iabp - page 2
Hello. I was wondering what the nurse patient ratio was for iabp's in other units. I work in a 16 bed ICU/CCU unit. Until recently it was 1:1. Most of the times the balloon pumps go to CVICU, but... Read More
Jul 17, '07Quote from Burnt2It takes me maaaaybe 5-7 mins to do the hourly balloon stuff (check pulses real fast, eyeball/assess site/catherter, record IABP numbers [either by printing a strip or just pausing waveform and running line], in addition to the routine vitals, outputs, and titration.It's pretty time consuming to do all the hourly checks, calcs, etc - even if they're stable.
Having a balloon inflating in the aorta isn't something to be taken lightly.
Policy at our hospital is 1:1, but i've had a vent patient and a stable pump twice in my time working there - mainly because of staffing issues.
I've had 2 pre-op IABPs and would take that assignment again in a heartbeat. A IABP really doesnt add 'that' much more paperwork or responsibility on a stable patient. Its basically just checking pulses, sites, timing (the CS100s pretty much can time themselves better than I can 85% of the time) and copying some numbers. Not to the extent CVVH or a VAD does.
I see IABPs pretty much daily, and am very comfortable driving them. Our perfusionists are great about giving tips and being on call should a problem arise, never even had to speak with a datascope rep.Last edit by TopherSRN on Jul 17, '07
Jul 17, '07Where do you all work where they are a mandatory 1:1? At our facility, they are 1:1 if they are busy and will need the attention for some reason, but stable balloons are 2:1.....Just curious....
Jul 17, '07Quote from diarygirl512I PM'd you .Where do you all work where they are a mandatory 1:1? At our facility, they are 1:1 if they are busy and will need the attention for some reason, but stable balloons are 2:1.....Just curious....
Jul 18, '07in our ccu, IABP's once dropped are sick enough to be a 1:1 for 8-12 hours, then we play it by ear... are we still playing with afterload reduction and pressers? if you've a wall of drips... equals a 1:1
CVSU, post open heart, these guys are 1:1 for 8 hours unless off pump done and extubated and stable comming out of OR with the IABP for afterload reduction or a BP kick to get off pump, then paired up with a post op day 2 for nights.
we never uniformly make an IABP a 1:1 for the sake of equiptment.... Non IABP's are frequently sicker, on many more titrating drips and qualify for the 1:1.
so every assignment is due to acuity, and you certainly can take an anterior MI with little drip titration on IABP with and ACS pt. going for cath in the am.
A blind 1:1, only increases facility costs as many of our patients routinely are pumped due to high risk and what not and they're the most stable on the unit. Blanket 1:1's are not the answer, you want management to respond to acuity, NOT the EQUIPTMENT. Writing numbers, checking urine output and pulse, with experience takes only moments...... Make my crashing septic vent on 3 plus pressers, dropping lines a 1:1. I'd take two same day fresh stable hearts on pumps any day, rather than the mutlisystem one.
The color here is gray and the staffing needs to flex as such. There is nothing wrong with pairing a stable post mi pump with another fitting assignment.
12 years in and yep, I'd offer to take another pt. rather than sit there for formalities sake.... I'm sure I'm in the manority here.... (I could argue to keep the 1:1, but we know, many times it's not warrented and this will lead the number crunchers to decide for us, I'd rather just speak up when I think I can handle more..... if it changes, we make the adjustments.
IMHO.... I know people feel very strongly against it, I just don't see all the hoopla with the pumps.... you know, you're skilled, you can pick when you can do more and you do it.
not a favorable response, but i's mine anyway.
Jul 18, '07I got the scoop on why my facility does IABPs 1:1. Something happened to one of these patients, and the surgeons demanded it. (Go surgeons!)
Jul 19, '07Quote from Baptized_By_FireA balloon blew and went unnoticed for a while in our CTCU, thus 1:1 policy now. No complaints here. I take my time with my IABP pt.I got the scoop on why my facility does IABPs 1:1. Something happened to one of these patients, and the surgeons demanded it. (Go surgeons!)
CTCU peeps don't do wedges anymore either because a pulmonary artery popped from overwedging.
Not that it makes a difference with calcs, wedge pressures are dependent on so many variables to be useful it's easier and safer just do do the PAP diastolic.
Oct 26, '07We generally take another pt. with an IABP pt, but there are exceptions if they're really unstable.
Oct 29, '07It all depends on how stable the IABP is, many IABPs are "Stable". Just because they're on an IABP doesn't necessarily mean they needed to be a 1:1.
Oct 30, '07We see them so rarely on our unit that they are usually 1:1 regardless of acuity (which is silly but a lot of our RNs are scared of new euipment despite proper training). You could easily take 2 pts with some of them.
Oct 30, '07I work in a CVICU and our IABP patients are always 1:1 with no exceptions. It is part of our hospital policy. Usually my balloon patients are either post op hearts or MI patients who are waiting for a CABG. Most of our balloon patients are hemodynamically unstable a.nd warrant the 1:1 status