PULLING IABP CATHETERS IS OUT OF THE SCOPE OF NURSING CARE. A DR OR PA CAN REMOVE IABP ONLY. THE NURSE'S JOB IS TO HOLD PRESSURE FOR 30 PLUS MINUTES AND TO MONITOR FOR POST REMOVAL COMPLICATIONS. NURSES WHO PULL IABP CATHETERS ARE PUTTING THEIR SELF AT RISK OF LOSING THEIR LICENSE. IF SOMETHING GOES WRONG, THE DR IS NOT GOING TO TAKE YOUR SIDE AND STATE, I TOLD THAT NURSE TO REMOVE THE PT'S IABP CATH. YOU REALLY NEED TO CHECK WITH YOUR STATE'S BOARD OF NURSING. BE VERY CAREFUL IN FOLLOWING "CRAZY" ORDERS FROM DR.

IABP Removal

I work in a very busy CCU. Staff nurses do not remove IABP catheters, and we are very happy not to do so. Admittedly, 99% of the time everything goes smoothly. But we have seen a few cases where everything went very bad, very fast.
One case in point was when the wire in the center of the catheter was broken on insertion and we did not know it. The CT surgeon went to remove the catheter, and ended up doing a cutdown at the bedside to save the patient from a catheter embolism in his aorta/femoral artery.
If you are an advanced practice RN on an invasive cardiology (or surgical cardiology) service, have been trained in IABP removal, and have medical/surgical staff available during removal, it would be another story. But it is risky business when you have no backup.
As always, you need to check with your state's standards of practice guidlines in order to see what you are and are not allowed to do under your license in your state.

For 21 years it has never been my job or responsibility and shall remain that way. I have seen TOO many problems from improper removal, bleeding, clots, immediate death from aortic laceration, femoral laceration, not to mention strokes and perminent loss of limbs & Black toes eeekkkky. IT IS NOT my job......... nor do I wish to loose my license. The CV surgeon or interventional Cardiologist are the ones who should remove them. Nothing in your scope of practice says you are covered, now if the patient pulls the thing out or climbs out of bed you best be there or it's your butt in the sling and notify the MD ASAP and yes you should know immediately what to do. GET HELP? LOTS OF IT>Turn IABP to standby, Check out the site, ect. CXRAY, Check pulses, urine output heart rate, ect. Level of acuity is another scope of care that needs to be addressed. IABP's at our facility are 1:1.sometimes 2:1 if they are particularly unstable with numerous gtts to titrate post op CABG or in acute cardiogenic shock. But our DR.s are close by also. Successful outcomes are important to all of us. DR.s hold pressure as long as it's necessary and if there are problems they direct the intervention. I like my job but clearly know what limitation it has. The same for pulling chest tube. If you've seen one bleeding and part of the new graft come out with the chest tube you realize the risk is not yours.. NURSE not MD. It is your job to check pulses, document clearly what is or isn't present, cms ect. and telling the MD if it changes ASAP. We are responsible for the outcome if something changes and following up with the MD. This does not mean waiting for the next shift to do it because it might mean you get out late. Things happen that we can and cannot control. Knowing the difference keeps your patients safe and with a good outcome. We are not Gods, but Goddesses will do!!!!!!!!!!! Tell you what I've seen and heard all kinds of rasons. Still not my job. All though how many surgeons actually let it back bleed out the clots or hold pressure below first then above the clear the clots. Always remind them to do this. Save the toes. Pink is pretty!!!!!!!!!!

Our facility has similar guidelines for pulling IABP's. Physician pulls pump after ACT levels are less than 150 and holds manual pressure for 5min and then the nurse steps in and finishes, usually holding pressure for 20-30min. Whether or not we use a fem-stop varies from doc to doc.

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?

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.

Re: IABP Removal

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.

Re: IABP Removal

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

Re: IABP Removal

Originally Posted 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

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.

Re: IABP Removal

Originally Posted 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.

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!