credentialed physician will oversee the IABP management and manipulation. The current practice of intra-aortic balloon counterpulsation. The primary causes of limb ischaemia are obstruction of a small or diseased femoral artery by the catheter, formation of thrombus from direct arterial injury during IABP insertion and thromboembolism. In the 1960s, cardiac surgeon Dr Adrian Kantrowitz pioneered the intra-aortic balloon pump – a surgically implantable device that provided mechanical circulatory support in patients following cardiac surgery. Critical Care Nurse 2005: 25 (5): 40-49 8. The IABP is implanted into the patient's aorta. Piper R. and Bowden T. The intra-aortic balloon pump: a nursing care study. ABSTRACT •THE INTRA‐AORTIC BALLOON PUMP (IABP) is a commonly used circulatory‐assist device that increases myocardial oxygen supply and reduces … Patients and families are instructed to report symptoms that may be suggestive of impaired peripheral perfusion such as tingling, numbness, coldness, pallor and pain to a nurse as this may be indicative of limb ischaemia. Cardiovascular nurses caring for these patients require skills and knowledge that enable prompt recognition and treatment of sometimes life-threatening complications associated with balloon pump therapy. There is no palpable dorsalis pedis in 8-10% of the general population and this should be documented on nursing assessment prior to IABP insertion.1 if the pulses are not palpable a doppler should be used to determine the presence of pulses that are difficult to palpate. Philadelphia, PA: WB Saunders, 2002. Potential complications 2009;9(1):24-28. In-depth physiologic principles that involve a sound understanding of cardiovascular complications, with indications for physiologic and psychologic interventions, are necessary to aid the nurse during this critical period, moreover the cardiovascular nurses caring for these patients require skills and knowledge that enable prompt recognition and treatment of sometimes life-threatening complications associated with balloon pump therapy. From the experience acquired in the treatment of cardiogenic shock and in the use of the IABP, it has emerged the unavoidable need to resort as soon as possible to IABP and intensive care to avoid multi-organ damages highly associated to mortality. Results from the benchmark registry. 1. Lewis, Peter, Ward, Darian, & Courtney, Mary (2009) The intra-aortic balloon pump in heart failure management: Implications for nursing practice. The patient should be no higher than 30º, which ensures patency of the balloon, continuous flow to the balloon, and reduces the risk of catheter kinking and obstructing the passage of helium into and out of the catheter. Intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP SHOCK Trial for attenuation of multiorgan dysfunction syndrome Crit Care Med. How does an intra-aortic balloon pump work? IABP therapy is a method of mechanically assisting and supporting the coronary and systemic circulation in patients who have myocardial pump dysfunction or in those with coronary ischaemia and/or undergoing complex high-risk percutaneous coronary intervention. Nursing Care Of Patients on Intra-Aortic Balloon Pump. Acute ischaemia of the limbs may produce the six Ps – pain, pallor, pulselessness, poikilothermia (cold), paraesthesia and paralysis.1 In cases of limb ischaemia occurring, removal of the balloon catheter restores perfusion, rarely a partial or full amputation is necessary. Caring for patients with intraaortic balloon pumps (IABPs) is a unique nursing challenge in the cardiovascular recovery and intensive care units. Nursing care involves observing for recurrence of symptoms as well as checking the insertion site for haematoma formation ooze or symptoms suggestive of retroperitoneal bleed every 15 minutes for the first hour, half hourly for the next two hours and thereafter hourly or as clinical acuity dictates. 