Downloaded 229 times
Uploaded byteja bayapalli
Iabp instrumentation, indications and complications
Intra-aortic balloon counterpulsation (IABP) provides temporary circulatory support through systolic unloading and diastolic augmentation. It increases coronary perfusion and decreases myocardial oxygen demand, and is used in patients with cardiogenic shock. Indications include cardiogenic shock, high-risk PCI, and post-cardiotomy shock. Contraindications are severe aortic insufficiency or aneurysm. The IABP catheter is inserted via the femoral artery and connected to a console for inflation and deflation. Waveform analysis ensures proper timing and augmentation.
In this document
Powered by AI
Dr. Sajeer KT introduces himself as a senior resident in Cardiology at MCH Calicut.
Intra-aortic balloon counterpulsation (IABP) is a mechanical circulatory support used for the left ventricle, focusing on systolic unloading and diastolic augmentation.
IABP is indicated for cardiogenic shock, CABG, high-risk coronary interventions, and stabilization before VAD insertion.
Contraindications include severe aortic insufficiency, aortic aneurysm, dissection, limb ischemia, and thromboembolism.
Describes phases of LV contraction, relaxation, and filling indicated in the cardiac cycle.
Introduction to interpreting IABP waveforms, critical for assessing cardiovascular performance.
Overview of the IABP system, the catheter's role, and the associated mobile console for control and monitoring.
The IAB inflation displaces blood during diastole, reducing the aortic afterload through a vacuum effect upon rapid deflation.
Key changes with IABP support: 20% SBP decrease, 30% increase in aortic diastolic pressure, and a 20% reduction in heart rate.
Describes the IAB catheter specifications, including length, volume capacity, and dual-lumen functionality.
Sizing considerations for IABP based on patient-specific anatomy and balloon volume.
Larger IABPs provide better blood volume displacement, diastolic augmentation, and systolic unloading.
Contents of an IABP kit including introducer needle, guide wire, dilators, and the balloon pump.
Step-by-step instructions for IABP catheter insertion, including precautions for vascular complications.
Importance of positioning the IAB catheter appropriately and confirming via imaging.
Connecting the IABP console, flushing the catheter, and initializing the monitoring system.
Different trigger modes used for the IABP: ECG, arterial pressure wave, and internal trigger mechanisms.
How to check and optimize waveforms for effective diastolic augmentation, identifying acceptable parameters.
Challenges of late inflation and deflation in the IABP process and their effects on hemodynamic performance.
Analyzes variations in balloon waveform due to changes in diastolic phase and complications like leaks or kinks.
Critical management strategies include anticoagulation monitoring, limb pulse checks, and limiting head elevation.
Guideline for weaning the patient off IABP and careful steps for catheter removal to ensure safety.
Series of quiz questions to assess understanding of IABP physiological effects and operational knowledge.
More Related Content
Similar to Iabp instrumentation, indications and complications
![INTRA AORTIC BALLON PUMP [IABP].ppt news](https://cdn.slidesharecdn.com/ss_thumbnails/intraaorticballonpumpiabp-240723151642-9cbe1595-thumbnail.jpg?width=640&height=640&fit=bounds)
Iabp instrumentation, indications and complications
- 1. Dr Sajeer KT SeniorResident Dept.of Cardiology, MCH Calicut 1
- 2. 2 Intra aortic ballooncounter pulsation( IABP): Most common and widely available methods of mechanical circulatory support Temporary support for the left ventricle by mechanically displacing blood within the aorta Concepts: - Systolic unloading - Diastolic augmentation Traditionally used in surgical and non surgical patients with cardiogenic shock
- 3.
- 4. 4 Indications for IABP 1.Cardiogenic shock: 2. In association with CABG : Preoperative insertion - Patients with severe LV dysfunction - Patients with intractable ischemic arrhythmias Postoperative insertion - Postcardiotomy cardiogenic shock - Associated with acute MI - Mechanical complications of MI - MR , VSD 3. In association with nonsurgical revascularization: -Hemodynamically unstable infarct patients -High risk coronary interventions - severe LV dysfunction, LMCA, complex coronary artery disease 4. Stabilization of cardiac transplant recipient before insertion of VAD Post infarction angina Ventricular arrhythmias relathed to ischemia
- 5.
- 6. 6 Contraindications to IABP Severe aortic insufficiency Aortic aneurysm Aortic dissection Limb ischemia Thrombo embolism
- 7.
- 8. 8 LV contraction: - Isovol.Contraction (b) - maximal ejection (c) LV relaxation: - start of relaxation and reduced ejection (d) - isovol.relaxation (e) LV filling: - LV filling , rapid phase (f) - slow LV filling (g) - atrial systole( a) Cardiac cycle
- 9.
- 10.
- 11.
- 12.
- 13.
- 14.
- 15.
- 16. 16 The IAB Counterpulsation system - two principal parts A flexible catheter -2 lumen • first - for distal aspiration/flushing or pressure monitoring • second - for the periodic delivery and removal of helium gas to a closed balloon. A mobile console • system for helium transfer • computer for control of the inflation and deflation cycle
- 17.
