IABP Removal

waicurn · Oct 12, 2002

I'm curious about what the incident rate of complication from IABP removal really is now a days. It doens't seem too long ago when the nurses can't remove cvp lines, chest tubes, and all sorts of other things. I wonder if IABP is just the next thing, or is the frequency of complication so great that it's a totally incomparable. Anybody out there got the stats?

lee1 · Oct 24, 2002

Absolutely not!!! A nurse's responbility is great enough without worrying about spending 20-30minutes holding a groin to remove the IABP. Who then has the hands to take care of the pts needs? Like titrating drips, intervening for post IABP complications, bleeding, pain management, etc. etc.

What is wrong with these MDs. Too busy to spend time with their own patients????? This is a good time for a MD/pt communication if the pt is not too sedated or vented.

USN_Heart · Mar 10, 2009

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.

JustMe · Mar 10, 2009

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 :twocents:

cruisin_woodward · Mar 10, 2009

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.

cruisin_woodward · Mar 10, 2009

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!

mark_ · Mar 11, 2009

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.

whynursing · Mar 13, 2009

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.

perkizme · Mar 13, 2009

Our residents dont even pull IABPs, the fellows have to (or attendings) never nurses

erintiong · Mar 13, 2009

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

caddismt · Mar 14, 2009

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.

USN_Heart · Apr 3, 2009

:yeah:Congrats on the things you can do in the OR as well as the ICU :yeah:

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 :up: . ( 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 :smokin: . Yeah , I know it makes some :nurse:s really :madface: , 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