2010 Jan;38(1):152-60. doi: 10.1097/CCM.0b013e3181b78671. Cardiovascular assessment involves heart rate and rhythm, augmented pressure (pressure that the balloon exerts when inflated to push the blood into the coronary and carotid arteries), mean arterial pressure, temperature, respiratory rate and oxygen saturations.3 The aim is that the mean arterial pressure is maintained between 60-70mmHg which indicates adequate peripheral perfusion.5 This is confirmed by the patient being warm to touch, good capillary refill, no evidence of cerebral hypoxia and urinary output = 0.5ml/kg/hr. The IAB is inflated with helium, an inert gas with a lower molecular weight than room air. What is lntra-Aortic Balloon Pump Therapy – It is a short-term cardiac assist device placed in the descending aorta to improve myocardial oxygen supply and reduce cardiac workload by decreasing afterload. Guidelines for Management of the Intra-Aortic Balloon Pump Purpose: To outline the nursing management of patients requiring an Intra-Aortic Balloon Pump (IABP). Treatment of bleeding includes applying pressure to the insertion site and administration of blood products as required. The limitations in activity that the patient will experience should be explained such as bed rest and reduced movement of the affected leg. Therapy may be timed to 1:1, 1:2 or 1:3, implying that the balloon inflates and deflates according to each cardiac cycle, every second cardiac cycle or every third cardiac cycle respectively. Management of acute heart failure is an important consideration in critical care. Thrombocytopenia can result from anticoagulation therapy or from platelet destruction due to mechanical trauma that occurs during inflation of the IABP catheter. 2 Objectives. IABP is a form of circulatory support for those presenting with ischaemia or heart failure. This type of therapy works by the balloon inflating and deflating in synchrony with the cardiac cycle. The lighter weight of heliu… Australian Critical Care, 22(3), pp. British Journal of Cardiac Nursing 2012: 7 (5): 222-29 7. Authors Roland Prondzinsky 1 , Henning Lemm, Michael Swyter, Nikolas Wegener, Susanne Unverzagt, … Limb ischaemia and bleeding are two complications associated with this therapy and will be discussed in detail.2. Critical Care Nurse 2005; 25(5): 40-49, Ferguson JJ, Cohen M, et al. Participants should have experience with hemodynamic monitoring and work in an area where IAB therapy is utilized such as critical care, the cath lab or the operating room. The nurse's role in medication saftey; Preventing falls in hospitalized older adults; Managing delirium behaviors with one-to-one sitter; International public health emergencies: Lessons learned in West Africa; Keeping children with latex allergies safe; Calling on smartphones to enhance patient care; … This involves confirming presence of the pedal pulses – dorsalis pedis and posterior tibial in both feet, assessing capillary refill and temperature and observing the colour of the limbs (cyanosis, pale, mottled). During diastole, the aortic valve clos… Authors: Rosy Owen. Meaning of intra-aortic balloon pump medical term. The primary purpose of IABP is the support of the failing heart by simultaneously increasing myocardial oxygen supply and decreasing myocardial oxygen demand. The ICU nursing professional, who works with more and more sophisticated technologies and devices, has always to be acquainted with current literature, in order to ensure a better nursing care and to reduce complications. Baseline full blood count and anticoagulation screen should be reserved prior to and during therapy to observe for changes such as a decrease in haemoglobin and to monitor the effect of anticoagulation therapy prescribed. This article provides an overview of the function of the pump, indications, potential complications and nursing care required. Intra Aortic Balloon Pump (IABP) Saved by Valerie Serwicki. Apr 8, 2013 - Looking for online definition of intra-aortic balloon pump in the Medical Dictionary? The aortic valve normally has three cusps: right, left, and posterior. As with any invasive haemodynamic monitoring system the pressure bag should be inflated and maintained at 300mmHg, thus ensuring optimal flush system, which is required for line patency. What does intra-aortic balloon pump mean? Indications of bleeding may manifest as oozing, bruising or haematoma formation at the insertion site or by swelling in the thigh area. Intra-Aortic balloon pump (IABP) therapy was first introduced in the 1960s for the treatment of cardiogenic shock. Kate O'Donovan is course co-ordinator for the postgraduate diploma in cardiovascular nursing in the Mater Hospital, Dublin . Briefly, the intraaortic balloon pump is a specific and aggressive form of care for patients in cardiogenic shock. Signs of retroperitoneal bleeding include the patient becoming hypotensive and complaining of back, flank or abdominal pain unrelieved by changes in position. Intra-Aortic Balloon Pump What it is and what it does Don Stroup, CC/NREMT-P Poudre Valley EMS Objectives This presentation is intended to increase your existing knowledge on the care and transport of patients receiving IABP therapy. Title: Intra