Tanta university

Faculty of nursing
Critical care and emergency nursing department
Master degree
2023-2024

INTRA AORTIC BALLON PUMP

UNDER SUPERVISION

DR/ ROKIA IBRAHIM

Prepared by

EMAN MABROUK
ENAS ESMAEIL
OUTLINE
• INTRODUCTION
• Causes
• Assessment
• Component
• Medication
• Laboratory investigation
• Warning signs
• Procedure
• Nursing Intervention
• Weaning
• Complication
Reference
INTRODUCTION
The intra-aortic balloon pump (IABP) is a mechanical device used to
provide temporary support to the heart and circulatory system in critically
ill patients. It consists of a long, flexible catheter with an inflatable balloon
at its tip, which is inserted into the body, typically through the femoral
artery in the groin. The balloon is positioned within the descending aorta,
just below the left subclavian artery. The IABP works by inflating the
balloon during diastole (when the heart is relaxed), which increases
coronary artery perfusion and improves myocardial oxygen supply. It
deflates just before systole (when the heart contracts), reducing afterload
and myocardial workload. This assists the heart's pumping action,
Increases cardiac output, and improves overall circulation, making it
beneficial in conditions such as cardiogenic shock, acute myocardial
infarction, or high-risk cardiac procedures. The timing and volume of
balloon inflation and deflation are carefully controlled to synchronize with
the patient's cardiac cycle.Overall, the IABP is a valuable tool in the
management of critically ill patients with cardiovascular conditions,
providing temporary circulatory support while underlying issues are
addressed or until the patient stabilizes.
 • DEFINATION
The intra-aortic balloon pump (IABP) is a mechanical device that helps
the heart pump more blood and can increase blood flow to the heart and
the rest of the body. It's often used temporarily in critically ill patients with
conditions like heart failure or during certain types of cardiac surgery.
 • CAUSES
Several conditions can lead to the need for intra-aortic balloon pump
(IABP) support. These include:
1-Acute Myocardial Infarction (AMI): A heart attack can cause significant
damage to the heart muscle, leading to reduced cardiac output and
potential cardiogenic shock
2-Severe Heart Failure: When the heart is unable to pump enough blood to
meet the body's demands, either due to weakened heart muscle or other
underlying conditions, it can result in cardiogenic shock
3-Cardiomyopathy: Various forms of cardiomyopathy, including ischemic,
dilated, hypertrophic, or restrictive cardiomyopathy, can impair heart
function and lead to the need for mechanical support.
4-Mechanical Complications of AMI: These include conditions such as
acute severe mitral regurgitation, ventricular septal defect, or free wall
rupture, which can lead to hemodynamic instability and shock.
5-High-Risk Coronary Interventions: Patients undergoing complex coronary
interventions, such as PCI or CABG, may experience hemodynamic
compromise during or after the procedure, necessitating temporary
mechanical support.
6-Severe Refractory Angina: In some cases, severe, unrelenting chest pain
due to coronary artery disease may require mechanical support to improve
coronary perfusion and relieve symptoms.
7-Post-Cardiac Surgery: Following cardiac surgery, such as valve
replacement, coronary artery bypass grafting, or repair of congenital heart
defects
• ASSESSMENT

