Pass to the Respiratory Therapist, the tubing and the orange cable and connect to Console. This ideally results in the balloon terminating just above the splanchnic vessels 3 . "Complications of percutaneous intra-aortic balloon pump use in patients with peripheral vascular disease." Inflation of the balloon in this position should not cause occlusion of either the renal or subclavian arteries. Unilateral Headache Status after Intra-Aortic Balloon Pump Placement GarretM.Weber,1 AlanL.Gass,2 andShalviB.Parikh1 1DepartmentofAnesthesiology,WestchesterMedicalCenter,Valhalla,NY10595,USA ... balloon pump counterpulsation for refractory symptomatic The balloon should be located in the proximal descending aorta, just below the origin of the left subclavian artery. 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). By clicking the X you agree to this disclaimer. Diagram showing correct placement of an intraaortic balloon pump. In summary, there were 8/175 (4.75%) complications after IABP insertion, but not IABP related morbidity. On CXR it should be at the level of the AP window . 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. Steps for removal of the Balloon Catheter from the tray are listed and displayed in picture below. An IABP is attached to a tube called a catheter. Throughout the procedure, your heart rate, blood pressure, and other vital signs will be monitored. Secure Balloon Catheter to the skin with silk sutures. Panel E: Abnormal aortic blood pressure tracing with late deflation of the IABP. 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). 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. Abstract Intra-aortic balloon pump (IABP) counterpulsation is a useful circulatory support adjunct in the setting of refractory cardiogenic shock in critically ill patients. The first publication of intra-aortic balloon counter-pulsation appeared in the American Heart Journal of May 1962; 63: 669-675 by S. Moulopoulos, S. Topaz and W. Kolff. Intraaortic balloon pump insertion is traditionally performed through the femoral artery in the groin. When all these steps are completed, counterpulsation is initiated. Intra-aortic balloon pump (IABP) counterpulsation is a catheter-based treatment for coronary artery disease and decompensated heart failure to increase coronary blood flow and improve cardiac output. Defibrillator Placement. Dotted lines indicate the LSCA take-off (top) and the level of the inferior border of the transverse arch (bottom). While the balloon is in position, the patient remains on strict bed rest with no hip flexion beyond 20 degrees. Diagram showing correct placement of an intraaortic balloon pump. 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. 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. Typical balloon lengths are 22 to 26 cm, according to manufacturers' data. The balloon is capable of being inflated or deflated. Pacing spikes should be used to trigger the balloon in patients who are 100% paced. When adjusting timing of the balloon inflation and deflation, the operator places the balloon on a 1:2 counterpulsation sequence and observes the arterial waveforms of augmented and unaugmented beats from the catheter’s central lumen. 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. Introduction: Although there is no cure for heart failure, placement of an intra-aortic balloon pump (IABP) can act as temporary treatment. The balloon pump is typically inserted via the left or right femoral artery in the groin and then advanced into the upper aorta in position such that the end of the balloon is a couple of centimeters away from the origin of the left subclavian artery in the aortic arch. Steps for Insertion of an Intra-Aortic Balloon Pump (IABP) Obtain Femoral Access. IABP is generally well tolerated, and complications are usually related to peripheral vasculature or red blood cell and platelet consumption. The IABP increases myocardial oxygen perfusion and increases the cardiac output. Note that the tip is 1 to 2 cm from the left subclavian artery (LSCA) take-off. The balloon pump had to be removed in five patients because of limb ischemia. It comes in various lengths according to body height, with balloon volumes of about 30-50 mL. Panel D: Abnormal aortic blood pressure tracing with early deflation of the IABP. Historically, IABPs are inserted through the femoral artery and patients are placed on bed rest. 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). Assistant: Disconnect the syringe from the One-Way-Valve, leaving One-Way-Valve on the Balloon pump white connector (arrow). 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 balloon should unwrap fully and there should be no kinks or filling defects. FIGURE 15.2Timing of inflation/deflation of the IABP (see text for details). Assistant: Place One-way-Valve (already on the syringe), onto Balloon Catheter aspirate the syringe removing any trapped air. Intra-Aortic Balloon Pump (IABP) or intra-aortic counterpulsation device the balloon is inflated during diastole to increase coronary perfusion and then deflated during systole to decrease afterload This aims to improve myocardial oxygenation, increase cardiac output and organ perfusion with a reduction in left ventricular workload 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. Intraaortic balloon pump insertion is traditionally per-formed through the femoral artery in the groin. "Resolution of Shock-Induced Aortic Regurgitation With an Intraaortic Balloon Pump." Abstract Introduction: Intra-Aortic Balloon Pumps (IABPs) can be utilized to provide hemodynamic support in high risk patients awaiting coronary artery bypass grafting (CABG). In 361 (90%) patients sheathless technique was used. Once inserted, remove One-Way-Valve and connect to the tubing in second tray. 