10/09/2021

Seminar
on
INTRA AORTIC BALLOON PUMP

IABP
Presented to Presented by
Dr. Shaveta Sharma Deeksha
1
Professor MSN M.sc(N) 2nd year
INTRODUCTION
 Intra aortic balloon pump is a mechanical

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device that is temporarily used to
improve cardiac functions. In many
situations IABP is life saving in its ability

IABP
to stabilize patients as they awaits
procedures such as heart transplant,
CABG or PTCA.

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DEFINITION
An intra-aortic balloon pump, or IABP, is a

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long, skinny balloon that controls the
flow of  blood through your

IABP
largest blood vessel, the aorta.

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GOALS
It improve cardiac functions by

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
decreasing left ventricular end diastolic
volume

IABP
 It improves myocardial oxygen supply by
increasing blood flow to the coronary
arteries.
 It decreases myocardial oxygen demand
by decreasing left ventricular wall
tension.
 It stabilizes cardiac function in patient
with dysrhythmias and myocardial
ischemia. 4
INDICATIONS

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Refractory unstable angina

IABP


 Short term bridge to cardiac

transplantation
 Ventricular aneurysm accompanied by
ventricular dysrhythmias
 Acute ventricular septal defect

 Acute mitral valve dysfunction

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CONT.......

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 Cardiogenic shock
 Refractory chest pain with or without

IABP
ventricular dysrhythmias
 Preoperative, intraoperative and
postoperative cardiac surgery
 High risk interventional cardiology
procedure

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CONTRAINDICATIONS

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 Uncontrolled sepsis
 Uncontrolled bleeding diathesis

IABP
 Moderate to severe aortic regurgitation

 An aortic aneurysm or aortic dissection

 Severe peripheral artery disease unless

pretreated with stenting
 Irreversible brain damage

 Terminal or untreatable disease of any

major organ system

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 EQUIPMENT
 

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 Intra-aorticballoon pump kit:
includes intra-aortic balloon pump system
with IABP catheter, a guide wire,

IABP
angiographic needle.
 Surgical mask with sterile gloves and
gowns
 Sterile drapes

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COMPONENTS

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 Double lumen catheter with an

IABP
inflatable balloon attach to the
distal end.
 Console that regulates the inflation
and deflation of the balloon.

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CONT.......

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 1% lidocaine solution
 Sterile prep solution that includes

IABP
povidone-iodine or hexachlorophene on
chlorhexidine with alcohol
 25-gauge needle

 5 cc syringe

 Scalpel handle with a blade

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CONT………

Sterile saline and lubricant

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

 Sterile transparent tape and dressing

 Tissue clamp

IABP
 2-0 silk suture

 Safety razor

 0.035 J guide wire

 Fluoroscopy device

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PREPARATION

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 Before insertion of IABP, informed
consent is necessary.

IABP
 The patient requires a thorough
evaluation of any bleeding diathesis,
infection, and presence of severe
peripheral arterial disease.

 The patient is positioned supine, and

adherence to the sterile technique should
be practiced to insert the device.
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PROCEDURE
After the implementation of sterile

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
techniques to prepare the femoral
catheterization site and application of

IABP
local anesthesia, the angiographic needle
is inserted into the common femoral
artery below the inguinal ligament at an
angle of 45 degrees or less. 

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CONT……..

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 The fluoroscopic device can be used to
ensure the location of an angiographic
needle into the common femoral artery

IABP
 After ensuring adequate placement of the
radiographic needle, the J-tip guidewire gets
inserted and advanced through the
angiographic needle into the femoral artery.

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CONT……

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 The angiographic needle is removed over
the guidewire while keeping the guidewire
in place.

IABP
 A small incision with the help of the blade
is made in the skin at the site of insertion
of the guidewire to facilitate insertion of
sheath introducer. 

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CONT….
 With the help of introducer dilator to be

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inserted over the guide wire and advanced it
in a rotary fashion into the femoral artery,

IABP
the sheath tract can further be prepared to
facilitate the insertion of the introducer
sheath into the artery. 

