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IABP (1)

The document provides a comprehensive overview of Intra Aortic Balloon Counterpulsation (IABP), detailing its introduction, history, principles, indications, contraindications, instrumentation, and techniques for insertion and removal. It discusses patient management during IABP support, including monitoring and weaning protocols, as well as potential complications. IABP is highlighted as a critical temporary support mechanism for patients experiencing cardiogenic shock, emphasizing the importance of proper technique and monitoring to ensure patient safety.

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vedhavegashini23
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8 views

IABP (1)

The document provides a comprehensive overview of Intra Aortic Balloon Counterpulsation (IABP), detailing its introduction, history, principles, indications, contraindications, instrumentation, and techniques for insertion and removal. It discusses patient management during IABP support, including monitoring and weaning protocols, as well as potential complications. IABP is highlighted as a critical temporary support mechanism for patients experiencing cardiogenic shock, emphasizing the importance of proper technique and monitoring to ensure patient safety.

Uploaded by

vedhavegashini23
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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INTRA AORTIC BALLON

COUNTERPULSATION
Contents
1. Introduction
2. History
3. Principle
4. Indications and Contraindications
5. Instrumentations
6. Insertion Techniques
7. Weaning
8. Removal of IABP
9. Complications
INTRODUCTION
Intra aortic balloon counter
pulsation( IABP):
• Temporary support for the left ventricle by
mechanically displacing blood within the aorta.

• Most common and widely available methods of mechanical


circulatory support.

• Traditionally used in surgical and non surgical patients


with cardiogenic shock.

HISTORY
• 1962 – First introduced by – Moulopoulos

• 1968 – Described clinically by - Kantrowitz


Principle
• Concepts:

• Synchronized counter pulsation

• Systolic unloading

• Diastolic augmentation
CONTRAINDICATIONS

• Absolute-
▫ Significant aortic regurgitation
▫ Aortic dissection
▫ Aortic stents
▫ Bilateral femoral popliteal bypass grafts for severe PVD

• Relative -
▫ Abdominal aortic aneurysm
▫ Uncontrolled septicemia
▫ Uncontrolled bleeding diathesis
▫ Severe bilateral peripheral vascular disease
IABP
Instrumentation
and techniques
Positioni
ng
- The end of the balloon should be just distal (1-2 cm) to the
takeoff of the left subclavian artery

- Position should be confirmed by fluoroscopy or chest x-ray


Without IABP

WITH IABP ASSIST 1:2


Factors affecting
diastolic augmentation
Patient
- Heart rate
- Mean arterial pressure
- Stroke volume
- Systemic vascular resistance

Intra aortic balloon


catheter
- IAB in sheath
- IAB not unfolded
- IAB position
- Kink in the IAB
catheter
- IAB leak
- Low helium
concentration

Intra aortic balloon


Variation in balloon pressure wave forms

ncreased duration of
lateau due to longer
diastolic phase Decreased duration
of plateau due to
shortened diastolic
phase

Varying R-R intervals


result in irregular
plateau durations
Increased height
or amplitude of
Decreased height or
amplitude of the
Gas
the waveform waveform
leak

Leak in the closed system causing the balloon


pressure waveform to fall below zero baseline..

- due to a loose connection


- a leak in the IAB catheter
- H2O condensation in the external tubing
- a patient who is tachycardiac and febrile which causes increased gas diffusion
through the IAB membrane
Cathete
r Kink

Rounded balloon pressure


waveform
- Loss of plateau resulting from a kink
or
obstruction of shuttle
gas

- Kink in the catheter


tubing
- Improper IAB catheter
position
- Sheath not being
pulled back to allow
inflation of the IAB
- IAB is too large for the
“Balloon
too large”
syndrome
Late
Inflation
 Inflation of the IAB markedly after closure of the
aortic valve.
 Waveform Characteristics:
• Inflation of IAB after the dicrotic notch.
• Absence of sharp V.
• Sub optimal diastolic augmentation
Early
Deflation
 Premature deflation of the IAB during the diastolic
phase.
Late
Deflation
 Late deflation of the IAB during the diastolic phase.

 Waveform Characteristics:
• Assisted aortic end diastolic pressure may be
equal to the
unassisted aortic end diastolic pressure.
• Rate of rise of assisted systole is prolonged.
• Diastolic augmentation may appear widened
Trigger
modes
Trigger
:
-E
v
e
n
t
t
h
e
p
u
m
p
u
s
e
ECG signal – most
common
• Inflation
- middle of T wave
• Deflation
– peak of R
wave

• Pacer (v/a)

• Arterial waveform

• An intrinsic pump
rate
(VF, CPB)
2
8
Expected changes with IABP support in
hemodynamic profile in
patients with Cardiogenic shock

- Decrease in SBP by 20 %

- Increase in aortic Diastolic Press. by 30 % ( raise coronary


blood flow)

- Increase in MAP

- Reduction of the HR by 20%

-Decrease in the mean PCWP by 20 %


Benefits of larger volume
IABs
• More blood volume
displacement
• More diastolic augmentation
• More systolic unloading
Patient Management
During IABP support
 Anticoagulation-- maintain apTT at 50 to 70 seconds

 CXR daily – to R/O IAB migration

 Check lower limb pulses - 2 hourly.


- If not palpable » ? - vascular obstruction
- thrombus, embolus, or
dissection (urgent surgical
consultation)

 Prophylactic antibiotics NOT INDICATED

 Hip flexion is restricted, and the head of the bed


should not be elevated beyond 30°.
Patient Management
During IABP support

 Never leave in standby by mode for more than 20 minutes >


thrombus formation

 Daily
– Haemoglobin (risk of bleeding or haemolysis)
– Platelet count (risk of thrombocytopenia)
– Renal function (risk of acute kidney injury secondary
to distal
migration of IABP
catheter)

 Wean off the IABP as early as possible as longer duration is


associated with higher incidence of limb complications
Weaning of IABP
Timing of weaning:

- Patient should be stable for 12 – 24 hours


- Decrease inotropic support
- Decrease pump ratio
– From 1:1 to 1:2 or 1:3
- Decrease augmentation
- Monitor patient closely

– If patient becomes unstable, weaning should be immediately discontinued

IABP Removal
-Discontinue heparin 1 hour prior to removal

-Disconnect the IAB catheter from the IAB pump

- Patient blood pressure will collapse the balloon membrane for withdrawal

- Withdraw the IAB catheter through the introducer sheath until resistance is met.

- NEVER attempt to withdraw the balloon membrane through the introducer sheath.

-Remove the IAB catheter and the introducer sheath as a unit.

- Check for adequacy of limb perfusion after hemostasis is achieved.


THANK

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