Perfusion Policies 101: IABP

Editor’s Note:

PERFUSION POLICIES 101

Welcome to PERFUSION POLICIES 101.  This will be a continuing series provided to assist your programs with that one puzzle piece we all run into now and then- that one time that an unexpected patient condition may give you pause…

The intention here is to disseminate some basic recipes that have probably been implemented at countless institutions, for God knows how long.  The usual disclaimers obviously apply:  

Due Diligence is the Responsibility of the Reader!

Use the information as you feel fit, recognizing that this is information gleaned from multiple sources, it is recruited from the public domain of the internet, with no implied assurance of accuracy- but is cogent, and based on logical and reasonable clinical rationale.

Frank Aprile 🙂

Intraaortic Ballon Pumps

DATASCOPE INTRAAORTIC BALLOON PUMP (IABP)

The IABP is an intravascular volume counterpulsation  device that augments the circulation by the displacement of aortic blood volume in diastole and reduces the work load of ventricular ejection in systole.

Expanded use of the IABP  now includes the following:

1. Unstable angina refractory to medical therapy.
2. Preoperative and intraoperative assist in the patient presented with cardiogenic shock.
3. Circulatory stabilization in patients with sudden development of ventricular septal defect and mitral regurgitation.
4. Postoperative interim organ support.

EQUIPMENT

1. Datascope IABP console 97/97E/cs100/300
2. Datascope balloon (with or without central lumen), including percutaneous insertion kit
3. Catheter extension
4. Pressure cable
5. Five-lead patient cable with electrosurgical interference suppresser filter blocks
6. Slave cable for both electrocardragrion (ECG) and pressure monitoring
7. Silver-Silver chloride ECG skin electrodes
8. Fiberoptic sensation balloon if using CS 300

PROCEDURE

CAUTION: Before operating the equipment the user must be familiar with controls and functions of the datascope IABP console.

1. Establish power. Console will automatically go through self test.
2. Perform safety chamber leak test (refer to operators manual for instructions on performing this test), if applicable.
3. Open helium cylinder (close when system is not in use).
4. Acquire ECG either with skin leads or via slave of existing monitor.
5. Acquire pressure trace either through central lumen of IABP catheter, arterial line, or via slave of existing monitor.
6. Select trigger. ECG usually safest and best trigger. Pressure trigger is useful during operation of electrosurgical (bovie) equipment, but requires periodic adjustments witht eh timing of the console and changes in the patien’s rathe of rhythm.  Pacer trigger is only operational if the ECG is being monitored directly by the IABP from electrodes placed on the skin.  The pacer trigger may not work while slaving from an external source.
7. Initiate assist. Best to start at an assist rate of 1:2 so that proper timing adjustments can be made.
8. Adjust timing. The system automatically establishes correct timing of the IABP in the autotiming mode.  The inflation and deflation controls may be adjusted to optimize IABP timing, following the manufacturer’s guidelines.