IABP blood pressure question

Specialties CCU

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When you have a patient on an IABP I know you can't use the cuff or a line pressure as your BP because the balloon messes with it. I've always heard to take the SBP/DBP from the pump (taken out of the balloon sheath) but today one of the nurses for the cardiologist (not an NP) said that you're supposed to use augmentation pressure/DBP for your vitals. This guy was a CCU nurse before going to work for this cardiologist so I assume he knows what he's talking about but I'd never heard that before. Anyone know what's right?

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Specializes in CVICU.

I've been trying to figure out the same thing. Which BP would you titrate gtts with and such? And if an aline isn going to be accurate with an IABP then why have one? Surely someone can shed some light on the issue.

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In this case, they specifically wrote to titrate his Dopamine to keep the augentation above 95.

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Specializes in ER/ICU/Flight.

With IABPs you'll find two schools of thought when it comes to blood pressure. 1) use a peripheral arterial line. there are several studies correlating radial art lines and nibp/iabp measurements. I don't know why the balloon would "interfere" with a radial line pressure if it was positioned properly.

2) use the aortic line, augmented and diastolic pressures. of course those have to be compared to something else to determine their accuracy.

Sometimes we use a nibp cuff, but if we have a radial art line then we use that. Otherwise you wouldn't be able to know for sure if your invasive pressures were accurate.

There are studies that endorse both methods, and as long as your iabp measurements are close (~10%) then use it.

As for charting, we list the invasive pressure sbp/dbp and the augmented pressure separately. Our drips are titrated for the augmentation.

Hope this helps. I'm no expert and maybe someone else could explain better.

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Regarding using a cuff or a-line: our IABP flowsheet states "when documenting vital signs on patients with IABP, systolic, diatomic and map readings MUST be obtained from IABP console. Cuff, NIBP, and a-line pressures will label the diastolic augmentation pressure as systole."

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Specializes in Telemetry, CCU.

Just to give another input here: At my hospital, we document systolic, diastolic and augmented diastolic on the flowsheet. All numbers are taken from the IABP console. A lot of times we do have a second art line for blood draws and BP monitoring when the balloon is d/c'd but our current flowsheet doesn't allow for documenting two different art lines on one paper. So we just stick to charting off the console and when it gets closer to d/c'ing the balloon start with cuff measurements and if there is another art line, make sure they are correlating.

Also your other part: from what I was taught, you do want to base gtt titrations and such off your augmented and make sure you are documenting that, because your systolic is going to be lowered from the afterload reduction affect of the pump and your augmented is a major part of the therapy (coronary perfusion) so that's why we titrate to augmented.

Hope that helps.

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Specializes in CTICU.

Yes use the IAB console. The monitor labels the highest point in the waveform as "systole", which of course in a balloon pt is the augmented diastole. You can still use the mean perfusion pressure. Technically you should titrate drugs to the point on which they work, but in practice we use the highest and lowest pressures, which end up being the augmented diastole, and the BAEDP.

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Specializes in Critical Care.

It depends on the doc, some docs will titrate drips to augmented BP and some will titrate to IABP mean. We document all of the #'s on our sheet, including peripheral A line BP's. The IABP #'s will be most accurate though and all hemodynamic calculations (ie SVR, PVR) should be calculated with those #'s. It's not so much that an IABP "messes" with your periperhal a-line numbers; technically, your peripheral a line SBP should be about the same as your Augmented BP on the IABP, because your periperal A line is measuring your highest possible BP # (which would therefore be the Augmented BP). That doesn't always seem to be the case in real life, but it's usually pretty close, within 10 points or so. That is why the mean reading on your IABP will be different than if you tried to figure out the IABP mean on paper; it takes augmented BP into account.

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It depends on the doc, some docs will titrate drips to augmented BP and some will titrate to IABP mean. We document all of the #'s on our sheet, including peripheral A line BP's. The IABP #'s will be most accurate though and all hemodynamic calculations (ie SVR, PVR) should be calculated with those #'s. It's not so much that an IABP "messes" with your periperhal a-line numbers; technically, your peripheral a line SBP should be about the same as your Augmented BP on the IABP, because your periperal A line is measuring your highest possible BP # (which would therefore be the Augmented BP). That doesn't always seem to be the case in real life, but it's usually pretty close, within 10 points or so. That is why the mean reading on your IABP will be different than if you tried to figure out the IABP mean on paper; it takes augmented BP into account.

yeah, that's what I meant by "messes with"...

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Specializes in Critical Care.

Not familiar with other IABPs besides the Datascope C100/300s but it on occasion will do two unaugment beats to check timings and will allow you to view accurate unaugmented pressures. It's ridiculously easy now with the C300's fiber optic line built in for pressure readings.

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