IABP Removal - page 3

I wanted to post a question to the board and get a feel for what is being done in other institutions. I work in busy CCU unit. We routinely care for IABP patients. We have a new cardiologist on... Read More

  1. by   USN_Heart
    After reading some of these posts, it seems that most nurses are concerned more with the "time factor" when pulling IABPs. Also I read the statement " I didn't put it in, so I'm not taking it out". So with this being said, Will you pull the foley catheter, arterial line, or IV lines? Most of them are put in at the time of surgery by anesthesia, circulating RN, or surgical first assistants ( ie surgical techs). And apparently some of these people have never seen complications from arterial lines or foleys. I feel that if you are PROPERLY trained to do such, then go for it. For the record, I am a Certified First Assistant Surgical Tech. I have pulled Swan-Ganz catheters and cordis, chest tubes, arterial lines, both radial and femoral, IABPS, and pacing wires. I am fully credentialed to do such in the facility I am employed with. With EVERYTHING you do comes a consequence. I think we have had more drug errors than complications from our lines.
    Each State and Facility has guidelines to assist in the "scope of practice". My state happens to be a liberal one I guess.
  2. by   JustMe
    I haven't seen anyone else mention this: In our facility the perfusionist pulls the IABP. Nurses make sure the Heparin is turned off, ACT or PTT is within a safe range, equipment is at the bedside. The perfusionist pulls the catheter and holds pressure for an appropriate length of time, then the nurse is responsible for monitoring the limb and groin after that as well as resuming the Heparin if ordered.

    Just my
  3. by   cruisin_woodward
    Quote from KR
    Hi! Although I am very new to the ICU I do know my departments policy. When pulling IABP we hold pressure for one minute and then apply the femstop. We have a group of seasoned nurses that are able to pull the IABP. They voluntarily go through this competency. They seem to like it. Whenever anyone needs an IABP pulled one of these specially trained nurses gets called if t hey are around. I hope this helps. Kimberly Rush, GN

    One minute?!? Holy macaroni!! Our residents pull the balloon. Our policy is that they (not us) hold pressure for a minimum of 30 minutes. Our nurses make sure they comply. At this point we use sand bags for pressure for 6 hours, and the o
    Pt must remain flat. It is against policy to use a fem stop, but we are changing that.
  4. by   cruisin_woodward
    Quote from USN_Heart
    After reading some of these posts, it seems that most nurses are concerned more with the "time factor" when pulling IABPs. Also I read the statement " I didn't put it in, so I'm not taking it out". So with this being said, Will you pull the foley catheter, arterial line, or IV lines? Most of them are put in at the time of surgery by anesthesia, circulating RN, or surgical first assistants ( ie surgical techs). And apparently some of these people have never seen complications from arterial lines or foleys. I feel that if you are PROPERLY trained to do such, then go for it. For the record, I am a Certified First Assistant Surgical Tech. I have pulled Swan-Ganz catheters and cordis, chest tubes, arterial lines, both radial and femoral, IABPS, and pacing wires. I am fully credentialed to do such in the facility I am employed with. With EVERYTHING you do comes a consequence. I think we have had more drug errors than complications from our lines.
    Each State and Facility has guidelines to assist in the "scope of practice". My state happens to be a liberal one I guess.
    I have worked OR for 14 years, FA, ST, and circulated... I'm confused! First of all, you work in the ICU? You are honestly equating what we are saying as, we are too busy or lazy? Are you freaking kidding me? I am not sure what your "scope of practice" is in the OR, which by the way us a much more controlled environment. I can suture and do all sorts of things in the OR that i can not do in the ICU. Do you have a License to protect? Not a certification, but a licence? NO ONE is saying they won't do it bc of a time factor. It is protecting the pt! I can't even believe you would come on this site and suggest that. Your job is vastly different than ours. The patient's safety is our priority!
  5. by   mark_
    obviously, the removal of femoral sheaths, iabp, ij, swan....etc all have unique problems with extraction. i hate to answer you question with another question but usually i find this a better method to respond. so what is the real difference in removing swan-ganz compared to removing iabp? anatomically the iabp does not actually go thru chambers of the heart. however, there is more pressure in the aorta compare to the pulmonary artery. what are the procedures for removing iabp. (nut shell- turn off the machine remove all air left behind in the tube via three way pit cock, remove slowly, hold pressure(manual/femstop)....possible complications - rupture of aorta..(you will see an immediate drop in pressure...i like to put my cuff on about q3min to watch trending/hopefully you already have an art line...you are there anyway holding pressure),bleeding (act/ptt-check pre removal...unless emergency), brady (atropine) pseudo (stat..doppler..call physician), loss pedal pulses (stat doppler....call physician), hematoma (hold pressure to express out...unsuccessful, stat doppler r/o pseudo call physician)..other complications related to electrolytes/dysrhythmias treat accordingly....labs to order h&h pre and post removal say two hours status post..close check on hr, bp, resp, pedal pulses, extraction site, and telemetry status post removal.
    i think most of the cv nurses have removed one or two swan-ganz j this particular line can/could cause problems too. this particular baby can cause v-fib, v-tach, and you still have the possibility of rupture, pseudo, damage valves etc.....
    so bjrn76, i would see this as an opportunity and check with state nursing board to see if you would be covered.
  6. by   whynursing
    In my instituition, the MD is responsible for the entire 45 minute manual pull. The RN cannot be tied up that long since we have more than one patient. And if the pull goes bad what can the nurse do.
  7. by   perkizme
    Our residents dont even pull IABPs, the fellows have to (or attendings) never nurses
  8. by   erintiong
    It's horrible right???All those cardiologist pushing the responsible to nurses.They know how to eat but do not know how to clean up the mess :P
  9. by   caddismt
    The nurses in our ICU never d/c pumps...that's why they have cath lab techs. I don't have time to stand and hold pressure...what if someone codes when I'm holding? It's a small unit and we need all hands on deck.
  10. by   USN_Heart
    Congrats on the things you can do in the OR as well as the ICU
    In the 12 years of doing this same job - I have never seen a complication from the IABP. And as far as my concern for patient safety, It is my first priority . ( which has nothing to do with a License or Certificate) That is why I don't mind doing the things that RNs choose not to. Good thing I'm credentialed to do so . Yeah , I know it makes some s really , but its the nature of the game. Ill continue my same job as soon as I graduate from PA school - Can I pull it then without jepardizing patient safety?:lol_hitti