- 18. 18 HEMODYNAMIC EFFECTS —Inflation and deflation of the balloon Blood is displaced to the proximal aorta by inflation during diastole. Aortic volume ( afterload) is reduced during systole through a vacuum effect created by rapid balloon deflation
- 19. 19 Expected changes withIABP 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 % - Elevation in the COP by 20%
- 20.
- 21. 21 IABP catheter: 10-20cm long polyurethane bladder 25cc to 50cc capacity Optimal 85% of aorta occluded (not 100%) The shaft of the balloon catheter contains 2 lumens: - one allows for gas exchange from console to balloon - second lumen - for catheter delivery over a guide wire - for monitoring of central aortic pressure after installation.
- 22.
- 23.
- 24. 24 Benefits of largervolume IABs More blood volume displacement More diastolic augmentation More systolic unloading
- 25. 25 Introducer needle • Guidewire • Vessel dilators • Sheath • IABP (34 or 40cc) • Gas tubing • 60-mL syringe • Three-way stopcock IABP Kit Contents
- 26.
- 27. 27 Connect ECG Set uppressure lines Femoral access – followed by insertion of the supplied sheath(7.5 F) 0.030 inch supplied J-shaped guide wire to the level of the aortic arch (LAO view) STEP BY STEP- IABP insertion
- 28. 28 Before taking theCatheter out of Tray
- 29. 29 Take the entirecatheter and T handle as one unit (DO NOT disconnect one-way valve when removing the extracorporeal tubing from the tray.) Pull out the T- handle only as shown
- 30. 30 • Remove stylet/aspirate/Flush •Insert the balloon only over the guide wire • Hold the catheter close to skin insertion point • Advance in small steps of 1 to 2 cm at a time and stop if any resistance. • The IABP should advance freely Inserting the Balloon catheter - Many vascular complications occur during insertion itself - Resistance during insertion either indicates PVOD, or dissection - Kinking of IABP » improper inflation/deflation
- 31. 31 - The endof 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 Positioning
- 32. 32 Connecting to console: -Connect helium gas tube to the console via a long extender - Open helium tank. - The central lumen of the catheter is flushed and connected to pressure tubing with 3 way and then to a pressure transducer to allow for monitoring of central aortic pressure. - Zero the transducer Initial set-up: - Once connected properly the console would show ECG and pressure waveforms. - Check Basal mean pressure - Make sure the setting is at “auto” - Usually IABP started at 1:1 or 1:2 augmentation - Usually Augmentation is kept at maxim
- 33.
- 34. 34 Trigger modes Trigger : -Event the pump uses to identify the onset of cardiac cycle (systole) - Pump must have consistent trigger in order to provide patient assist - If selected trigger not detected, counter pulsation will interrupted 1.ECG - uses the slope of QR segment to detect triggering point 2. AP(Arterial pressure wave) - Systolic upstroke of the arterial pressure wave form is the trigger 3. IN(Internal trigger)
- 35. 35 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)
- 36. 36 Auto Operation Mode Automaticlead and trigger selection Automatic and continuous inflation and deflation timing management - User has ability to fine-tune deflation timing Automatic management of irregular rhythms Semi-Auto Operation Mode Operator selects most appropriate lead and trigger source Initial settings
- 37.
- 38.
- 39.
- 40.
- 41. 41 Increased coronary perfusion The “normal”augmented waveform
- 42. 42 Not all Suboptimal augmentation is due to Timing errors/kinks
- 43. 43 Factors affecting diastolicaugmentation 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 pump - Timing - Position of IAB augmentation control
- 44. 44 How to checkwaveform is acceptable ? First change from 1:1 to 1:2 augmentation
- 45.
- 46. 46 How to checkwaveform is acceptable ? First change from 1:1 to 1:2 augmentation Check the dicrotic notch See if augmentation starts at that point This should produce a sharp “V” at inflation.
- 47. 47 How to checkwaveform is acceptable ? First change from 1:1 to 1:2 augmentation Check the dicrotic notch See if augmentation starts at that point This should produce a sharp “V” at inflation. Check if diastolic augmented wave is › systolic wave
- 48. 48 How to checkwaveform is acceptable ? First change from 1:1 to 1:2 augmentation Check the dicrotic notch See if augmentation starts at that point This should produce a sharp “V” at inflation. Check if diastolic augmented wave is › systolic wave Confirm if end diastolic wave following the augmented wave is less than an non augmented wave. Is Deflation slope ok
- 49.
- 50. 50 Late Inflation Inflationof 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
- 51. 51 Early Deflation Prematuredeflation of the IAB during the diastolic phase.
- 52. 52 Late Deflation Latedeflation 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
- 53. 53 Once Arterial waveformis ok, check balloon waveform Normal Balloon Pressure Waveform
- 54.
