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. 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. Our intensive care unit during a typical procedure to insert an intra-aortic balloon pump The primary purpose of IABP is the support of the failing heart by simultaneously increasing myocardial oxygen supply and decreasing myocardial oxygen demand. Change of dressing is as per clinical need and hospital guidelines, aseptic technique must be employed to minimise the risk of infection. 1976 Feb 12;142(6):48-51. 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. Ward RN MScb, Mary D. Courtney RN PhDa a Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Queensland 4059, Australia Aside from gathering the equipment specific to IABP insertion, nursing care involves preparing the patient, eg. Br J Cardiac Nursing 2005; 1(12): 582-588, Darovic GO. During left ventricular systole, the aortic valve opens and the aortic cusps are reflected superiorly to obstruct the coronary ostia. Nursing care involves care of the pump as well as assessing patient from a cardiovascular and haemodynamic perspective . 13. intra-aortic balloon pump explanation free. 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. 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. Nursing care of patients during intraaortic balloon pumping, https://doi.org/10.1016/j.jsha.2015.05.230. IABP is a form of circulatory support for those presenting with ischaemia or heart failure. Lewis PA(1), Ward DA, Courtney MD. Intra-aortic balloon pump therapy is widely used for patients with left ventricular dysfunction, despite recent controversy regarding its benefit. 12. 14. What is intra-aortic balloon pump? 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. Intra Aortic Balloon Pump (IABP) Counterpulsation. Section IV: Management of Patients on Intra-Aortic Balloon Pump. Australian Critical Care, 22(3), pp. 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. Intra-Aortic balloon pump (IABP) therapy was first introduced in the 1960s for the treatment of cardiogenic shock. Nursing care involves checking the insertion site every hour for bleeding or haematoma formation and documenting findings. Apr 8, 2013 - Looking for online definition of intra-aortic balloon pump in the Medical Dictionary? For an average patient, the intra-aortic balloon (IAB) is 20 to 25 cm long. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. 49. Limb ischaemia and bleeding are two complications associated with this therapy and will be discussed in detail.2. Indications Nursing Apps Cardiac Nursing Nursing Notes Nursing Career Arterial Line Cath Lab Nurse Ultrasound Physics Nurse Teaching Rn Humor. This is a frightening time for the patient and family. 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. The IABP consists of a long polyurethane type catheter with a 10-15cm balloon at the end. The level of the transducer is at the phlebostatic axis that is confirmed using the spirit level and is changed as per patient position. Patient position is an important consideration if the IABP is to be effective. Authors: Rosy Owen. Results from the benchmark registry. The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. Intra-aortic balloon pumping and nursing care: what did we learn in the last decade? The primary purpose of IABP is the support of the failing heart by simultaneously increasing myocardial oxygen supply and … Nursing Care Of Patients on Intra-Aortic Balloon Pump. Lewis, Peter, Ward, Darian, & Courtney, Mary (2009) The intra-aortic balloon pump in heart failure management: Implications for nursing practice. Indications of bleeding may manifest as oozing, bruising or haematoma formation at the insertion site or by swelling in the thigh area. These days, it is a widely used, invaluable piece of equipment that is often inserted and removed in the intensive care unit. Take the course “Intra-aortic balloon pump” Learning Link NE014-7029 How it works 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. Thoroughness when obtaining the patient’s medical history is essential for recognising factors that predispose the patient to the development of complications. 1. Hemodynamic Monitoring, Data Acquisition and Assessment of Efficacy of Diastolic Augmentation. The patient is assessed for their tolerance of lying flat and also their need for sedation or anxiolytics as per hospital guidelines. The intra-aortic balloon pump: a nursing care study. 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. On-Line Program Annual Review ; Special Care Manual SP I 2.0 SP - I 2.3 SP I 2.4 SP - I 6.0. Signs of retroperitoneal bleeding include the patient becoming hypotensive and complaining of back, flank or abdominal pain unrelieved by changes in position. May 2012; British Journal of Cardiac Nursing 7(5):222-229; DOI: 10.12968/bjca.2012.7.5.222. 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. Thrombocytopenia can result from anticoagulation therapy or from platelet destruction due to mechanical trauma that occurs during inflation of the IABP catheter. 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. It consists of a cylindrical polyurethane balloon that sits in the aorta, approximately 2 centimeters (0.79 in) from the left subclavian artery. 125-131. Kate O'Donovan is course co-ordinator for the postgraduate diploma in cardiovascular nursing in the Mater Hospital, Dublin . The insertion site dressing should be transparent which enables visual inspection of the site. Cardiogenic shock is a condition of diminished cardiac output that severely impairs cardiac perfusion. 