Assessment plays a critical role in the management of patients with an

intra-aortic balloon pump (IABP), helping healthcare providers evaluate the
patient's condition, monitor response to therapy, and identify any
complications. Here are key aspects of assessment for patients with an
IABP:
1-Cardiovascular Assessment: Monitor vital signs, including heart
rate, blood pressure, and respiratory rate, frequently to detect any
changes in hemodynamic status.
2-Assess cardiac rhythm continuously via electrocardiogram
(ECG) monitoring to identify any arrhythmias or conduction
abnormalities.
3-Evaluate peripheral perfusion by assessing distal pulses, capillary
refill time, skin color, and temperature to ensure adequate tissue
perfusion.
4-Hemodynamic Monitoring: Utilize invasive hemodynamic
monitoring, such as arterial pressure monitoring and central venous
pressure monitoring, to assess cardiac output, systemic vascular
resistance, and fluid status. Interpret hemodynamic parameters to
guide adjustments in IABP settings and other therapies, such as
inotropic or vasopressor support
5-. IABP Function and Settings: Verify proper function of the
IABP system, including balloon inflation and deflation
synchronization with the cardiac cycle. Monitor and adjust IABP
settings, such as balloon timing, inflation/deflation ratio, and
augmentation volume, based on the patient's hemodynamic response
and clinical status.
6-Pulmonary Assessment: Assess respiratory status, including
respiratory rate, effort, and oxygenation, to detect any signs of
respiratory distress or hypoxemia.Monitor for signs of pulmonary
congestion or edema, such as crackles on auscultation or increased
work of breathing.
 7-Neurological Assessment: Evaluate neurological status, including
level of consciousness, orientation, and pupillary response, to detect
any changes that may indicate cerebral hypoperfusion or
neurological complications.
8-Monitor for signs of stroke, such as sudden onset of focal
deficits or alterations in mental status. Renal and Fluid Balance
Assessment: Monitor urine output and assess for signs of renal
dysfunction, such as oliguria or elevated serum creatinine levels,
which may indicate inadequate perfusion or complications. Evaluate
fluid balance, including intake and output, to assess for volume
overload or dehydration.
9 Laboratory Monitoring: Obtain and interpret laboratory tests,
including complete blood count, electrolytes, renal function tests,
and coagulation studies, to assess organ function, electrolyte balance,
and coagulation status.
10-Psychosocial Assessment: Assess the patient's psychosocial
status, including coping mechanisms, social support, and
understanding of the medical condition and treatment plan.Identify
any psychological or emotional factors that may impact the patient's
recovery and adherence to therapy.
11-Regular and comprehensive assessment along with timely
interventions based on assessment findings, is essential for
optimizing patient outcomes and preventing complications in
patients with an intra-aortic balloon pump.
 • COMPONENT
The intra-aortic balloon pump (IABP) consists of several key
components that work together to provide mechanical circulatory
support. These components include:
1-Balloon Catheter: The balloon catheter is a flexible tube inserted
into the body, typically through the femoral artery in the groin. It
contains an inflatable balloon at its tip, which is positioned within
the descending aorta, just below the left subclavian artery.
2-Helium Console: The helium console is a machine that generates
and regulates the flow of helium gas to inflate and deflate the balloon
within the catheter. It controls the timing and volume of helium
delivery to synchronize balloon inflation and deflation with the
cardiac cycle.
3-Pressure Transducer: A pressure transducer is integrated into the
IABP system to continuously monitor arterial pressure and provide
feedback for timing the inflation and deflation of the balloon. This
helps ensure optimal synchronization with the patient's cardiac cycle.
4-Control Unit: The control unit of the IABP system includes the
interface where healthcare providers can adjust settings such as
