IABP Removal

  1. 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 staff who thinks that the bedside nurse should D/C the IABP's when ordered without a physcian present or potentialy even in house . Currently our policy is to have a physcian D/C pumps. Our nurses do have a lot of autonomy, more than any other CCU I've been in. So I'm wondering if this is common practice in other CCU's or if we are getting into murky waters. Thanks for your input.
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  2. 45 Comments

  3. by   smignoni
    Our nurses donot remove IABP this is usually done by the PA of the cardiology group.
    I have a question does anyone out there use the femstop device for IABP removal? Right now our PA's hold manual pressure for 30 mins then we wedge the sit efor 8 hours.Sam
  4. by   justanurse
    At our facility, it is the responsibility of the physician to remove the IAB. He will generally hold pressure about 5 minutes then expect the nurse to take over. Usually they want us to hold for 30 minutes, other times some want us to hold for 30 minutes and then put a femostop on for a couple of hours.
  5. by   20year veteran
    It is the responsibility of the physician who inserted the IABP to be the one to remove it. [that or a member of the practice]. Our cardiovascular surgeons have a PA who does the removal for them.

    We don't hold any manual pressure. After the initial 15 minutes held by the MD or PA we then apply a femostop.
  6. by   CardiacRN
    Yes, you're in murky waters. I do not feel it is the RN's responsibility, I wouldn't do it. If someone is on a balloon in CCU, they are obviously not stable, and the MD needs to be there.

    Yes, we use Femstops. There's no way I would hold for 30 min.
  7. by   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
  8. by   joybelle
    We routinely remove IABP's in our unit . We first discontinue any heparine the pt might be on , we then do a activated clotting time & if this is less than 180sec the IABP is removed . Two people must be present & pressure is applied manually for 20 to 30 min. We then put on a pressuse bandage for up to 8 hours . We have found that it is alot easier if pt. cooperatin can be obtained .
    Hope it helps .
  9. by   HPMSeese
    Originally posted by BJRN76:
    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 staff who thinks that the bedside nurse should D/C the IABP's when ordered without a physcian present or potentialy even in house . Currently our policy is to have a physcian D/C pumps. Our nurses do have a lot of autonomy, more than any other CCU I've been in. So I'm wondering if this is common practice in other CCU's or if we are getting into murky waters. Thanks for your input.
    We often habe Patients who need the IABP in my facility. Mostly after a Bypass OP. When it can be removed we check the ACT and when it is less then 180 - 200 we hold a manual pressure for 310 - 20 minutes and then put a femstop an for minimum 8 hours. In all cases a MD is on ICU. Greetings from Germany, Holger

  10. by   Nurseblueeyes
    This is ridiculous. THe physician that inserts the IABP should ALWAYS D/C it. In our institution, whomever inserted it will take it out but we are to be at the bedside and assist with the removal. After about 10-15 minutes of the Dr. holding pressure then we take over. There are a lot of potential complications that could arise during and after IABP removal and a physician needs to be at the bedside. Think about the complications, the tip of the IABP for some reason breaking apart as you remove it, bleeding after removal that you can not stop.
    That patient could bleed to death and if you can't stop the bleeding then what are you going to do? This is very serious and like others have said in their replys, these people are sick and anything could happen at any moment.
    This leads me to my next problem that I have with physicians, some of them just do whatever it takes to fix the immediate problem and then the nurse is made to be responsible for issues and situations that are not within their Rem of practice, therefore putting there license on the line and while the Dr. has done all he thinks he needs to do, he is getting paid big bucks.
    But what do us nurses get in return, disrespect, underpaid for what we do and know.
    Who is always trying to keep the families updated on the status of their loved one, well, it is not the Dr. Where I practice, it takes a fit throwing, tantrum before some of our Dr.s will speak to the families and that is not right. So, NO, I would not or even consider D/Cing a IABP without the presence of the Dr. If he wanted me to and ordered it so, I would tell him that the IABP will be still in use until you arrive because I refuse to do such thing. And then what is he going to do, nothing, he will come in a do it. May not be happy and be mad, but you know he is the Dr. not me.



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    Nurseblueeyes
  11. by   jenadox
    The nurses where I work NEVER d/c IABPs. The reason is reaaly simple...our licenses do not cover it I think that any nurse who does d/c an IABP, no matter how many years experience she has, is putting herself on the line. That's just my honest opinion, of course.

    Jena
  12. by   PatriceM
    IABP's in our busy CCU are d/c'd by the caridiac fellow or the PA. After which a femstop is applied. After 30 minutes to an hour or if the RN is concerned, the technician (PA or Fellow) returns to decrease the pressure in the femstop or if bleeding is severe--hold pressure. It is not that nurses cannot do this--it is that we do not place IABP's and therefore we do not d/c them. That is the policy with all lines. If we do not place them--we do not remove them. Kinda simple-but that is it.
  13. by   delirium
    Hi everyone!
    I know this is probably a stupid question, but I am only a nursing student and we haven't covered this yet. Could someone explain to me what an IABP is?
    This is a very interesting thread as i hope to move into CCU eventually (but not as a new grad--to me that would be too scary).
    Thanks,
    MsP
  14. by   justanurse
    IABP = Intra-Aortic Balloon Pump
    This device is a near ventilator size machine attached to an arterial line placed into the patient's femoral artery. On the end of the line is a balloon that is rhythmically inflated and deflated with helium. This is timed just right by the machine to correspond with the patient's heart rhythm. As the balloon inflates it pushes blood back against the aortic valve and into the cardiac arteries (increasing blood flow to the heart) and down the aorta (increasing blood flow to the rest of the body). The balloon has to be positioned just right by the cardiologist (or other specially trained Dr) so that it does not occlude the renal arteries or the left subclavian artery.

    Hope this helps!

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