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. Cardiogenic shock is also sometimes called “pump failure”. Table 2 summarises the main elements of nursing care as illustrated by Catton.4. Post removal the patient is kept on bed rest with the leg kept straight as per local guidelines. on ECG the balloon will deflate on the R wave), which is normally set to ECG. The net result of inflation and deflation is increased coronary and cerebral perfusion and reduced myocardial workload respectively. References . This serves as a baseline for assessments post insertion. 2. Explore. 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. Briefly, the intraaortic balloon pump is a specific and aggressive form of care for patients in cardiogenic shock. Cardiovascular assessment is performed hourly or more frequently if haemodynamic status deteriorates. 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. Haemodynamic Monitoring: Invasive and Noninvasive Clinical Application. 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; … 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. The IABP is implanted into the patient's aorta. 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. Management of Patients on Intra-Aortic Balloon Pump in Special Situations. Nursing care 2010 Jan;38(1):152-60. doi: 10.1097/CCM.0b013e3181b78671. Philadelphia, PA: WB Saunders, 2002. 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. Pharmacologic Treatment. •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 ). Philadelphia, PA: Lippincott Williams and Wilkins, 2005, Catton J. Intra aortic balloon pump counterpulsation therapy. 16. Cont Edu Anaesth Crit Care & Pain. British Journal of Cardiac Nursing 2012: 7 (5): 222-29 7. How does an intra-aortic balloon pump work? Today. The aortic valve normally has three cusps: right, left, and posterior. 15. Treatment of bleeding includes applying pressure to the insertion site and administration of blood products as required. What does intra-aortic balloon pump mean? J Am Coll Cardiol 2001; 38(5): 1456, Woods S, Sivarajan Froelicher ES, Underhill Motzer SA. The lighter weight of heliu… 5th Ed. da.ward@qut.edu.au Management of acute heart failure is an important consideration in critical care. Nursing considerations regarding the intra-aortic balloon pump, the TandemHeart, the Impella, and extracorporeal membrane oxygenation. 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. and Cottrell D. Nursing care of patients receiving Intra-aortic Balloon Counterpulsation. It reflects severe left-sided heart failure. Other indications include septic shock, cardiac support for non-cardiac related surgery and support post correction of anatomical defects. Once the patient’s condition has stabilised the IABP is considered for removal. Briefly, the intraaortic balloon pump is a specific and aggressive form of care for patients in cardiogenic shock. 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. Historically, most patients in cardiac care units (CCUs) have been admitted with the diagnosis of acute myocardial infarction (AMI) or a complication of AMI. ence of the dicrotic notch on the pressure waveform, which triggers balloon inflation. Table 3 lists the potential complications associated with IABP therapy. 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. Reid and Cottrell1 list the following as risk factors: female gender, pre-existing peripheral arterial disease, older age, diabetes mellitus, smoker, hypertension and obesity. 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. The intra-aortic balloon pump in heart failure management: implications for nursing practice. The IABP is a cardiac assist device consisting of a long, cylindrical polyethylene balloon at the end of a flexible catheter. 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). 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. Weaning and removal The most common indications are low cardiac output due to left ventricular dysfunction and myocardial ischaemia. Upper limb assessment is essential so that balloon migration obstructing blood flow down the left subclavian artery can be detected promptly. 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. 6. 2009;9(1):24-28. Please keep in mind this information does not replace formal didactic and hands on training. 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). 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. Reid MB, Cottrell D. Nursing Care of Patients receiving intra-aortic balloon counterpulsation. This article provides an overview of the function of the pump, indications, potential complications and nursing care required. 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. 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. 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. The limitations in activity that the patient will experience should be explained such as bed rest and reduced movement of the affected leg. Reid MB. Caring for patients with intraaortic balloon pumps (IABPs) is a unique nursing challenge in the cardiovascular recovery and intensive care units. Title: Intra Aortic Balloon Pumping 1 Intra Aortic Balloon Pumping. ABSTRACT •THE INTRA‐AORTIC BALLOON PUMP (IABP) is a commonly used circulatory‐assist device that increases myocardial oxygen supply and reduces … The catheter comes in three sizes 34cc, 40cc, 50cc and is selected according to the height of the patient. 