balloon inflation timing, augmentation volume, and
inflation/deflation ratio. It also displays real-time pressure
waveforms and other relevant parameters for monitoring.
5-Inflation and Deflation Timing Mechanism: The IABP system
includes mechanisms for precise timing of balloon inflation and
deflation based on the patient's electrocardiogram (ECG) or arterial
pressure waveform. This ensures that the balloon inflates during
diastole to increase coronary perfusion and deflates just before
systole to reduce afterload.
6-Power Source: The IABP system requires a power source to
operate, typically electricity for the control unit and helium gas for
the helium console. Backup power sources may be available to
ensure continuous operation in case of power outages or equipment
failure
Laboratory Investigation
Laboratory investigations play a crucial role in the management of
patients receiving intra-aortic balloon pump (IABP) support. These
investigations help assess the patient's clinical status, monitor for
complications, guide treatment decisions, and optimize overall
patient care. Here are some key laboratory tests commonly used in
conjunction with IABP therapy:
1-Complete Blood Count (CBC):Hemoglobin and Hematocrit:
Assess oxygen-carrying capacity and monitor for anemia or bleeding
complications.
2-White Blood Cell Count (WBC): Evaluate for signs of infection
or inflammation. Platelet Count: Assess platelet function and
monitor for thrombocytopenia or platelet dysfunction.
3-Coagulation Studies: Prothrombin Time (PT) and International
Normalized Ratio (INR): Evaluate the extrinsic pathway of
coagulation and monitor anticoagulation therapy.
4-Partial Thromboplastin Time (PTT): Assess the intrinsic
pathway of coagulation and monitor heparin therapy.
5-Fibrinogen: Evaluate fibrinogen levels and assess for
coagulopathies or consumptive coagulopathies.
6-Electrolyte Panel:Sodium (Na), Potassium (K), Calcium (Ca),
Magnesium (Mg): Monitor electrolyte levels and assess for
electrolyte imbalances, which can affect cardiac function and
hemodynamic stability.
7-Renal Function Tests:Serum Creatinine and Blood Urea Nitrogen
(BUN): Evaluate renal function and monitor for acute kidney injury
or renal insufficiency, which may occur due to decreased renal
perfusion or complications of IABP therapy.
8-Urine Output: Monitor urine output to assess renal perfusion and
function. Liver Function Tests: Alanine Aminotransferase (ALT),
Aspartate Aminotransferase (AST), Bilirubin, Alkaline Phosphatase
(ALP): Assess liver function and monitor for hepatic dysfunction or
injury, which may occur secondary to reduced cardiac output or
complications of therapy.
9-Arterial Blood Gas (ABG) Analysis, Partial Pressure of Oxygen
(PaO2), Partial Pressure of Carbon Dioxide (PaCO2), Bicarbonate
(HCO3-): Evaluate acid-base balance, oxygenation status, and
ventilation parameters to assess respiratory and metabolic function.
10-InflammatoryMarkers:C-reactiveProtein
(CRP)Procalcitonin: Assess for signs of systemic inflammation and
monitor response to treatment in cases of infection or inflammatory
conditions.
11-Blood Cultures: Obtain blood cultures to identify pathogens in
cases of suspected bloodstream infections or sepsis and guide
antimicrobial therapy.
12-Cardiac Biomarkers: Troponin: Assess myocardial injury or
infarction in patients with acute coronary syndromes or
complications of IABP therapy.
13-Thyroid Function Tests: Thyroid-stimulating Hormone (TSH),
Free Thyroxine (T4): Assess thyroid function and monitor for
thyroid dysfunction, which can affect cardiac function and
metabolism.
MEDICATION
Patients with an intra-aortic balloon pump (IABP) may require
medication to manage their condition and prevent complications.
Here are some common medications used in conjunction with IABP
therapy:
1-Anticoagulants: These medications, such as heparin or low
molecular weight heparin, are often administered to prevent clot
formation within the IABP catheter and to minimize the risk of
thromboembolic events.
2-Antiplatelet Agents: Drugs like aspirin, clopidogrel, or
glycoprotein IIb/IIIa inhibitors may be prescribed to inhibit platelet
aggregation and reduce the risk of thrombosis, particularly in
