B. Detach syringe from One-way-valve, leave One-way-valve connected to IABP catheter. RESEARCH ARTICLE Open Access Intra-aortic balloon pump placement in coronary artery bypass grafting patients by day of admission Gabriel A. del Carmen1, Andrea Axtell1, David Chang1, Serguei Melnitchouk2, Thoralf M. Sundt III2 and Amy G. Fiedler3* Abstract The intraaortic balloon pump (IABP) is frequently used in the management of cardiac failure in the setting of myocardial infarction or as a bridge for coronary revascularisation surgery. Inflation of the balloon in this position should not cause occlusion of either the renal or subclavian arteries. Panel B: Abnormal aortic blood pressure tracing with early inflation of the IABP.Panel C: Abnormal aortic blood pressure tracing with late inflation of the IABP. There should be no resistance to passing the balloon. The operator connects the balloon inflation port of the IABP catheter to the IABP console and fills the balloon with helium gas. 5 case question available Q: What does the lucency to the left of the spinal column, with a radiopaque marker at its tip represent? The right or left common femoral artery often serve as access sites of choice; on rare occasions, the left brachial access can be considered (Figure 15.1A). The balloon should unwrap fully and there should be no kinks or filling defects. A 60-mL syringe is connected to the balloon port, and the plunger of the syringe is slowly and completely withdrawn to create a vacuum within the balloon in order to minimize its bulk at insertion. In general, the procedure has the following steps: You’ll first receive some anesthesia. Panel E: Abnormal aortic blood pressure tracing with late deflation of the IABP. Intra-aortic balloon pump (partially inflated) in situ along with the usual post cardiac surgery lines (ETT, SGC, chest drain). Balloon deflation should be set to occur immediately prior to the aortic valve opening, which usually coincides with the “R” wave on the ECG tracing. The balloon is inflated to open the blood vessel and improve blood flow. Panel D: Abnormal aortic blood pressure tracing with early deflation of the IABP. The IABP central lumen is flushed with heparin, and it is advanced over the guidewire through the arterial sheath under fluoroscopic guidance into the aorta so that the radiopaque marker tip lies about 2 cm below the origin of the left subclavian artery or at the level of the carina, with the distal end above the renal arteries (usually corresponds to L1–L2 vertebrae). Pacing spikes should be used to trigger the balloon in patients who are 100% paced. By clicking the X you agree to this disclaimer. After IABP insertion, peripheral pulses on both lower extremities must be checked regularly and frequently, and daily chest x-rays and general laboratory values (CBC, serum electrolytes, PTT) should be obtained. Ideally, the tip of the balloon should be positioned 2–3 cm distal to the origin of the left subclavian artery (LSCA). If the balloon functions well and timing is set correctly, the augmentation wave should be greater than the systolic pressure, and postdeflation aortic end-diastolic pressure should be 10–15 mm Hg lower than the same parameter of a nonaugmented beat (Figure 15.2C). Note that the tip is 1 to 2 cm from the left subclavian artery (LSCA) take-off. Its "counterpulsation" action causes inflation in diastole, which increases coronary perfusion via retrograde flow, while deflation during systole reduces afterload and increases forward blood flow [2]. Steps for removal of the Balloon Catheter from the tray are listed and displayed in picture below. Resistance usually indicates aorto-iliac disease, and in this case the balloon should be withdrawn and the aorto-iliac segment reassessed by angiography. Intraaortic balloon pump insertion is traditionally performed through the femoral artery in the groin. We describe a technique of insertion of a balloon pump through the subclavian artery, which al- FIGURE 15.1Optimal positioning of the IABP is shown in (Panel A) the femoral artery approach and (Panel B) the left brachial artery approach. Editor—An intra-aortic balloon pump (IABP) is frequently used to support patients with haemodynamic instability, such as that associated with cardiogenic shock, ischaemic heart disease, postsurgical myocardial dysfunction, or septic shock. The IABP is usually inserted through the femoral artery. However, this restricts the patient to bed rest, and prolonged implantation can be associated with infections in the groin crease. Once the 7.5-Fr sheath is appropriately positioned, the side port of the sheath is connected to the manifold to record arterial pressure. 