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.
Might be better of starting your own thread about that.
Basically, inflating in diastole helps by pushing blood through the coronaries (coronaries perfuse during diastole). Deflating in systole creates a sort of vacuum that means the heart pumps into lower pressure and doesn't have to work so hard. Overall: increased myocardial oxygenation and decreased myocardial oxygen demand.
As an added extra, you get better perfusion to your head and kidneys as well.
Luckily, our unit is 1:1 for IABP's and thus far no ruptured balloons. I am taking the class in the next month or so to start taking IABP's so it was good to read these posts.
I had a patient with a balloon rupture. During the night shift there were frequent alarms for a leak but the helium tank seemed full and the patient had stable vs and it continued pumping. When i arrived at 7am i noticed that the tube looked "dirty" and turned the lights on. We looked closely and saw little brown specks on the tubing wall and decided that there may be a rupture. The interventional team came and we took the patient emergntly to the cvl and attempted to remove the pump but it would not come out. A surgeon was called in stat to surgically remove the balloon while another one was placed in the other groin as the patient was extremely balloon dependent. A cutdown was down and the catheter removed and was found to have a very large hardened dried blood formation in the tube about 3/4" wide and 2' long. It would have ruptured the femoral had the surgeon not removed the catheter. The patient did well and was eventually weaned but this is reason that our hospital requires 1:1 nursing care of the iabp patient.
At our hospital, balloon pumps are 1:1. Every hour the nurse is supposed to do an assessment... start at the patient's leg and make sure dressing is CDI, gently palpate the area around it to make sure skin is still soft and there are no signs of a hematoma, then follow the tubing down to the IABP machine to make sure there's no blood in the line. Then we feel radial and dorsalis pedis pulses, along with posterior tibialis pulses (usually with a doppler).
Just a brief answer about how the balloon "knows" to inflate - we generally have patients on "EKG Trigger" in which the machine is reading the EKG and inflates at just the right time. If a patient is having serious dysrhythmias or is asystole and we start chest compressions, the machine can be turned to "pressure trigger" so that it knows when to based on the pressures in the heart.
Correct me if I'm wrong about any of this, I'm a new ICU nurse so I'm just getting familiar with IABPs.
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s4twin
7 Posts
Wow.... iabp 1:1, never where i worked for eight years. how about one pt with a balloon(no perfusionist) an your other on cvvhd.