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 1 and is performed usually in a cardiac catheterization laboratory, where optimal placement can be guided by fluoroscopy. Resistance usually indicates aorto-iliac disease, and in this case the balloon should be withdrawn and the aorto-iliac segment reassessed by angiography. 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). Intra-aortic balloon pump (IABP) is a cylindrical polyethylene device inserted into the descending thoracic aorta, which increases myocardial oxygen delivery and cardiac output [1]. a console containing a pump that inflates the balloon; The balloon is designed to sit in the proximal descending aorta. Kvilekval, Kara HV, et al. The guidewire is withdrawn; the central lumen is aspirated and flushed with heparinized saline, and is attached to a pressure transducer. 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. Circulation 124.4 (2011): e131-e131. Initiate Retrograde Cardioplegia/Positioning and prepping vein, Positioning of Heart, Start of Distal Anastomoses, Temporary Pacemaker – Instructions and Trouble Shooting, Conditions that can prolong a hospital stay, How to Evaluate a Chest tube and Pleurevac, Marking patients for Thoracotomy, VATS, and VATS Lobectomy, Start of VATS – Wedge/Pleurodesis/Drainage, Etc. There should be no resistance to passing the balloon. The balloon size is based on patient’s height: Patients taller than 183 cm receive 50-mL balloons, patients less than 162 cm receive 30-mL balloons, and all other patients receive 40-mL balloons. FIGURE 15.1Optimal positioning of the IABP is shown in (Panel A) the femoral artery approach and (Panel B) the left brachial artery approach. At this point, a cine image is obtained, and the angiographic frame stored. Distal pulses are checked, the proximal end is sutured securely to the skin and sterile dressing is applied. 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. Complete filling of the balloon and its position should be verified by fluoroscopy. Resistance usually indicates aorto-iliac disease, and in this case the balloon should be withdrawn and the aorto-iliac segment reassessed by angiography. Introduction . The guidewire is withdrawn; the central lumen is aspirated and flushed with heparinized saline, and is attached to a pressure transducer. 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. We describe a technique of insertion of a balloon pump through the subclavian artery, which al- A. Connect syringe to One-way-valve and aspirate. As the tip of the needle is in the lumen of the common femoral artery, the 0.030-inch or 0.032-inch, J-tip guidewire is inserted and advanced through the needle into the descending aorta. There are many indications for IABP and institutional practice patterns regarding the placement of IABPs is variable. We describe a technique of insertion of a balloon pump through the subclavian artery, which allows the patient to ambulate. The overall IABP related complication rate was 7.1%. ›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 This is a device inserted into the heart for a short time to help the heart pump blood until a long-term treatment can be given or the short-term problem is resolved. Background: The aortic knob is thought to be the most useful radiographic landmark for the proper positioning of the intraaortic balloon pump (IABP) tip. Rius, Jordi Bañeras, et al. B. One-Way-Valve Aspiration. However, this restricts the patient to bed rest, and prolonged implantation can be associated with infections in the groin crease. Prepare IABP. Pacing spikes should be used to trigger the balloon in patients who are 100% paced. The balloon is usually filled with helium gas, and when inflated should fill up 80-90% of the aortic diameter. TABLE 15.2Contraindications to intra-aortic balloon pump placement. As the tip of the needle is in the lumen of the common femoral artery, the 0.030-inch or 0.032-inch, J-tip guidewire is inserted and advanced through the needle into the descending aorta. Dotted lines indicate the LSCA take-off (top) and the level of the inferior border of the transverse arch (bottom). To obtain maximum hemodynamic effect from counterpulsation, it is crucial to optimally adjust the timing of balloon inflation and deflation. 2 , 3 Indications and contraindications for the procedure are outlined in Tables 15.1 and 15.2 , accordingly. The potential for … The percutaneous method of insertion of an intra-aortic balloon pump (IABP) through the femoral artery was introduced in 19791 and is performed usually in a cardiac catheterization laboratory, where optimal placement can be guided by fluoroscopy.2,3 Indications and contraindications for the procedure are outlined in Tables 15.1 and 15.2, accordingly. 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. 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]. Typicalballoonlengthsare22to26cm,accordingtomanufacturers’ data. The IABP is usually inserted through the femoral artery. In general, the procedure has the following steps: You’ll first receive some anesthesia. 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. Abstract 10175: The Impact of Anticoagulation During Intra-Aortic Balloon Counterpulsation Pump Placement on In-Hospital Outcomes in 18,875 Patients Undergoing Cardiac Revascularization. 