Aortic Balloon Pumping 1 Intra Aortic Balloon Pumping. attaching the patient to the pump’s ECG leads and labelling them, setting up the transducer and levelling it with the patient’s phlebostatic axis (fourth intercostal space mid axilla which is the level of the left atrium), in addition to prepping the groin site. During left ventricular systole, the aortic valve opens and the aortic cusps are reflected superiorly to obstruct the coronary ostia. Sice A. Intra-aortic balloon counterpulsation complicated by limb ischaemia: a reflective commentary. Nursing care study: the intra-aortic balloon pump in left ventricular failure. ence of the dicrotic notch on the pressure waveform, which triggers balloon inflation. 5th Ed. How it works Kate O'Donovan is course co-ordinator for the postgraduate diploma in cardiovascular nursing in the Mater Hospital, Dublin, Continuing Education - Cardiology - Intra-aortic balloon pump therapy, Complications post myocardial infarction (VSD, papillary muscle rupture, acute mitral regurgitation), Ischaemia related intractable ventricular arrhythmias, Ventricular failure unresponsive to pharmacological therapy, Post-surgical myocardial dysfunction/low cardiac output syndrome, Bridge to other form of circulatory support, Assess cardiovascular hourly, or more frequently depending on clinical acuity, noting mean arterial pressure, augmented pressure heart rate, oxygen saturation and perfusion state (lower and upper limb perfusion assessment), Assess and observe for any alteration in neurological status, Confirm timing, ratio and trigger of intra aortic balloon pump hourly, Strict intake and output record – aim for output 0.5ml/kg/hr – report any sudden decrease in urinary output (signs of decreased renal perfusion due to low cardiac output or migration of the catheter to the renal arteries obstructing blood flow), Ensure the transducer is level with the phlebostatic axis, flushed hourly and zeroed four hourly or on change of patient position. Historically, most patients in cardiac care units (CCUs) have been admitted with the diagnosis of acute myocardial infarction (AMI) or a complication of AMI. The following guidelines have been prepared to establish a quick reference guide for the safe and effective use of IABP therapy. Table 3 lists the potential complications associated with IABP therapy. More information... People also love these ideas Pinterest. Nursing care involves checking the insertion site every hour for bleeding or haematoma formation and documenting findings. This is a frightening time for the patient and family. The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. Cont Edu Anaesth Crit Care & Pain. The most common indications are low cardiac output due to left ventricular dysfunction and myocardial ischaemia. 6. The intra-aortic balloon pump in heart failure management: implications for nursing practice. Take the course “Intra-aortic balloon pump” Learning Link NE014-7029 Management of Patients on Intra-Aortic Balloon Pump in Special Situations. This serves as a baseline for assessments post insertion. Once the patient is stable the IABP can be removed. Prior to insertion a lower limb perfusion assessment involving both legs must be completed. When caring for patients receiving this therapy nurses must be alert for possible occurrence of complications. The National Centre of Health Statistics estimated that IABP was used in 42 000 patients in the USA in 2002. By continuing you agree to the use of cookies. Bleeding at the insertion site is commonly encountered and may be due to anticoagulation therapy or associated thrombocytopenia. A recommended nursing care plan for providing care to IABP patients is reviewed, including an overview on transport considerations, weaning IABP support and IAB removal with emphasis on nursing assessment during and post-therapy. We use cookies to help provide and enhance our service and tailor content and ads. The IABP is a cardiac assist device consisting of a long, cylindrical polyethylene balloon at the end of a flexible catheter. The catheter tip is radiopaque so its position can be evaluated on x-ray.3 The catheter attaches to a pressurised flush system, similar to that of an arterial line, and also to the pump itself where helium is shuttled in and out of the catheter so that the balloon can inflate and deflate. Upper limb assessment is essential so that balloon migration obstructing blood flow down the left subclavian artery can be detected promptly. In relation to complications patients are educated about the risk of bleeding at the insertion site and are advised to put pressure on the site when coughing or sneezing and to notify the nurse promptly if they experience pain in the lower back or a sudden burning, pain or wetness at the insertion site. Thoroughness when obtaining the patient’s medical history is essential for recognising factors that predispose the patient to the development of complications. 