Historically, most patients in cardiac care units (CCUs) have been admitted with the diagnosis of acute myocardial infarction (AMI) or a complication of AMI. 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. During diastole, the aortic valve clos… Nurses are welcome to attend a class at any location. Our intensive care unit during a typical procedure to insert an intra-aortic balloon pump Ward RN MScb, Mary D. Courtney RN PhDa a Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Queensland 4059, Australia In our hospital it is completed hourly. On-Line Program Annual Review ; Special Care Manual SP I 2.0 SP - I 2.3 SP I 2.4 SP - I 6.0. Barrie-Shevlin P. Haemodynamic Monitoring: Invasive and Noninvasive Clinical Application. 2009;9(1):24-28. Patients receiving IABP therapy are normally maintained on an anticoagulation regimen to avoid thrombus formation at the tip of the catheter or within the folds of the balloon. The current practice of intra-aortic balloon counterpulsation. The left main coronary artery originates just above the left aortic cusp; similarly, the right coronary artery originates just above the right aortic cusp. 2010 Jan;38(1):152-60. doi: 10.1097/CCM.0b013e3181b78671. The lighter weight of heliu… 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 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. The primary purpose of IABP is the support of the failing heart by simultaneously increasing myocardial oxygen supply and decreasing myocardial oxygen demand. Pharmacologic Treatment. It reflects severe left-sided heart failure. The net result of inflation and deflation is increased coronary and cerebral perfusion and reduced myocardial workload respectively. Critical Care Nurse 2005; 25(5): 40-49, Ferguson JJ, Cohen M, et al. 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. The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. The aortic valve normally has three cusps: right, left, and posterior. 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. Table 3 lists the potential complications associated with IABP therapy. Br J Cardiac Nursing 2005; 1(12): 582-588, Darovic GO. This catheter is normally inserted via the femoral artery and passed into the descending thoracic aorta until the tip is positioned 2cm just below the left subclavian artery2 and the lower end of the balloon just above the renal arteries. Balloon size generally depends on the patient's height and aortic diameter. Change of dressing is as per clinical need and hospital guidelines, aseptic technique must be employed to minimise the risk of infection. 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. 2 Objectives. 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. Patient position is an important consideration if the IABP is to be effective. The IABP is implanted into the patient's aorta. Nursing care of patients during intraaortic balloon pumping, https://doi.org/10.1016/j.jsha.2015.05.230. This course is designed to prepare nurses to care for patients with a Datascope intra-aortic balloon pump. 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. 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. 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. Briefly, the intraaortic balloon pump is a specific and aggressive form of care for patients in cardiogenic shock. Nursing Care Of Patients on Intra-Aortic Balloon Pump. on ECG the balloon will deflate on the R wave), which is normally set to ECG. During left ventricular systole, the aortic valve opens and the aortic cusps are reflected superiorly to obstruct the coronary ostia. 14. Caring for patients with intraaortic balloon pumps (IABPs) is a unique nursing challenge in the cardiovascular recovery and intensive care units. Table 1 lists the many indications for IABP therapy. 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. Signs of retroperitoneal bleeding include the patient becoming hypotensive and complaining of back, flank or abdominal pain unrelieved by changes in position. This article provides an overview of the function of the pump, indications, potential complications and nursing care required. and Cottrell D. Nursing care of patients receiving Intra-aortic Balloon Counterpulsation. 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. 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. 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