- 55. 55 Variation in balloonpressure wave forms Increased duration of plateau due to longer diastolic phase Decreased duration of plateau due to shortened diastolic phase
- 56. 56 Variation in balloonpressure wave forms Varying R-R intervals result in irregular plateau durations
- 57. 57 Variation in balloonpressure wave forms Increased height or amplitude of the waveform Decreased height or amplitude of the waveform
- 58. 58 Variation in balloonpressure wave forms Gas 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
- 59. 59 Catheter Kink Rounded balloonpressure 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 aorta - IAB is not fully unwrapped - H2O condensation in the external tubing
- 60.
- 61. 61 Patient Management DuringIABP 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 --?? Hip flexion is restricted, and the head of the bed should not be elevated beyond 30°.
- 62. 62 Never leavein 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 Patient Management During IABP support
- 63.
- 64. 64 Weaning of IABP Timingof 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
- 65. 65 IABP Removal -Discontinue heparin1 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.
- 66.
- 67. • 1. Majorphysiological effects of counter pulsation include? ▫ A) increased coronary artery perfusion, increased preload, decreased after load, decreased myocardial oxygen consumption ▫ B) increased coronary artery perfusion, increased preload, increased after load, decreased myocardial oxygen consumption ▫ C) increased coronary artery perfusion, decreased preload, decreased after load, increased myocardial oxygen consumption ▫ D) increased coronary artery perfusion, decreased preload, decreased after load, decreased myocardial oxygen consumption 67
- 68. 2. the dicroticnotch on the arterial wave form reflects A) aortic valve opening B) aortic valve closure C) isovolumetric contraction D)rapid ejection 68
- 69. 3. Expected changeswith IABP support in hemodynamic profile in patients with Cardiogenic shock include all except? A) Decrease in SBP by 20 % B) Increase in aortic DP by 30 % C) Decrease in MAP by 10% D) Reduction of the HR by 20% E)Decrease in the mean PCWP by 20 % 69
- 70. 4. late inflationof the balloon can result in? A) premature augmentation B) increased augmentation C) decreased augmentation D) increased coronary perfusion 70
- 71. 5. A roundedballoon pressure wave form indicate? A) helium leak B) power failure C) hypovolemia D) balloon occluding the aorta 71
- 72. 6. width ofballoon pressure wave form corresponds to A) length of systole B) length of diastole C) arterial pressure D) helium level 72
- 73. 7. true statement a)Dicrotic notch- land mark used to set deflation b) Deflation is timed to occur during period of iso volumetric contraction c) Most common trigger used is arterial pressure wave method d) Internal trigger mode is acceptable to use in a patient with normal sinus rhythm 73
- 74. 8. true statement A)pacing spikes are automatically rejected in ECG triggered modes B) pacing trigger modes can be used in a patient of 50% paced rhythm C) Varying R-R interval result in regular plateau durations in Balloon pressureWave form 74
- 75. 9. Identify thetracing abnormality 75
- 76. 10. Identify thetracing abnormality 76
- 77. • 1. Majorphysiological effects of counter pulsation include? ▫ A) increased coronary artery perfusion, increased preload, decreased after load, decreased myocardial oxygen consumption ▫ B) increased coronary artery perfusion, increased preload, increased after load, decreased myocardial oxygen consumption ▫ C) increased coronary artery perfusion, decreased preload, decreased after load, increased myocardial oxygen consumption ▫ D) increased coronary artery perfusion, decreased preload, decreased after load, decreased myocardial oxygen consumption 77
- 78. 2. the dicroticnotch on the arterial wave form reflects A) aortic valve opening B) aortic valve closure C) isovolumetric contraction D)rapid ejection 78
- 79. 3. Expected changeswith IABP support in hemodynamic profile in patients with Cardiogenic shock include all except? •A) Decrease in SBP by 20 % •B) Increase in aortic DP by 30 % •C) Decrease in MAP by 10% •D) Reduction of the HR by 20% •E)Decrease in the mean PCWP by 20 % 79
- 80. 4. late inflationof the balloon can result in? • A) premature augmentation • B) increased augmentation • C) decreased augmentation • D) increased coronary perfusion 80
- 81. 5. A roundedballoon pressure wave form indicate? • A) helium leak • B) power failure • C) hypovolemia • D) balloon occluding the aorta 81
- 82. 6. width ofballoon pressure wave form corresponds to • A) length of systole • B) length of diastole • C) arterial pressure • D) helium level 82
- 83. 7. true statement a)Dicrotic notch- land mark used to set deflation b) Deflation is timed to occur during period of iso volumetric contraction c) Most common trigger used is arterial pressure wave method d) Internal trigger mode is acceptable to use in a patient with normal sinus rhythm 83
- 84. 8. true statement A)pacing spikes are automatically rejected in ECG triggered modes B) pacing trigger modes can be used in a patient of 50% paced rhyth C) Varying R-R interval result in regular plateau durations in Balloon press. Wave form 84
- 85.
- 86.