General

Course

Education Team 1
 The Intra-Aortic Balloon Pump (IABP) is a circulatory

assist device that is used to support the left ventricle.

 The IABP uses counter pulsation where aortic blood is

displaced with the inflation and deflation of the balloon

catheter, which is timed to the cardiac cycle.

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 A pump connected to a balloon device that is inserted into the descending aorta

to provide temporary assistance to the heart in the management of left

ventricular failure.

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 Increases coronary artery perfusion .

 Increases myocardial oxygen supply.

 Decreases myocardial oxygen demand.

 Decreases left ventricular work load .

 Increases blood pressure .

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 Acute left ventricular failure post cardiac surgery.
 Severe unstable angina.

 Cardiogenic shock post myocardial infarction.

 Bridge to cardiac transplantation .

 Ventricular Dysrhythmias.

 Septic shock.

 Cardiac patients requiring procedural support during PCI

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 Cardiac contusion.
 Absolute:

 Aortic valve insufficiency (because inflation increases aortic regurgitation).

 Dissecting aortic aneurysm .

 Bilateral femoral-popliteal bypass grafts (femoral route only contraindicated).

 Aortic stent
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 Relative:

 End stage terminal disease.

 Abdominal aortic aneurysm.

 Severe atherosclerosis.

 Uncontrolled bleeding disorder.

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 It consists of a catheter and a drive console

 The catheter has a long balloon mounted on the end.

 The catheter can be inserted at the bedside, in a cath lab or operating room.

 On chest x-ray the tip should be visible in the 2nd or 3rd intercostal space

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 The balloon catheter is inserted either percutaneously or surgically by cut

down into the patients’ femoral artery.

 The catheter is threaded up through the femoral artery and located in the

descending thoracic aorta, distal to the subclavian artery and proximal to

renal arteries.

 The tip is approximately 1 to 2 cm below the origin of the left subclavian

artery and above the renal arteries. 11

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 The size of the balloon is dependent on the patients height to prevent occlusion

of subclavian or renal arteries.

 <160 cm use 34 cc

 160 – 182cm use 40 cc

 >182cm use 50cc

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 The IAB is inflated at the onset of diastole,which is timed to just after the closure of the

aortic valve , This is shown on the arterial waveform as the diacrotic notch.

 It displaces blood volume within the descending thoracic aorta.

 Proximal blood is returned to the heart to oxygenate the coronary arteries as well as

being distributed through the branches in the aortic arch.

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 Blood in the distal descending aorta is circulated systemically.
 Balloon deflation is timed to occur immediately prior to the onset of systole before the

heart start to eject blood.

 Balloon deflation leaves the aorta partially empty thus reducing afterload, maximising

left ventricular ejection fraction and reducing mitral regurgitation.

 By augmenting coronary artery and systemic perfusion pressures, IABP improves:

 Myocardial oxygen supply

 Decreases myocardial oxygen consumption by reducing cardiac workload. 17

 Timing is the most important aspect of having an IABP , as incorrect timing will

cause the heart to work harder and not give the full benefit of afterload reduction

and maximize coronary artery perfusion.

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 Early inflation : occurs when the balloon inflates prior to aortic valve closure, then

there will be insufficient blood in the aorta, resulting in a ↓ in supply to coronary

arteries, premature closure of aortic valve and ↑ afterload.

 Late inflation : occurs when the balloon inflates to late after the closure of the Aortic

Valve and blood escapes down the aorta to the rest of the body, instead of being directed

to the coronary arteries. 19

 Early deflation : causes retrograde blood flow to the coronary arteries

and affecting forward blood flow to other vessels and ↑ afterload.

 Late deflation : causes ventricular wall stress.

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 Limb Ischemia

 Bleeding from site and internal.

 Infection.

 Aortic dissection

 Embolism

 Thrombosis

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 Aortic Valve Rupture

 Pump failure

 Balloon Catheter rupture and gas loss

 Catheter obstruction due to improper positioning with renal arteries or

subclavian artery.

 Incorrect timing

 Acute renal failure 22

 No trigger :This means that the IABP has lost its tracing of ECG or Pressure and
is unable to time the inflation and deflation.

 Action: To reconnect the ECG leads or pressure cable, or change the ECG leads
or tracing lead to obtain a better trace.

 IAB Disconnected : this means the IAB catheter extension tubing has been
disconnected and the pump will stop working.

 Action: Reconnect the extension tubing, PRESS IAB Fill for 3 seconds till prompt
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is on the screen and the PRESS Assist/Standby to start pumping.
 Rapid Gas Loss : This will appear if there is a leak or hole in the balloon or extension
tubing. This means the balloon may be ruptured, you will see flecks of blood in the tubing.

 Action: It will mean that the catheter will need to removed and replaced. Check all

connections for any leaks or disconnections.

 Low Battery : This means the battery has less than 30 minutes of operating time.

 Action: Ensure that the balloon pump is connected to the mains power at all times, to
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recharge the battery.
 IAB Failure : This means that the IABP console fails to pump, usually as a result of

electrical malfunction.

 Action: Disconnect patient from the IAB console and obtain another IAB console.

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 Timing of weaning

 Patient should be stable for 24 – 48 hours.

 Decreasing inotropic support.

 Decreasing pump ratio :

 From 1:1 to 1:2 to 1:3

 Decrease augmentation.

 Monitor patient closely 26

 If patient becomes unstable, weaning should be immediately discontinued.

 Discontinue heparin 6 hrs prior.

 Check platelet and coagulation factor.

 Deflate the balloon.

 Apply manual pressure above and below IABP insertion site.

 Remove balloon while alternating pressure above and below insertion site to expel clots.

 Apply constant pressure to the insertion site for a minimum of 30 minutes.

 Check distal pulse frequently. 27

 Cardiovascular:

 Monitor temperature, pulse, systolic, diastolic and mean arterial blood pressure hourly

 Observe and record the IABP waveform

 Ensure ECG leads are secure

 Monitor and treat arrhythmia’s

 Maintain therapeutic anticoagulation

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 Monitor radial and pedal pulses hourly
 Educate the patient about the need to be elevated no more than 30 degrees and to keep

the affected leg straight.

 Observe pressure areas.

 Use the SKIN bundle and turn patient every 2- 4 hours. Use a minimum of three

members of staff to ensure that the balloon is not moved

 Ensure that the insertion site is visible with maintaining patient dignity.

 Check IABP entry site hourly and observe for bleeding and /or hematoma formation. 29

 Monitor limb perfusion hourly.

 Monitor respiratory rate and pulse oximetry hourly.

 Provide supplementary oxygen as required.

 Encourage deep breathing exercises.

 Renal system:

 Monitor urine output hourly.

 Monitor renal function daily.

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