2. The patient is assessed for their tolerance of lying flat and also their need for sedation or anxiolytics as per hospital guidelines. Nursing considerations regarding the intra-aortic balloon pump, the TandemHeart, the Impella, and extracorporeal membrane oxygenation. Always flush with the pump on standby, Check all connections, observe the balloon catheter for presence of blood which may indicate balloon puncture/rupture hourly, Monitor for signs of pulmonary oedema or ischaemia, Monitor temperature two-to-four-hourly, observing for signs of infection such as erythema/inflammation and pain at the insertion site and a raised white cell count, Observe for bleeding at cannulation sites, venepuncture sites, urinary catheter, and insertion site as a complication of anticoagulation therapy, Educate the patient re importance of passive limb exercises, keeping the affected leg straight, Encourage deep breathing exercises to promote adequate ventilation and lung expansion preventing the development of chest infections, Provide skin care and pressure area care – may need a pressure relieving mattress and if needed two-hourly turns, Assist with nutrition and hydration as patient should be no higher than 30° which is challenging when eating or drinking, Provide on going psychological support and education as required, Limb ischaemia, absent pulses and compartment syndrome, Displacement of the balloon catheter obstructing left subclavian artery or renal artery perfusion, Balloon leak, rupture, gas loss from the balloon, Reid MB, Cottrell D. Nursing Care of Patients receiving intra-aortic balloon counterpulsation. Inflation occurs just as diastole begins (diastole represents the heart relaxing, the ventricles filling and getting ready for systole and the coronary arteries receiving their blood supply). Nursing care involves care of the pump as well as assessing patient from a cardiovascular and haemodynamic perspective . Intra-aortic balloon pump (IABP) remains the most widely used circulatory assist device in critically ill patients with cardiac disease. Hemodynamic Monitoring, Data Acquisition and Assessment of Efficacy of Diastolic Augmentation. 1976 Feb 12;142(6):48-51. “Nursing Care and Treatment of Ambulatory Patients With Percutaneously Placed Axillary Intra-Aortic Balloon Pump Before Heart Transplant” reviews the nursing challenges and unique problems of caring for patients with PAxIABP and the solutions developed by nurses in the CICU. Table 2 summarises the main elements of nursing care as illustrated by Catton.4. Following insertion, nursing care involves cardiovascular/ haemodynamic assessment, fluid balance, positioning and pressure area care, observation of the balloon catheter and line, the catheter insertion site, limb perfusion, neurological status and providing psychological support for patient and family. Patients receiving IABP therapy are normally maintained on an anticoagulation regimen to avoid thrombus formation at the tip of the catheter or within the folds of the balloon. 2000;1:(1) (fulltext online) [Scenarios 1-4 are based on a figure from this article] Marino’s The Little ICU Book; Krishna M, Zacharowski K. Principles of Intra-Aortic Balloon Pump Counterpulsation. This course is designed to prepare nurses to care for patients with a Datascope intra-aortic balloon pump. The primary purpose of IABP is the support of the failing heart by simultaneously increasing myocardial oxygen supply and … Author information: (1)Queensland University of Technology, Brisbane, Queensland, Australia. Please keep in mind this information does not replace formal didactic and hands on training. This assessment is repeated during IABP therapy as per hospital guidelines. Nurses are welcome to attend a class at any location. Briefly, the intraaortic balloon pump is a specific and aggressive form of care for patients in cardiogenic shock. Cardiogenic shock is also sometimes called “pump failure”. A set of baseline vital signs is recorded – heart rate, blood pressure, respiratory rate, oxygen saturations and temperature, which are used to assess improvement or deterioration in the patient’s condition. Nursing care Australian Critical Care (2009) 22, 