    - The Squid with Skills
  11. by   ghillbert
    Quote from USN_Heart
    Congrats on the things you can do in the OR as well as the ICU. In the 12 years of doing this same job - I have never seen a complication from the IABP. And as far as my concern for patient safety, It is my first priority . ( which has nothing to do with a License or Certificate) That is why I don't mind doing the things that RNs choose not to. Good thing I'm credentialed to do so . Yeah , I know it makes some s really , but its the nature of the game. Ill continue my same job as soon as I graduate from PA school - Can I pull it then without jepardizing patient safety?
    When you have a license, yes you are less of a danger to patients because you have a certain level of education and training associated with it.

    If you genuinely think that nurses are mad because you are credentialled to do things they don't want to do, then you are most likely mistaken. They DON'T WANT to do them.

    Finally, as someone who specializes in mechanical support devices, I can say if you have really "never seen a complication from the IABP", then you obviously haven't seen many IABPs.
  12. by   cruisin_woodward
    actually, unless you have not provided all of your "credentials", it is out of your scope of practice. According to the NSAA, an SA (it does not indicate RN or ST) assists the surgeon during surgical procedures under the direct supervision of the surgeon. They are not even supposed to leave the room while you close... Obviously that is never going to happen, they leave all the time...

    I am all for the rights of CSTs, and I think they need more respect and responsibility.. It was my job for 10 years, before graduating as an RN. I had an Associate of applied science, just like the ADNs have. I think they are qualified to circulate (I recently started circulating, and it does not need to be an RN, but in most hospitals, it must be an RN) and FA (we just recently started hiring CSTFAs).

    When you graduated as a PA, then you will be a MLP, and yes, pull what you will, in the mean time, I hardly doubt you would be covered by the hospital if you got sued if something went wrong. I doubt your insurance plan would cover you either bc it is out of your scope.
    Last edit by BBFRN on Apr 7, '09 : Reason: TOS
  13. by   CCRNCCU2008
    BEDSIDE RN's (CCU) always pull them without an MD present if its at night the mds that deal with iabp are not even in house... never had a problem (matter of fact pulled one last night)

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