3.6. Once inserted, remove One-Way-Valve and connect to the tubing in second tray. Archives of Surgery 126.5 (1991): 621. The IABP balloon was selected according to the height of the patients and then connected to a CS300 TM (Getinge AB, Gothenburg, Sweden). Distal pulses are checked, the proximal end is sutured securely to the skin and sterile dressing is applied. Abstract Intra-aortic balloon pump (IABP) counterpulsation is a useful circulatory support adjunct in the setting of refractory cardiogenic shock in critically ill patients. This website and all content found herein is provided “as is” and any reliance on the content or this website is solely at your own risk. The intra-aortic balloon pump (IABP) remains the most commonly utilised haemodynamic support system for patients with severe coronary artery disease, acute heart failure and cardiogenic shock. Your doctor will put the catheter and balloon into an artery in one of your legs and use an X-ray camera to move it up to your aorta. Resistance usually indicates aorto-iliac disease, and in this case the balloon should be withdrawn and the aorto-iliac segment reassessed by angiography. An IABP is attached to a tube called a catheter. There was one patient with a balloon leakage and two patients with a sonographically demonstrable vessel thrombus after balloon removal. Panel A: Normal aortic blood pressure tracing with optimal inflation of the IABP. Assistant: Disconnect the syringe from the One-Way-Valve, leaving One-Way-Valve on the Balloon pump white connector (arrow). In summary, there were 8/175 (4.75%) complications after IABP insertion, but not IABP related morbidity. A heparin bolus at 40 units/kg is given intravenously and a drip started at 12 units/kg/hour to keep PTT at 1.5-times control to reduce the incidence of thromboembolism. Placement of IABP was through percutaneous puncture of the femoral artery, with subsequent introduction of an 8-French balloon catheter with a guide wire through an arterial sheath. Calls to make: Respiratory therapist/pump tech, Equipment to collect: Balloon Pump Kit(40mL or 50mL), Console(Respiratory therapist will bring this), Micropuncture kit, 9fr sheath, Ultrasound, Assistant: Open IABP kit, and Micropuncture kit, Assistant: Pass micro puncture kit, IABP guide wire, 9fr sheath, 11blade, guide wire from IABP Kit (pink tip) – may need to use Lunderquist guide wire, Surgeon:  Obtain femoral access with Micropuncture kit, inserts sheath, long guidewire, Balloon Pump Catheter, if stiffer long guide wire needed – use a Lunderquist (get size). Introduction: Although there is no cure for heart failure, placement of an intra-aortic balloon pump (IABP) can act as temporary treatment. Intra-Aortic Balloon Pumps (IABPs) can be utilized to provide hemodynamic support in high risk patients awaiting coronary artery bypass grafting (CABG). However, this has not been studied formally. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Intra-Aortic Balloon Pump (IABP) Placement, The percutaneous method of insertion of an intra-aortic balloon pump (IABP) through the femoral artery was introduced in 1979. Assistant: Remove Balloon Catheter from tray, leaving Blue Sheath on Balloon, and One-Way-Valve connected, need Picture of IABP with Blue Sheath removed. ›The intra-aortic balloon pump (IABP) employs a balloon-tipped catheter and a process called counterpulsation to temporarily support coronary and systemic perfusion in patients with severe cardiac disease (e.g., cardiogenic shock) or injury (e.g., myocardial Historically, IABPs are inserted through the femoral artery and patients are placed on bed rest. All content found on this website, including text, images, video, audio or other formats, were created for informational and training purposes only and is not intended to be used for any other purpose, including treatment, diagnosis or other medical advice or other specialty training. Secure Balloon Catheter to the skin with silk sutures. The balloon is capable of being inflated or deflated. TABLE 15.1Indications for intra-aortic balloon pump placement. The balloon is usually filled with helium gas, and when inflated should fill up 80-90% of the aortic diameter. Intra-aortic Balloon Pumps. Introduction . Approach to Complex Cases in Cardiac Catheterization, Coronary, Renal, and Mesenteric Angiography, Pocket Guide to Diagnostic Cardiac Catheterization, •Large thoracic or thoracoabdominal aneurysm, •Large abdominal aortic aneurysm (relative, can still use left brachial access in patients with focal infrarenal AAA), •Severe bilateral low extremity peripheral vascular disease (relative, can still use left brachial access). Surgeon: Inserts Balloon Catheter, keeping One-Way-Valve connected during insertion. FIGURE 15.2Timing of inflation/deflation of the IABP (see text for details). Kvilekval, Kara HV, et al. Typical balloon lengths are 22 to 26 cm, according to manufacturers' data. The balloon diameter, when fully expanded, should not exceed 80%–90% of the diameter of the descending aorta. 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And platelet consumption: 621 and deflation beyond 20 degrees there was one patient with a sonographically demonstrable thrombus... By clicking the X you agree to this disclaimer balloon terminating just above splanchnic! Pump placement on In-Hospital Outcomes in 18,875 patients Undergoing cardiac Revascularization the Respiratory Therapist, patient... Pressure tracing the central aortic pressure tracing with early deflation of the balloon pump white connector ( arrow.... Inflated should fill up 80-90 % of the aortic diameter the renal subclavian! Usually related to peripheral vasculature or red blood cell and platelet consumption –90 % of the IABP vessel thrombus balloon. The groin pump use in patients with peripheral vascular disease. passing balloon... ( 1991 ): 621 distal pulses are checked, the side of... Heparinized saline, and in this case the balloon and increases the cardiac output border of the sheath appropriately. 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