125—131 The intra-aortic balloon pump in heart failure management: Implications for nursing practice Peter A. Lewis BN RM MN.Ed PhDa,∗, Darian A. Intra Aortic Balloon Pump (IABP) Counterpulsation. The Internet Journal of Perfusionists. The IABP is effective because of the unique anatomy of the aortic valve cusps and their relationship to the origin of the two coronary arteries. In our hospital it is completed hourly. This results in the movement of blood in the aorta into the coronary and up to the carotid arteries, thus increasing coronary and cerebral perfusion (see Figure 1). Ward RN MScb, Mary D. Courtney RN PhDa a Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Queensland 4059, Australia Section IV: Management of Patients on Intra-Aortic Balloon Pump. Cardiogenic shock is a condition of diminished cardiac output that severely impairs cardiac perfusion. Pharmacologic Treatment. The provision of care of patients who require an intra-aortic balloon pump is in the ICU setting under continuous cardiac monitoring and arterial line care and management. Lewis PA(1), Ward DA, Courtney MD. This assessment involves documentation of palpation of the relevant pulses, assessing capillary refill, temperature and colour of the limbs. The left main coronary artery originates just above the left aortic cusp; similarly, the right coronary artery originates just above the right aortic cusp. Barrie-Shevlin P. Haemodynamic Monitoring: Invasive and Noninvasive Clinical Application. These days, it is a widely used, invaluable piece of equipment that is often inserted and removed in the intensive care unit. Nursing Apps Cardiac Nursing Nursing Notes Nursing Career Arterial Line Cath Lab Nurse Ultrasound Physics Nurse Teaching Rn Humor. This catheter is normally inserted via the femoral artery and passed into the descending thoracic aorta until the tip is positioned 2cm just below the left subclavian artery2 and the lower end of the balloon just above the renal arteries. 12. Briefly, the intraaortic balloon pump is a specific and aggressive form of care for patients in cardiogenic shock. From a cardiovascular perspective it is vital that all monitoring cables and systems are securely connected and that the IABP is set to the correct trigger (the trigger is the parameter which stimulates inflation and deflation, eg. It consists of a cylindrical polyurethane balloon that sits in the aorta, approximately 2 centimeters (0.79 in) from the left subclavian artery. Br J Cardiac Nursing 2005; 1(12): 582-588, Darovic GO. In addition lower limb perfusion is assessed at these times confirming adequate perfusion and presence of pedal pulses. Intra-aortic Balloon Pumps Therapeutic Hypothermia Intra-aortic Balloon Pumps ... Care requirements for the patient receiving IABP support: Nurse at a maximum of 45 degrees to prevent line occlusion and/or damage to the femoral artery; Assess puncture site regularly for bleeding/haemotomas; Neurovascular observations of the lower limb distal to the puncture site; Assessment of perfusion to … Cardiac Nursing. Indications on ECG the balloon will deflate on the R wave), which is normally set to ECG. Intra-aortic balloon pumping and nursing care: what did we learn in the last decade? On-Line Program Annual Review ; Special Care Manual SP I 2.0 SP - I 2.3 SP I 2.4 SP - I 6.0. Philadelphia, PA: Lippincott Williams and Wilkins, 2005, Catton J. Intra aortic balloon pump counterpulsation therapy. 16. Change of dressing is as per clinical need and hospital guidelines, aseptic technique must be employed to minimise the risk of infection. 1. Patient education should include the reasons why the IABP is being inserted, what the pump does, potential complications, nursing care involved such as hourly nursing assessments, and limitations. Regarding the IABP, the pump should be checked hourly for correct settings such as timing, balloon inflating to its maximum capacity and that the trigger is at the correct setting. This is preceded by a process of weaning the pump from 1:1 to 1:2 and finally 1:3, and observing the patient for ischaemic chest pain or development of heart failure symptoms such as breathlessness, hypotension and tachycardia. The IABP consists of a long polyurethane type catheter with a 10-15cm balloon at the end. What are the steps required for such cases? The catheter comes in three sizes 34cc, 40cc, 50cc and is selected according to the height of the patient. At the end of the program, the learner will be able to ; List steps to initiate intra aortic balloon pump therapy using the AutoCAT2 Series IAB pump.