Re: IABP Removal

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.

Re: IABP Removal

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.

Re: IABP Removal

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

Re: IABP Removal

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 :P

Re: IABP Removal

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.

Re: IABP Removal

Congrats on the things you can do in the OR as well as the ICU
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 . ( 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 . Yeah , I know it makes some s really , 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?

- The Squid with Skills

Re: IABP Removal

Originally Posted by USN_Heart

Congrats on the things you can do in the OR as well as the ICU. 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 . ( 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 . Yeah , I know it makes some s really , 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?

When you have a license, yes you are less of a danger to patients because you have a certain level of education and training associated with it.

If you genuinely think that nurses are mad because you are credentialled to do things they don't want to do, then you are most likely mistaken. They DON'T WANT to do them.

Finally, as someone who specializes in mechanical support devices, I can say if you have really "never seen a complication from the IABP", then you obviously haven't seen many IABPs.

Re: IABP Removal

actually, unless you have not provided all of your "credentials", it is out of your scope of practice. According to the NSAA, an SA (it does not indicate RN or ST) assists the surgeon during surgical procedures under the direct supervision of the surgeon. They are not even supposed to leave the room while you close... Obviously that is never going to happen, they leave all the time...

I am all for the rights of CSTs, and I think they need more respect and responsibility.. It was my job for 10 years, before graduating as an RN. I had an Associate of applied science, just like the ADNs have. I think they are qualified to circulate (I recently started circulating, and it does not need to be an RN, but in most hospitals, it must be an RN) and FA (we just recently started hiring CSTFAs).

When you graduated as a PA, then you will be a MLP, and yes, pull what you will, in the mean time, I hardly doubt you would be covered by the hospital if you got sued if something went wrong. I doubt your insurance plan would cover you either bc it is out of your scope.

Re: IABP Removal

BEDSIDE RN's (CCU) always pull them without an MD present if its at night the mds that deal with iabp are not even in house... never had a problem (matter of fact pulled one last night)

Re: IABP Removal

At my hospital, the MD pulls the IAB and we use the FemoStop. We then treat it as a usual sheath removal (FemoStop on for about an hour, then wedge pressure dressing on for 6 hours).

There are many things that can happen during the dc of an IAB (like entrapment). It is just good and safe practice for the MD to pull the IAB.