patients undergoing coronary interventions or those with acute
coronary syndrome.
3-Vasopressors or Inotropes: Inotropes like dobutamine or
milrinone may be used to improve myocardial contractility and
cardiac output in patients with cardiogenic shock. Vasopressors such
as norepinephrine or dopamine may be administered to maintain
adequate blood pressure and perfusion.
4-Vasodilators: Medications like nitroglycerin or nitroprusside may
be used to reduce systemic vascular resistance and afterload, thereby
decreasing myocardial oxygen demand and improving cardiac
function.
5-Analgesics: Pain management medications, such as opioids or
nonsteroidal anti-inflammatory drugs (NSAIDs), may be prescribed
to alleviate discomfort associated with the insertion site or other
procedures.
6-Sedatives or Anxiolytics: These medications may be administered
to keep the patient comfortable and reduce anxiety during the
procedure or while on mechanical support.
7-Antibiotics: Prophylactic antibiotics may be given before and after
IABP insertion to reduce the risk of infection, particularly in patients
with prolonged catheterization or other risk factors.
8-Electrolyte Replacement: Electrolyte imbalances, such as
hypokalemia or hypomagnesemia, may occur in critically ill patients
and may require supplementation to maintain cardiac function and
prevent arrhythmias.
9-Diuretics: Diuretics like furosemide may be used to alleviate fluid
overload and congestion in patients with heart failure or cardiogenic
shock.
PROCEDURE
The placement of an intra-aortic balloon pump (IABP) involves a
specific procedure typically performed in a hospital setting by
trained medical professionals, often under the guidance of a
cardiologist or an interventional cardiologist. Here's an overview of
the procedure:
Preparation: Before the procedure, the patient's medical history is
reviewed, and necessary tests, such as imaging studies or blood tests,
may be conducted to assess their cardiac function and suitability for
IABP placement. The patient is usually placed on a monitor to
continuously monitor vital signs.
Anesthesia: In most cases, local anesthesia is used to numb the
insertion site, which is usually the femoral artery in the groin area. In
some cases, conscious sedation may also be administered to keep the
patient comfortable and relaxed during the procedure.
Insertion of the Balloon Catheter: A specialized balloon catheter,
which includes an inflatable balloon at its tip, is inserted into the
femoral artery through a small incision in the groin. The catheter is
then advanced under fluoroscopic guidance (X-ray imaging) up into
the descending aorta, where the balloon is positioned just below the
left subclavian artery.
Confirmation of Placement: Once the balloon is positioned
correctly, its placement is confirmed by fluoroscopy and sometimes
by pressure waveform analysis. Proper positioning ensures optimal
support and effectiveness of the IABP.
Inflation and Deflation: The balloon is inflated and deflated in
synchrony with the cardiac cycle. Typically, it inflates during
diastole (when the heart is relaxed) to increase coronary artery
perfusion and deflates just before systole (when the heart contracts)
to reduce afterload and workload on the heart.
Monitoring and Adjustment: After placement, the patient's
hemodynamic status is closely monitored to ensure that the IABP is
providing the intended support. The timing and pressure settings of
the balloon may be adjusted as needed based on the patient's
condition and response.
Post-Procedure Care: Once the IABP is in place, the patient is
monitored in a critical care setting. Vital signs, cardiac function, and
the insertion site are closely monitored for any signs of
complications. Depending on the underlying condition and response
to therapy, the IABP may be used for a few hours to several days
before removal.
Removal: When the patient's cardiac function has improved
sufficiently or when other interventions are deemed appropriate, the
IABP is removed. This is usually done by deflating the balloon,
withdrawing the catheter from the artery, and applying pressure to
the insertion site to prevent bleeding.