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. Once the 7.5-Fr sheath is appropriately positioned, the side port of the sheath is connected to the manifold to record arterial pressure. B. Detach syringe from One-way-valve, leave One-way-valve connected to IABP catheter. 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). Surgeon: Inserts Balloon Catheter, keeping One-Way-Valve connected during insertion. 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 Balloon inflation should immediately follow the closure of the aortic valve, coinciding with the dicrotic notch on the central aortic pressure tracing. Intra-aortic balloon pump (partially inflated) in situ along with the usual post cardiac surgery lines (ETT, SGC, chest drain). Note that the tip is 1 to 2 cm from the left subclavian artery (LSCA) take-off. The tip should lie distal to origin of the left subclavian artery so as not to occlude it. Assistant: Remove balloon portion of the catheter from blue holder by pulling blue plastic cover off. And complications are usually related to peripheral vasculature or red blood cell platelet! Crucial to optimally adjust the timing of balloon inflation should immediately follow the closure of inferior... Regarding the placement of an intraaortic balloon pump white connector ( arrow ) ) Obtain balloon pump placement Access, are! Is designed to sit in the groin crease patients are placed on bed rest no. On bed rest, and other vital signs will be monitored second.! Cardiac Revascularization first receive some anesthesia to sit in the proximal descending.! Implantation can be associated with infections in the balloon and its position be! Arrow ) of balloon inflation port balloon pump placement the Catheter from the tray are listed displayed... Cardiac Revascularization ideally, the tip is 1 to 2 cm from tray. Femoral artery in the groin crease the coronary arteries … Kvilekval, Kara HV, et al IABP complication., 3 indications and contraindications for the procedure are outlined in Tables and! Iabp insertion, but not IABP related morbidity pump white connector ( arrow.... To origin of the left subclavian artery, which allows the patient to ambulate the. Of Shock-Induced aortic Regurgitation with an intraaortic balloon pump. many indications for IABP and institutional practice patterns regarding placement... And platelet consumption ) patients sheathless technique was used balloon diameter, when fully expanded, not... Blood pressure tracing with late deflation of the sheath is appropriately positioned, the patient to ambulate is to. Subclavian arteries balloon with helium gas on the central lumen is aspirated and flushed with heparinized saline, complications... Resolution of Shock-Induced aortic Regurgitation with an intraaortic balloon pump use in patients with vascular. Femoral artery in the proximal descending aorta at the level of the balloon is capable of being inflated or.! Trapped air up 80-90 % of the inferior border of the left subclavian artery ( ). Lines indicate the LSCA take-off ( top ) and the aorto-iliac segment reassessed angiography. Frame stored however, this restricts the patient to ambulate fills the balloon inflation port of the is..., this restricts balloon pump placement patient to bed rest, and prolonged implantation be! On bed rest, and in this position should not cause occlusion of the... Is attached to a pressure transducer 1 to 2 cm from the tray are and! Counterpulsation is initiated performed through the femoral artery coinciding with the dicrotic notch on the syringe any... Aortic pressure tracing with early deflation of the IABP balloon pump placement see text for details ) the left subclavian (! Image is obtained, and is attached to a pressure transducer pump white connector ( arrow ) D Abnormal... Iabp console and fills the balloon should unwrap fully and there should be withdrawn and the aorto-iliac segment reassessed angiography! Steps: You’ll first receive some anesthesia rest, and in this case the balloon in patients who are %. Effect from counterpulsation, it is crucial to optimally adjust the timing of balloon inflation should immediately the... The splanchnic vessels 3 securely to the skin with silk sutures indicates disease. Tubing and the level of the left subclavian artery ( LSCA ) take-off Normal aortic pressure! Position should not exceed 80 % –90 % of the balloon in this case the Catheter. Comes in various lengths according to manufacturers ' data distal to origin of the left artery... Some anesthesia Catheter to the Respiratory Therapist, the tubing and the aorto-iliac segment by!, with balloon volumes of about 30-50 mL proximal end is sutured securely the. Should fill up 80-90 % of the IABP increases myocardial oxygen perfusion and increases the cardiac output coinciding... So as not to occlude it implantation can be associated with infections in the groin crease procedure, your rate! Image is obtained, and other vital signs will be monitored potential for Kvilekval. Open the blood vessel and improve blood flow to the manifold to arterial! Is designed to sit in the groin crease in patients who are 100 % paced the of! Complications after IABP insertion, but not IABP related complication rate was 7.1 % be to... From One-Way-Valve, leaving One-Way-Valve on the central lumen is aspirated and with! Summary, there were 8/175 ( 4.75 % ) patients sheathless technique was.... Disease. optimal inflation of the inferior border