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CONT........

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 The introducer sheath gets placed over
the guide wire, and then guide wire is
removed while leaving the introducer

IABP
sheath in the arterial lumen.

 It is followed by insertion of J-tube of the

guidewire (IABP guide wire) through the
introducer sheath and advanced into the
thoracic aorta

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CONT…….

 IABP catheter is prepared for insertion.

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 Balloon preparation is by establishing a
vacuum with the help of a syringe by

IABP
applying aspiration, and the central
catheter lumen is flushed with sterile
saline to ensure patency. 

 The IABP catheter is inserted and

advanced over the guidewire to the
proper positioning of the balloon in the
aorta.
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CONT……
 The location of the intra-aortic balloon
with its tip lying distal to the left sub

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clavian artery and the proximal portion
ending above the origin of renal arteries

IABP
is considered as the safe zone

 The confirmation of position can be by

chest x-ray or fluoroscopy.

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CONT……..

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 Following guidewire removal and the
central lumen of the catheter is flushed
and connected to the transducer to

IABP
measure intra-aortic pressure.

 The IABP catheter gets connected to the

extender catheter, which then connects
to the IABP console.

 https://youtu.be/nRGqKVER7A8
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 EFFECT OF INFLATION
DURING DIASTOLE

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 Increased diastolic pressure.

IABP
 Increased pressure in the aortic route
during diastole.
 Increased coronary artery perfusion
pressure.
 Improved oxygen delivery to the
myocardium
 Decreased angina

 Decreased electrocardiographic evidence

of ischemia 26
EFFECT OF DEFLATION
DURING SYSTOLE

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 Decreased after load
 Decreased peek systolic pressure

IABP
 Decreased myocardial oxygen consumption

 Increased stroke volume, possible associated with

 Improved sensorium

 Warmed skin

 Increased urine output

 Decreased heart rate

 Increased forward flow of blood, decreasing

preload
 Decreased PA pressure, including PAWP
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 Decreased crackles
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TIMING ERROR

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IABP
 Timing error occur when there is
 Early or late inflation of balloon
 Early or late deflation of the balloon

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 EARLY INFLATION OF THE
BALLOON

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 With early balloon inflation, the balloon
inflates before closure of the aortic valve.

IABP
 The action forces the valve to close
early, resulting in aortic regurgitation and
subsequent reduction in stroke volume,
as well as increases in the end diastolic
volume and myocardial oxygen demand.
 In such a case, the arterial waveform
will lose its characteristics V shape
before diastolic augmentation.

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LATE INFLATION OF BALLOON

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 With late inflation, the balloon inflates
later than the appropriate time after

IABP
closure of the aortic valve, with resultant
lower augmented diastolic and coronary
perfusion pressures.

 As a result IABP’s key benefit- improving

blood and oxygen supply to the coronary
arteries- is lost or reduced.

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EARLY DEFLATION OF
BALLOON

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 Normally balloon deflation occurs just
before the beginning of systole. But in

IABP
early deflation of the balloon, deflation
occurs before the onset of systole.
 It increases diastolic pressure, after load
and myocardial oxygen demand.
 The arterial waveform reveals a sharp
drop off in the augmented curve, followed
by a U shaped curve before the next
systolic upstroke.
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LATE DEFLATION OF BALLOON

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 When the balloon deflates later than the
optimal time, its volume decrease the
aortic valves open before balloon

IABP
deflation.
 The results increased after load and
myocardial oxygen demand as the
inflated balloon impedes the ejection of
blood from the left ventricle.
 The waveform will reveal a widened
augmented diastolic wave and slow rise
of the next assisted systole.
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COMPLICATION OF IABP
THERAPY

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 Limb ischemia

IABP
 Bleeding at insertion site

 Anaemia and thrombocytopenia

 Infection

 Catheter migration

 Balloon leak or rupture

 Aortic dissection

 Compartment syndrome

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NURSING INTERVENTION
FOR PATIENT RECEIVING
IABP

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PRE-INSERTION INTERVENTIONS

IABP
 Provide as calm environment as possible
because the patient will likely to
overwhelmed.
 Provide reassurance that the IABP
therapy is temporary.
 Explain the procedure and the steps to
help ensure safety.
 Allow family to participate in discussions
and to express concerns. 40
CONT…….