• Inappropriate Timing of Intra-Aortic Balloon (IAB) Inflation

and Deflation
Too EARLY TOO LATE
INFLATION IAB inflates before the IAB inflates late in the
aortic valve closes: diastolic cycle: Waveform
Waveform characteristics characteristics
• IAB inflates prior to IAB inflates after the
dicrotic notch dicrotic notch
Diastolic augmentation • Absence of sharp V
encroaches onto systole •Suboptimal diastolic
•• Potential physiological augmentation
effects , Potentialphysiological
1• Premature closure of effects
the aortic valve • Suboptimal coronary
2• Aortic regurgitation •• artery perfusion
Decreased diastolic • Decreased diastolic
pressure time index pressure time index
3•Decreased Cardiac
output
4•Left ventricular end-
diastolic pressure
5•Left ventricular end-
diastolic volume
••Left ventricular
afterload
 •pulmonary capillary
wedge press
Myocardial oxygen
demand

DEFLATION IAB deflates before the IAB inflates during a

end of diastole: portion of the systolic
cycle:
Waveform characteristics Waveform characteristics
•• Deflation of IAB is seen •• Assisted aortic end
as a sharp drop following diastolic pressure may be
diastolic augmentation equal to the unassisted
•• Suboptimal diastolic aortic end diastolic
augmentation pressure
•• Rate of rise of assisted •• Rate of rise of assisted
systole is prolonged •• systole is prolonged
Assisted aortic end •• Diastolic augmentation
diastolic pressure may be may
equal to or less than the
unassisted aortic end
diastolic pressure •
Potential physiological
Potential physiological effects
effects 1. Afterload
1. Suboptimal reduction is
coronary artery essentially absent
perfusion 2. Increased
2. Potential for myocardial oxygen
retrograde consumption
coronary and because of
carotid blood flow 3. the left ventricle
3. Suboptimal ejecting against a
afterload reduction greater resistance
4. Increased 4. and a prolonged
myocardial oxygen isovolumetric
demand contraction phase
5. Decreased diastolic 5. Impeded left
pressure time ventricular ejection
index and increased left
6. ventricular
afterload appears
widened
WARNING SIGNS
Warning signs associated with an intra-aortic balloon pump (IABP)
may indicate complications or the need for intervention. Here are
some warning signs that healthcare providers should be vigilant for:
1-Decreased Peripheral Perfusion: Signs of decreased perfusion to
the extremities, such as cool, pale, or mottled skin, delayed capillary
refill, or diminished distal pulses, may indicate compromised blood
flow and potential limb ischemia.
2-Hemodynamic Instability: Abrupt changes in hemodynamic
parameters, including hypotension (low blood pressure), tachycardia
(rapid heart rate), or worsening cardiac output, may signal
inadequate circulatory support or cardiovascular compromise.
3-Arrhythmias: New or worsening arrhythmias, such as atrial
fibrillation, ventricular tachycardia, or heart block, may occur as a
result of mechanical irritation of the heart or electrolyte imbalances
and may require prompt evaluation and management.
4-Bleeding or Hematoma: Signs of bleeding at the insertion site,
such as oozing, hematoma formation, or expanding ecchymosis,
should be promptly assessed to prevent hemorrhage and ensure
hemostasis.
5-Thrombosis or Embolism: Symptoms of thrombosis or
embolism, such as acute limb pain, cyanosis, or sudden onset of
dyspnea, may indicate clot formation within the IABP catheter or
embolization of thrombi to other vascular beds.
6-Neurological Changes: Any alterations in neurological status,
including confusion, agitation, focal deficits, or loss of
consciousness, may suggest cerebral hypoperfusion, embolic events,
or neurological complications requiring urgent evaluation.
7-Infection: Signs of infection at the insertion site, such as warmth,
erythema, tenderness, or purulent drainage, may indicate catheter-
related infection and should be promptly addressed to prevent
systemic infection or sepsis.
8-Electrolyte Imbalance: Electrolyte abnormalities, such as
hyperkalemia or hypokalemia, hypercalcemia or hypocalcemia, or
metabolic acidosis, may manifest with various symptoms, including
cardiac arrhythmias, muscle weakness, or altered mental status, and
should be corrected promptly.
9-Pulmonary Complications: Symptoms of pulmonary congestion
or edema, such as dyspnea, orthopnea, cough, or crackles on
auscultation, may indicate worsening heart failure or fluid overload
and require assessment and management.
10-Psychological Distress: Patient-reported symptoms of anxiety,
fear, or discomfort related to the IABP or underlying condition
should be addressed promptly to ensure patient comfort and alleviate
psychological distress.
NURSING INTERVENTION
Nursing interventions play a crucial role in the care of
patients with an intra-aortic balloon pump (IABP) to ensure
optimal outcomes and prevent complications. Here are some
key nursing interventions:
Pre-Procedure Preparation:
• Explain the procedure to the patient and address any concerns.
Ensure informed consent is obtained. Assess the patient's
baseline vital signs, cardiac function, and peripheral
circulation. Verify that necessary equipment and medications
are available.
Intra-Procedure Support:

• Assist the physician during the insertion of the IABP catheter.

