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.

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

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!

Thanks!

Thanks very much for your explanation, it helps a lot.
I appreciate that you've taken the time to explain it to me.
Take care,
MsP

At my facility the MD who puts it is takes it out. The RN responsibilites are to have ACT ready usuallly <150. The MD removes and holds manual pressure for 1-5 minutes (depending on MD of course) and then hands it over to the nurse responsible of taking care of the pt. I always am ready With a fem-o-sto near by. Also I tell another nurse that I will be "Stuck in the room" for a while so If I need something??????

It's very important that you check with your State Board to see their view on this. I have done classes for Datascope Balloon Pumps and they do not endorse that RN's d/c IABP's because of the rare but real danger of balloon entrapment. THis happens if there is a small leak in the the balloon, the helium reacts with the blood that leaks into the circuit, and hardens to a cement like substance. Worst case scenario, can rip the aorta when the catheter is withdrawn. Hence the need for a physician present. (Of course my favorite smart-mouth cardiologist remarked,"What difference does it make if I'm there or not, the patint's going to die anyway!") Seriously, some hospitals do not even allow the physician to D/C the IAPB unless a surgery team in house. So the issue is not hemostasis, because if you're like us , we D/C 9 and 10 sheaths all the time, the issue is the entrapment.

I have never worked anywhere where it was the RNs responsibility to remove the IABP catheter . Currently where I work it is always removed by the physician, or his mid- level practitioner (ie. PA, CNS or NP) who has been trained to do so by the physician in most cases. This skill falls under the category of advanced practice in my opinion and should not be performed by an RN.

In my CCU (a 10 bed unit) we do not pull IABPs, the cath lab staff comes to floor and performs an ACT and if it is within range (<160) they pull the line. The femstop device has not been used very often here, the cath lab staff will hold pressure for 20-30 minutes and then place a 5# sandbag on the site. The patient is then kept on 6 hours of bedrest.

I work in a combination CCU and CTICU. On our surgical pateints the nurse practitioners d'c the IABP's. If it is a CCU patient the IABP is d/c'd by the cath lab fellow or the CCU fellow. I would not want to be responsible for pulling the IABP. Also it is just another thing added to your day that you do not have time for !

Wow that is really murky water. I work in a Cardiothoracic ICU and we see our fair share of balloons. Our surgeons always d/c the balloon, hold pressure for ~5 minutes (sometimes using the Syvek Patch) then pass the responsibility to the PA/NP on duty.

I would hate the responsibility, I onceheard of an incident where the balloon was entraped and not only was the balloon d/c'd but the femoral artery was too!!!

I worked too hard and long for my license and do not want that liability.

Good luck in your research.

Denise