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. Table 1 lists the many indications for IABP therapy. Meaning of intra-aortic balloon pump medical term. Potential complications “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. What are the steps required for such cases? The left main coronary artery originates just above the left aortic cusp; similarly, the right coronary artery originates just above the right aortic cusp. In our hospital it is completed hourly. Cardiac Nursing. A credentialed physician will oversee the IABP management and manipulation. Copyright © 2020 Elsevier B.V. or its licensors or contributors. In addition lower limb perfusion is assessed at these times confirming adequate perfusion and presence of pedal pulses. Education plays a pivotal part in nursing care. This type of therapy works by the balloon inflating and deflating in synchrony with the cardiac cycle. This assessment is repeated during IABP therapy as per hospital guidelines. The National Centre of Health Statistics estimated that IABP was used in 42 000 patients in the USA in 2002. The goal of IABP therapy is to improve myocardial oxygen supply and reduce myocardial oxygen demand. Guidelines for Management of the Intra-Aortic Balloon Pump Purpose: To outline the nursing management of patients requiring an Intra-Aortic Balloon Pump (IABP). 12. Nurs Mirror Midwives J. Although it was originally designed to support patients in cardiogenic shock the indications have expanded because of continued research. 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 Piper R. and Bowden T. The intra-aortic balloon pump: a nursing care study. Intra Aortic Balloon Pump (IABP) Saved by Valerie Serwicki. An intra-aortic balloon pump (IABP) is a device that supports the heart in pumping a sufficient amount of blood around the body. More information... People also love these ideas Pinterest. 2 Objectives. 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. Bleeding at the insertion site is commonly encountered and may be due to anticoagulation therapy or associated thrombocytopenia. The current practice of intra-aortic balloon counterpulsation. When caring for patients receiving this therapy nurses must be alert for possible occurrence of complications. Prior to insertion of the IABP a baseline assessment is performed incorporating lower and upper limb perfusion. 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. The IAB is inflated with helium, an inert gas with a lower molecular weight than room air. 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. 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 … Nursing care involves care of the pump as well as assessing patient from a cardiovascular and haemodynamic perspective . 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. Nursing care study: the intra-aortic balloon pump in left ventricular failure. By continuing you agree to the use of cookies. 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. 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. 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. Caring for patients with intraaortic balloon pumps (IABPs) is a unique nursing challenge in the cardiovascular recovery and intensive care units. Critical Care Nurse 2005: 25 (5): 40-49 8. Barrie-Shevlin P. 1. 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. Intra-aortic balloon pump (IABP) remains the most widely used circulatory assist device in critically ill patients with cardiac disease. Prior to insertion a lower limb perfusion assessment involving both legs must be completed. 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. 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 diastole, the aortic valve clos… Authors Roland Prondzinsky 1 , Henning Lemm, Michael Swyter, Nikolas Wegener, Susanne Unverzagt, … Author information: (1)Queensland University of Technology, Brisbane, Queensland, Australia. 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). Complaining of back, flank or abdominal pain unrelieved by changes in position prepared! Of IABP is implanted into the patient and family insertion a lower molecular weight than room.. To the insertion site every hour for bleeding or haematoma formation at the insertion site or by swelling in intensive... Decreasing myocardial oxygen demand Special Situations straight as per local guidelines and removal Once the patient assessed... 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By Valerie Serwicki welcome to attend a class at any location inflating and deflating in with! M, et al Ultrasound Physics Nurse Teaching Rn Humor of lying and... Circulatory support for those presenting with ischaemia or heart failure I 6.0 that... Woods s, Sivarajan Froelicher ES, Underhill Motzer SA of acute heart failure management: implications for practice... Site or by swelling in the Medical Dictionary so that balloon migration obstructing blood flow the... Low cardiac output that severely impairs cardiac perfusion three sizes 34cc,,! Patient becoming hypotensive and complaining of back, flank or abdominal pain by! R. and Bowden T. the intra-aortic balloon pump is a specific and aggressive form care... Of cardiogenic shock stable the IABP catheter an overview of the failing by! Replace formal didactic and hands on training Darovic GO result from anticoagulation or. Experience should be explained such as bed rest with the leg kept as!