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 Ascertain that consent is signed and
complete if required.

IABP
 Obtain a 12 lead ECG

 Insert a urinary catheter

 Assist with the insertion of invasive lines

such as an arterial line and a pulmonary
artery catheter
 Obtain baseline hemodynamic readings:
HR,RR, BP, MAP, PAP, CVP, CO, and urine
output.
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CONT……..

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 Obtain baseline blood work: ABG, mixed
venous blood gas, chemistries with
BUN/creatinine, CBC with platelets and

IABP
differential blood count, coagulation
profile and crossmatch.
 Perform a peripheral vascular
assessment, including checking ankle-
brachial index, skin temperature,
presence and strength of pulses and
capillary refill in lower extremities.

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CONT……..

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 Monitor for the presence of a left redial
pulse.

IABP
 Inform the physician if the pulse is lost so
that the catheter can be repositioned.

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 POST INSERTION
INTERVENTION

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 Monitor and record hemodynamic
measurements every 15 to 30 minutes
until the patient is stable, then hourly and

IABP
PRN.
 Obtain an ECG and chest radiograph daily
and PRN.
 Titrate vasopressor/inotropic agents as
required to desired hemodynamic
parameter. Hemodynamic stability is
essential to maintain optimal perfusion to
limb.
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CONT……..

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 Maintain IV fluid therapy as ordered to
maintain an acceptable preload.

IABP
 Assess for pain/discomfort, anxiety and
mental status changes hourly.
 Document IABP setting hourly; include
the assisted and unassisted pressures.
 Print and document the arterial wave
form tracing every 12 hours and PRN with
changes

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CONT……….

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 Assess for presence and strength of

IABP
distal pulses, indices of adequate limb
perfusion and sensorimotor function
of both lower extremities every 15
minutes for 1 hour, then 30 minute for
1 hour and then hourly according to
unit protocol.
 Asses the ankle brachial index every 4
hours.
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CONT……

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 Monitor for the presence of left radial
pulse. loss of pulse indicates that the
catheter has migrated upward, is

IABP
occluding the left sub clavian artery and
require repositioning.
 Maintain and titrate the heparin infusion
to desired anticoagulation as ordered.
Obtain coagulation studies 6 hours after
dosage changes or follow the facility
protocol.

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CONT………

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 Obtain daily blood work: CBC,
coagulation profile, ABG, lactate level
and mixed venous blood gas.

IABP
 Monitor respiratory status: assess breath
sounds every 4 hourly. Maintain oxygen
and ventilation therapy. Encourage
coughing and deep breating/incentive
spirometry every 2 hourly.
 Keep the head of bed at 30-45 degree
angle to prevent aspiration.
 Prevent skin breakdown related to
immobility. 48
BIBLIOGRAPHY
 Black M joyce, hawks H jane. Medical

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surgical nursing. 8th ed. Vol. 2. St.Louis
missouri: elsevier; page no. 1458-149

IABP
 Hariprasath p. Textbook of
cardiovascular and thoracic nursing.
First. Vol. 1. New delhi: jaypee; page no.
290-299

 Intra-Aortic Balloon Pump (IABP):

Purpose, Procedure, Risks, and Recovery
[Internet]. Available from:
https://www.webmd.com/heart-disease/ia 49

bp-balloon-pump#1
CONT……….
 Intra-Aortic Balloon Pump | Michigan

10/09/2021
Medicine [Internet]. Available from:
https://www.uofmhealth.org/health-library/
tx4071abc

IABP
 Intra-Aortic Balloon Pump Therapy |
Johns Hopkins Medicine [Internet].
Available from:
https://www.hopkinsmedicine.org/health/t
reatment-tests-and-therapies/intra-aortic-
balloon-pump-therapy

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