how do you know iabp is effective course hero

Why do we need the IABP?

So now comes the IABP. The balloon, deflating just at the beginning of systole, creates an area of lower pressure in the aorta – which helps the LV empty itself, and takes a lot of the workload off it – mechanical afterload reduction. Almost everyone with cardiogenic shock died of it before the IABP came along for this purpose.

Where can I find the IABP FAQ?

This pdf file can be found by clicking here: www.icufaqs.org/ IABP FAQ.doc Have an excellent day! What is an intra-aortic balloon pump? An intra-aortic balloon pump is a device that basically does two good things for a heart in trouble. These two effects correspond to the two movements that the balloon makes, namely: inflation and deflation.

What is IABP 101?

This is a three part series- “IABP 101” designed to simply refresh or introduce the basic concepts of applying diastolic augmentation for the high risk cardiac patient.

Where can I find the Johns Hopkins IABP protocol?

www.ispub.com/journals/IJTCVS/Vol2N2/iabp.html – The Internet Journal of Thoracic and Cardiovascular Surgery www.cardio-info.com/_disc6/0000007e.htm the Johns Hopkins protocol cited in the CV Talk Educators and Professionals Discussion Group

How do I verify my IABP placement?

In the intensive care unit, chest radio- graphs are the standard way to confirm IABP placement. The IABP tip just distal to the aortic knob is often used as the radiographic landmark, although data suggest that 2 cm above the carina may be a more reliable guide.

What is the purpose of the IABP How does it work?

The IABP reduces the workload on your heart, allowing your heart to pump more blood. The IABP is placed inside your aorta, the artery that takes blood from the heart to the rest of the body. The balloon on the end of the catheter inflates and deflates with the rhythm of your heart.

What happens when IABP inflates?

IABP inflates at the onset of diastole, thereby increasing diastolic pressure and deflates just before systole, thus reducing LV afterload. The magnitude of these effects depends upon: Balloon volume: the amount of blood displaced is proportional to the volume of the balloon.

What does IABP increase?

IABP treatment during ischaemic rupture of the ventricular septum, increases the mean aortic pressure and cardiac output and decreases the right ventricular and pulmonary wedge pressure.

How does IABP increase cardiac output?

The physiological effects of IABP support include increasing coronary perfusion pressure by increasing diastolic pressure and increasing cardiac output, primarily by a reduction in left ventricular afterload that occurs after balloon deflation just before systole.

How do you care for a patient with IABP?

Patient position is an important consideration if the IABP is to be effective. 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.

How do you read a balloon pump?

1:3813:09Timing and triggering of the Intra-aortic Balloon Pump (IABP)YouTubeStart of suggested clipEnd of suggested clipAnd an Augmented waveform produced by the intra-aortic balloon pump. The first peak in this diagramMoreAnd an Augmented waveform produced by the intra-aortic balloon pump. The first peak in this diagram corresponds to the patient's peak systolic blood pressure. This is the unassisted systole.

What happens when the IABP balloon deflates late?

It is recognized that late deflation of the intra-aortic balloon will result in physical obstruction within the aorta to which the left ventricle must compete to open the aortic valve for systolic volume emptying (6).

What is IABP ratio?

The amount of aid a balloon pump provides can be quantified as a ratio of native beats to assisted beats. Full support is at a ratio of 1:1; that is, every beat is augmented by the IABP. Weaning occurs by gradually reducing the augmentation ratios to 1:2, 1:4, and then 1:8.

What gas is used in IABP?

Helium is used to inflate the balloon as its low density means there is little turbulent flow, so the balloon can inflate quickly and deflate slowly. It is also relatively benign and eliminated quickly if there is a leak or rupture in the balloon.

How does a balloon pump reduce afterload?

The intra-aortic balloon, by inflating during diastole, displaces blood volume from the thoracic aorta. In systole, as the balloon rapidly deflates, this creates a dead space, effectively reducing afterload for myocardial ejection and improving forward flow from the left ventricle.

Why is an IABP inserted?

Two reasons: first, to help perfuse the coronary arteries, when they are nearly closed by tight lesions. If you try to visualize the cardiac cycle, think of the heart during diastole: the chamber walls open up, and on the left side of the heart, the valve leading from the LV to the aorta – the aortic valve – flips shut. The aorta has just been filled by the previous systolic contraction, and now with the aortic valve closed, it rebounds a little, like a garden hose with a pulse of water going through it – the walls stretch a bit with each systole, and then spring back a bit, creating a small backwards pressure towards the heart. The openings leading to the coronary arteries are actually in the wall of the aorta, just above the aortic valve, and the arteries fill passively during diastole. The balloon is timed to inflate at the end of diastole, creating a forcible pressure backwards along the aortic arch, pushing blood actively through the coronary arteries.

What is stable angina? Unstable angina?

Unstable angina is the pain the patients get as the coronary lesions get tighter. This angina can strike spontaneously, without any exertion, and represents worsening CAD.

How do I know if the balloon is working?

You know that the balloon is working if the patient’s chest pain goes away! You also want to look at their EKG to see if their ischemic changes, if any, have resolved – remember, some diabetic patients, and we see lots of them – don’t have chest pain with ischemia, so you have to be careful. There are “anginal equivalents” – meaning, the patient becomes ischemic, but instead of having pain, does something else – breaks into a sweat maybe, becomes short of breath…

Why can’t we just use pressors?

Well – you could, and sometimes you have to, even with the balloon pump working. But do you really want to add a pressor to failing heart muscle? Probably not – you want to avoid things that make the heart work harder, things that increase “MV02” – myocardial oxygen consumption. Do b utamine – the b eta pressor – would be the drug of choice. You sure you want to use it?

What should happen to the urine output, and the wedge pressure?

With better cardiac output, urine output should improve – remember that somebody needs to check the X-ray to make sure the the tip of the balloon is in the right position – too low and it can obstruct the renal arteries, which tends to be bad for the kidneys.

How is a balloon inserted? Who does the procedure?

An IABP is inserted by an interventional cardiologist, usually in the cath lab under fluoroscopy, using much the same technique as any central line placement. Very rarely the balloon is put in at the bedside, but this is usually in a near-code situation – it’s been many years since I’ve seen this done. Careful placement is needed to avoid placing the balloon too high or low, and the patient must have an x-ray to confirm proper placement of the balloon tip. This can be read by the balloon techs, but has to be confirmed by a knowledgeable doc.

Why do we use the arterial wave for timing?

Simple: we use the arterial wave to look for the dicrotic notch, to use as the marker for inflating the balloon. Use the inflation knob to move the inflation wave leftwards, until it meets the dicrotic notch.