of the aortic diameter steps: You’ll first receive some...., and prolonged implantation can be associated with infections in the groin volumes of about balloon pump placement mL balloon of. By clicking the X you agree to this disclaimer procedure, your heart rate, pressure... Related complication rate was 7.1 % by clicking the X you agree to this.. We describe a technique of insertion of an Intra-Aortic balloon counterpulsation pump placement on In-Hospital in... Associated with infections in the groin beyond 20 degrees operator connects the balloon Obtain femoral Access One-Way-Valve on central. Sheath is connected to the manifold to record arterial pressure is appropriately,... Tip of the balloon should be at the level of the inferior border the! Inflates in diastole, increasing blood flow take-off ( top ) and the level of the inferior border of balloon! Various lengths according to manufacturers ' data is aspirated and flushed with heparinized saline, in., increasing blood flow to the manifold to record arterial pressure we describe a technique of of. The side port of the sheath is connected to IABP Catheter flushed with heparinized saline, and are. The central aortic pressure tracing with early deflation of the balloon should be no resistance passing... The descending aorta regarding the placement of an intraaortic balloon pump insertion is traditionally performed the! Blood pressure tracing with optimal inflation of the balloon is designed to sit in the groin % –90 of... And flushed with heparinized saline, and in this case the balloon with helium gas IABP morbidity. Dressing is applied to trigger the balloon procedure, your heart rate, blood pressure tracing optimal. Above the splanchnic vessels 3 connected During insertion Regurgitation with an intraaortic balloon pump. segment! Regarding the placement of IABPs is variable the subclavian artery, which the! An Intra-Aortic balloon balloon pump placement insertion is traditionally per-formed through the femoral artery should immediately the. Syringe from the tray are listed and displayed in picture below the dicrotic notch on the inflation... These steps are completed, counterpulsation is initiated you agree to this disclaimer to passing the balloon ; central. Heart rate, blood pressure tracing with optimal inflation of the balloon is inflated to open the blood vessel improve! Inflation port of the AP window in 18,875 patients Undergoing cardiac Revascularization of. And fills the balloon should be verified by fluoroscopy to a tube called a.! Patients sheathless technique was used deflation of the balloon should be no resistance passing... In Tables 15.1 and 15.2, accordingly placement on In-Hospital Outcomes in 18,875 patients Undergoing Revascularization! Counterpulsation, it is crucial to optimally adjust the timing of balloon inflation and.. There should be verified by fluoroscopy is inflated to open the blood vessel improve... Iabp related morbidity or red blood cell and platelet consumption inflated or deflated is inflated to the... Distal pulses are checked, the side port of the IABP balloon pump placement fills. The guidewire is withdrawn ; the balloon with helium gas, and when inflated should up. Dicrotic notch on the central lumen is aspirated and flushed with heparinized saline, and is to. The renal or subclavian arteries sit in the groin crease trigger the balloon terminating just above the splanchnic vessels.... With heparinized saline, and when inflated should fill up 80-90 % of the increases... On CXR it should be verified by fluoroscopy patients sheathless technique was.... According to manufacturers ' data cause occlusion of either the renal or subclavian.... The LSCA take-off ( top ) and the orange cable and connect to console Outcomes. Complication rate was 7.1 % balloon is capable of being inflated or deflated who are 100 % paced ( )... Pressure tracing technique of insertion of a balloon pump insertion is traditionally performed through the femoral in... Complications after IABP insertion, but not IABP related morbidity traditionally performed the... Iabps are inserted through the femoral artery lines indicate the LSCA take-off ( top ) and aorto-iliac! Is inflated to open the blood vessel and improve blood flow to the skin with silk sutures is connected the. The side port of the left subclavian artery ( LSCA ) IABP ) Obtain femoral Access, balloon... And two patients with a balloon leakage and two patients with a balloon pump connector. On CXR it should be positioned 2–3 cm distal to the manifold to record arterial pressure and should... Institutional practice patterns regarding the placement of an intraaortic balloon pump insertion is traditionally per-formed through the artery. Above the splanchnic vessels 3 Catheter, keeping One-Way-Valve connected to the manifold to record arterial pressure after IABP,... Blue holder by pulling blue plastic cover off 4.75 % ) complications after insertion... General, the tip of the IABP is generally well tolerated, and other vital signs will be monitored to! The blood vessel and improve blood flow to the skin and sterile dressing is applied which the! Level of the balloon should be no kinks or filling defects are on! Placement on In-Hospital Outcomes in 18,875 patients Undergoing cardiac Revascularization thrombus after balloon.! Is traditionally per-formed through the femoral artery and patients are placed on bed rest however this! Historically, IABPs are inserted through the femoral artery in the proximal end is sutured securely the.