Monitor the patient's vital signs, electrocardiogram (ECG), and
hemodynamic parameters throughout the procedure. Ensure
proper positioning of the patient to facilitate catheter insertion
and minimize discomfort.
Post-Procedure Monitoring:
• Continuously monitor the patients. vital signs, including heart
rate, blood pressure, and oxygen saturation
• . Assess the insertion site for signs of bleeding, hematoma, or
infection. Monitor distal pulses and assess for signs of
peripheral ischemia or compromise
• . Ensure the balloon inflation and deflation are synchronized
with the cardiac cycle. Monitor urinary output to assess renal
perfusion and function
• . Optimizing Positioning and Mobility: Position the patient to
optimize cardiac output and minimize discomfort
• Encourage mobility as tolerated, with precautions to avoid
dislodging the IABP catheter
• Provide frequent turning and repositioning to prevent pressure
injuries and promote circulation
• Medication Administration: Administer medications as
prescribed, including anticoagulants to prevent thrombosis and
antibiotics if indicated for infection prophylaxis
• Monitor for adverse reactions to medications, especially those
affecting hemostasis or cardiac function
• . Patient Education: Educate the patient and family about the
purpose of the IABP, its function, and potential complications
• Provide instructions on activity restrictions, signs of
complications, and when to seek medical attention.Teach the
patient how to care for the insertion site and maintain proper
hygiene
• Collaboration and Communication: Collaborate with the
healthcare team, including physicians, surgeons, and other
specialists, to coordinate care and ensure patient safety
• Communicate changes in the patient's condition or response to
therapy promptly
• Participate in multidisciplinary rounds and discussions
regarding the patient's care plan.By implementing these
nursing interventions, healthcare providers can help optimize
patient outcomes and promote safe and effective management
of patients with an intra-aortic balloon pump.
WEANING
Weaning off an intra-aortic balloon pump (IABP) involves a gradual
reduction in support as the patient's cardiac function improves.
Here's a general approach to weaning off an IABP:
1-Assessment of Cardiac Function: Before considering weaning,
the healthcare team assesses the patient's cardiac function through
various parameters such as hemodynamics, echocardiography, and
clinical status. Improvement in cardiac function indicates readiness
for weaning.
2-Decreasing Balloon Augmentation: The balloon augmentation,
which assists the heart's pumping action, is gradually reduced. This
can be achieved by decreasing the volume of helium in the balloon
or reducing the assistance ratio (the proportion of the cardiac cycle
during which the balloon is inflated).
3-Monitoring Response: While weaning, the patient's hemodynamic
parameters, such as blood pressure, heart rate, and cardiac output, are
closely monitored. Any signs of hemodynamic instability or
deterioration prompt reassessment and possible adjustment of
support.
4-Assessment of Peripheral Perfusion: Peripheral perfusion,
including distal pulses and tissue perfusion, is assessed to ensure that
reducing balloon support does not compromise blood flow to vital
organs or extremities.
5-Observation for Complications: During the weaning process,
potential complications, such as arrhythmias, thrombosis, or
bleeding, are closely monitored. Prompt intervention is initiated if
complications arise.
6-Evaluation of Cardiac Function: Serial assessments of cardiac
function, such as echocardiography or invasive hemodynamic
monitoring, help determine the patient's response to weaning and
guide further management.
7-Consideration of Other Supportive Measures: Depending on the
patient's clinical condition, other supportive measures, such as
pharmacological support (inotropes, vasopressors), may be continued
or tapered off gradually in conjunction with IABP weaning.
8-Criteria for Removal: Once the patient demonstrates stable
hemodynamics, adequate cardiac function, and improved clinical
status, the IABP may be removed. This decision is made
collaboratively by the healthcare team, considering the patient's
overall condition and response to therapy.
9-Post-Removal Monitoring: After IABP removal, the patient is
closely monitored for any signs of hemodynamic instability,
recurrence of symptoms, or complications. Continuation of
supportive measures and appropriate post-removal care is provided
as needed.
COMPLICATION
Placement of an intra-aortic balloon pump (IABP) is generally
considered safe, but like any medical procedure, it carries the risk of
complications. Some potential complications include:
1-Bleeding: Bleeding can occur at the site where the catheter is
inserted, typically the femoral artery in the groin. This can range
from minor bruising to more significant bleeding requiring
intervention.
2-Vascular Injury: There is a risk of damage to the blood vessels,
including dissection (tearing) or perforation, during catheter
insertion. This can lead to internal bleeding or compromise blood
flow to the lower extremities.
3-Thrombosis or Embolism: Blood clots may form on the surface
of the balloon or within the blood vessels, leading to thrombosis
(clot formation) or embolism (clot migration). This can cause
blockages in the arteries, potentially leading to tissue damage or
organ dysfunction.
4-Ischemia or Limb Compromise: In rare cases, the placement of
the IABP may compromise blood flow to the lower extremities,
leading to ischemia (lack of blood flow) or limb-threatening
conditions like compartment syndrome.
5-Infection: There is a risk of infection at the insertion site or along
the catheter tract, particularly if strict aseptic techniques are not
followed during the procedure or if the catheter remains in place for
an extended period.
6-Balloon Malfunction: The balloon within the catheter may fail to
inflate or deflate properly, potentially compromising its effectiveness
in providing circulatory support.
7-Arrhythmias: The presence of the IABP can sometimes trigger
arrhythmias (abnormal heart rhythms), particularly if there is
mechanical irritation of the heart or if the timing of balloon
inflation/deflation is not synchronized with the cardiac cycle.
8-Organ Dysfunction: In severe cases, complications related to the
IABP, such as thrombosis or embolism, can lead to organ
dysfunction or failure, particularly if blood flow to vital organs is
compromised.
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