by catshowlady

Had a horrible day yesterday. Had a pt on a balloon pump, and the balloon failed! I had just re-dressed the site because the dressing became loose d/t oozing (pt on reopro, etc.). I have done this many times d/t bleeding. Five minutes later, I got a high pressure alarm, and I was checking my tubings for kinks, etc. but there were none. Next thing I knew (I swear I heard it pop), there was a foot of blood in the helium tubing! Pump was immediately put into standby, doc ended up ordering us to pull it.

Pt did OK.

Anybody else ever experience this?

Re: Anybody ever see an IABP balloon failure?

Multiple times - ruptured balloon catheters are not uncommon, and are the reason every time I check an IABP pt, I follow the tubing from the console to the patient to check for blood.

Most important thing is to make sure it gets stopped and pulled within 30mins MAX to prevent helium embolus or balloon entrapment and subsequent vascular damage (or requirement for surgical removal).

We keep the catheters and return to the company for analysis too.

Re: Anybody ever see an IABP balloon failure?

Thanks. We don't see balloon pumps everyday - a few a month, usually, and they come in batches. This is the first time I have ever seen one fail. Of course we are trained to know what to do, but it was sure a shock. None of the other nurses on my unit have ever seen one fail either (and I had the rather surreal experience of watching every nurse in my unit come to see my pt and her pump!).

We also kept the catheter for return and inspection.

Re: Anybody ever see an IABP balloon failure?

The balloon should cease immediately due to a failure in pressurization; it should be pulled right away and replaced via the same sheath.

If the pt is sick enough to require the IABP I wouldn't leave them w/o the support, let alone the thrombotic risk of it sitting there.

Re: Anybody ever see an IABP balloon failure?

Doc arrived within ten minutes of my call to him; I specifically asked about a new balloon. He decided against it as the pt had stabilized significantly over the course of the day, among other reasons. We are not allowed to pull them, although I would have figured out something if he hadn't been able to come right away.

Re: Anybody ever see an IABP balloon failure?

Yeah, like an unplanned extubation, sometimes it leads to a happy accidental wean! In my experience it's very unusual to have them put a new catheter right back in the same sheath.

Re: Anybody ever see an IABP balloon failure?

Agree with OP's. It's always a good idea to develop a systematic assessment to perform. I do the following: ensure leveling,flush line, hemodynamics, inspect full length helium tubing, inspect and palpate site, pulses. I also document a cuff pressure every hour- our hosp policy.
We had a pt who's balloon ruptured in the middle of the night-no perfusionist or cath lab in house that late. Doc was in house and had to pull. Rn's can not do this in our hospital, Ended up calling in cath lab to put in new IABP as pt was still very ill. We do not use the same sheath in case it is damaged in any way-better safe than sorry.

Re: Anybody ever see an IABP balloon failure?

This is as good a reason as any that EVERY pt with an IABP should be a 1:1. In our facility some pts come from the cath lab with a pump before they go to surgery the next day. They are relatively stable for the time being, so our manager says they're not a 1:1. Complications from IABP placement can be life-threatening even if the pt is stable.

Re: Anybody ever see an IABP balloon failure?

Complications from many things in critical care can be lethal, but that doesn't necessarily make them require 1:1. Nor should any piece of equipment - that patient's condition should dictate the level of care required. Like anything else, monitoring is what will identify a problem - ruptured balloons are not common (0-6% is the data I just read) and gas emboli resulting from a ruptured balloon is significantly rarer.

A stable patient on ventilator, IABP, CRRT, inotropes... all of them can die if something goes wrong. The incidence of unplanned extubation far outweighs that of IABC rupture and many places don't have 1:1 care of mechanically vented patients.

Staffing level is of course immensely important. The important thing is education of staff to recognize the signs and symptoms of device complications - even if you're 1:1, you'd better turn that IAB console off fast if you get low pressure/helium leak alarms and/or see blood in the tubing.

Re: Anybody ever see an IABP balloon failure?

Originally Posted by JustMe

This is as good a reason as any that EVERY pt with an IABP should be a 1:1. In our facility some pts come from the cath lab with a pump before they go to surgery the next day. They are relatively stable for the time being, so our manager says they're not a 1:1. Complications from IABP placement can be life-threatening even if the pt is stable.

I don't remember the last time an IABP was a 1:1. Those were the days! While I think they are a 1:1 too, I've adjusted to having them in a pair. Management speak... :we can't staff for "what ifs".... I'm with you though.

I've never had a balloon rupture, although I've had the balloon fold back in on itself when in a 1:3 mode and not unfold.... some patients are very dependent on even a 1:3. We can't pull them either, so the doc's have to come in if perfusion is in on a case in the OR.