INTRA-AORTIC BALLOON PUMP (IABP)
IABP manufactoring companies: Datascope website
Intra-Aortic Balloon Counterpulsation - Pump (IABP):
A slender polyurethane balloon mounted on a catheter is placed in the descending thoracic Aorta with tip just distal to origin of left subclavian artery. A Console shuttles helium in and out of the balloon thus inflating and deflating it.
The balloon inflates during diastole thus causing augumentation of diastolic pressure, coronary perfusion and increasing MVO2 supply.
In Systole the balloon is deflated thus causing a decrease in aortic pressure, afterload and cardiac work. Myocardial oxygen consumption decreases
and cardiac Output increases.
Secondary effects associated with counterpulsation include a decrease in heart rate, systemic vascular resistance,left end diastolic pressure or PCWP, an increase in cardiac output and mean arterial pressure.
• Neuro: - Increase cerebral perfusion
• Renal: - Increase renal perfusion
• Vascular: - a decrease in SVR with an improvement in peripheral perfusion
• Respiratory: - a decrease in PADP /PCWP with a resultant improvement in respiratory function.
Indication for Use of IABP:
• Failure to wean from cardiopulmonary bypass
• Support during PTCA
• Acute Myocardial Infarction
• Unstable Angina
• Stunned Myocardium
• Severe Aortic incompetence
Intra-Aortic Balloon Pumping Insertion Instructions:
• Prior to use of the Intra Aortic Balloon Pump the manual should be read and made familiar with.
• Also manuals provided with each individual balloon catheter and insertion kit should be read.
• Before proceeding to the area of insertion, check that the following items are present on the balloon pump:-
3-lead ECG (with pads)
Disposable transducer (checking packaging and expiry date)
Transducer holder (on IABP stand)
500ml Heparinised Saline (checking package and expiry date)
• Ensure that there is ample helium in the cylinder by turning the valve fully anti-clockwise. The gauge should read >25% before proceding, if not the cylinder should be changed.
• The disposable transducer should then be flushed through with the HepSaline and the pressure bag pressurised to 200mmHg. The transducer should be mounted on the holder and attached to the balloon pump with the monitoring cable.
• If the height of the patient is not known the 3 different sized sized catheters with insertion kits (34, 40, & 50cc) should then be taken with the balloon pump to the destination, i.e. ITU, CCR, CCU, or theatre.
• The corresponding size for different patient heights are as follows:-
Patients height <5’4” use a 34cc balloon.
Patients height >5’4” but <6’0” use a 40cc balloon.
Patients height >6’0” use a 50cc balloon.
• On arrival at the specified area the 3-lead ECG should be applied to the patient and plugged into the balloon pump.
Red lead to the front of the right shoulder.
Yellow lead to the front of the left shoulder.
Green lead to the patient’s left side.
• The site at which the balloon pump is going to be inserted should then be obtained, either left or right leg.
• The balloon pump should then be plugged into a nearby mains outlet and powered up.
• After the pump system checks have been completed the transducer should then be zeroed. During this time the patient’s height can be obtained and the relevant balloon catheter handed to the scrub staff for opening
• At this point the type of insertion can be discussed with the scrub staff:- sheathed or sheathless.
Sheathed, if the patient is obese, has had previous cannulae inserted in, or near the insertion site i.e. scar tissue, or the patient is an arteriopath.
Sheathless if none of the above criteria are met.
• When the balloon pump has finished powering up an ECG should be present on the screen and a flashing diamond should be seen along the trace. The flashing diamond indicates a valid trigger. If there is no ECG trace present, cycle through the different leads, if still no trace, check all lead connections and replace electrodes.
• The ECG trace size can be altered at this point.
• The doctor inserting the balloon should now be trying to locate the femoral artery using the angiographic needle supplied with balloon insertion kit.
• The balloon (still in the tray) should have a vacuum applied to it using the valve and the 50cc syringe. The syringe should be up to 40ml and then removed.
• The stylet running through the monitoring lumen of the balloon should be removed and kept sterile, if angiography is not available to ensure correct positioning of the balloon at the end of the procedure.
• The balloon is inserted using the Seldinger technique, so once the artery is found the guide-wire is inserted through the needle, and the needle removed.
• Next, the first dilator is passed over the guide-wire, inserted into the artery and then retracted.
• If the balloon is to be inserted sheathed then the second dilator should be used, removed and the sheath inserted.
• If insertion is sheathless then the balloon is removed from its tray horizontally, passed over the guide-wire and up into the artery.
• If the balloon is inserted sheathed, after the balloon is inserted into the artery it is connected to the sheath.
• During insertion of the balloon the 2 monitoring lines ( on the catheter tray) are connected with the 3-way tap in the middle, and flushed with Heparinised Saline.
• The flushed monitoring line is attached to the top of the pressure transducer on the balloon pump, and flushed while being attached to the monitoring lumen of the balloon catheter.
• The pressure trace should show an arterial waveform. If the trace is damp, then the monitoring line should be flushed with 10mls of Hepsaline until the trace improves. If it doesn’t the monitoring circuit should be checked (connections) and the positioning of the balloon should investigated by the inserting doctor.
• If no trace is obtained replacement of the disposable transducer should be considered.
• If an arterial trace is still not obtained but a low pressure the doctor inserting the balloon should be notified immediately and the balloon removed. This may mean insertion of the balloon into the femoral vein.
• If a good arterial waveform is observed the balloon catheter should be connected to the balloon pump.
• The positioning of the catheter should be checked either using angiography (if in CCR) or using the stylet (which is the length of the balloon). As the tip of the balloon is radio-opaque if positioning is incorrect the balloon should be moved.
• If positioning is correct the IABP fill button should be depressed for 2 seconds until ‘Autofilling’ appears on the screen. The inserting doctor should be notified that the balloon is being filled.
• After a short period the balloon will be purged of air and filled with Helium. The balloon will then enter a standby state.
• Depression of the standby button will start the balloon augmenting. The start time of augmentation should be noted.
• Fine-tuning of the timing of the balloon should now be set. Changing the frequency from 1:1 to 1:2 will help. Also, highlighting the inflation and deflation phase on the pressure trace will help.
• At this point the augmentation alarm should be set to the desired level.
• Once suitable operation of the balloon is achieved the catheter should be sutured in by the doctor.
• During insertion and operation of the balloon pump any problems that arise should be investigated using the supplied manuals. There is also a help menu available on the balloon pump itself.
• Bridge to Cardiac Transplantation
• Cardiogenic and Septic Shock
• Transport of Patients
• Some paediatric patients