IABP

Question 1

Tip of balloon placement

Answer 1

Just distal to L Subclavian

Question 2

Balloon inflation events

Answer 2

During diastole, blood shot down aorta. Shot backwards towards closed aorta valve, into coronary arteries, head and arms.

Question 3

Balloon deflation events

Answer 3

During systole, provides empty potential in aorta, heart does not fight afterload, negative pressure can suck blood out of heart.

Question 4

West zones 1, 2, 3

Answer 4

1. More air in lung than blood, over inflation, under perfused (usually in apexes)
2. 50/50 matchup
3. More perfusion than air

Question 5

X-Ray & IABP

Answer 5

Tip of balloon pump should be in 2nd or 3rd intercostal space & 2 cm below aortic arch

Question 6

IABP contraindications

Answer 6

• aortic valve insufficiency (if valve will not close, blood will overload LV)
• Severe aortic disease
• Severe peripheral vascular disease

Question 7

IABP complications

Answer 7

• limb ischemia (#1 complication)
• Aortic dissection
• thrombocytopenia
• infection / septicemia
• renal complications
• gas emboli - rare

Question 8

Early inflation

Answer 8

• Inflation before aortic valve closure
• inflation during systole
• acts as a cork in aorta
• causes reflux of blood in LV
• decreases cardiac output & increases SVR
• very harmful to pt (immediate intervention needed)

Question 9

Late inflation

Answer 9

• late phase diastole inflation
• results in sub-optimal augmentation
• minimal displacement of blood back toward coronary arteries

Question 10

Early deflation

Answer 10

Vacuum effect and afterload reduction is lost

• pressures decrease in aorta while aortic valve still closed.
• by the time aortic valve opens, aortic pressures have equalized.
• not harmful, but does not help situation.

Question 11

Late deflation

Answer 11

Balloon still inflated during beginning of ventricular systole..
Most harmful. Increases LV workload
-pressures are extremely high when balloon deflates (can lead to ruptures in brain and coronaries)

Question 12

Proper timing waveform will exhibit

Answer 12

1. Nice sharp V where balloon pump kicks in, level with dicrotic notch.
2. IABP deflation should show a nice uniform U shape blends nicely into beginning of next arterial waveform.

Question 13

Which is safer? Inward or outward waveform adjustment.

Answer 13

Safer to move inward

outward:
- inflation: early inflation (harmful)
- deflation: late deflation (most harmful)

Inward:

• inflation: late deflation (not helpful, but not harmful)
• deflation: early deflation (not helpful, but not harmful)

Question 14

Balloon purge

Answer 14

On ascent about 1000 ft agl

• due to Boyles law
• will be less than 1 minute. Monitor for decompensation

Question 15

Normal pump trigger

Answer 15

EKG

Question 16

Cardiopulmonary arrest considerations

Answer 16

Place trigger mode on arterial pressure or internal trigger mode.

• Leave pump running.
• May assist efforts

Question 17

In the event of power failure

Answer 17

Balloon pump needs manual pumping q 30 minutes to prevent thrombus formation

Question 18

Positioning the patient for balloon pump rupture

Answer 18

Rust colored flakes!!!
-place patient in trendelenburg position and roll so patient insertion site is high. Helium will travel and trap at insertion site. Prevents emboli

Question 19

Goals of IABP therapy

Answer 19

• Decreasing afterload (decrease workload on heart)
• augment diastolic coronary perfusion
• improve cardiac output
• limits myocardial ischemia
• prevent cardiogenic shock