Documenting IABP numbers

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Specializes in CVICU.

There has been a new revision to our IABP policy that states the following:

  1. RN assessments completed and documented every hour include the following:

Pumping frequency (1:1, 1:2).

Position of augmentation control (Is it at maximum? If not, why not?).

Mean arterial pressure.

Augmented diastolic pressure.

Assisted systolic pressure.

Unassisted systolic pressure.

Assisted end diastolic pressure.

Unassisted end diastolic pressure.

Now we all know that Unassisted SBP and Unassisted DBP only display if the IABP is on 1:2. What the powers that be are saying is that even if the patient is ordered to be in a 1:1 ratio that we are to put the IABP on 1:2 q1h and document the IABP numbers.

This would be fine if the patient is ordered to be in 1:2, but charting numbers in 1:2 one minute when the IABP is on 1:1 the other 59 minutes of the hour IMHO doe not accurately reflect the patients true state. The reason being is that for the minute you document numbers on 1:2 you have increased afterload and decreased coronary perfusion. It would be like turning your inotropes down 50% charting vitals then putting the inotropes back up.

The reason I'm putting this out there is that I teach IABP class and having to teach this goes against my common sense right now and I am starting to experience some dissonance teaching something I don't believe to be the right thing to do.

So therefore I put it out there to the masses. Do you do this at your facility? I guess if this is the currently accpepted practice then I will accept it, shut up, and teach it.

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Specializes in CTICU.

Yes. You have to go to 1:2 in order to assess the IABP timing, which is obviously not possible in 1:1. It is certainly not equivalent to reducing inotropes by 50% - you only have to go to 1:2 for a few seconds, get one screen worth of complexes, freeze it, and return to 1:1 pumping. You can then chart the numbers at your leisure without affecting the patient's hemodynamics. Even if you are running 1:1 for the other 59:50 mins of the hour, you still need to determine if you're optimizing the support. Otherwise there's no point having the IABP at all.

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Specializes in ICU.

I would go to 1:2, hit PRINT, then back to 1:1.

Certainly, if the patient is unstable and drops their BP by just turning on a light, forget that! :woot:

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Specializes in Telemetry, ICU.

We always change our pumps in 1:2 just long enough to get a strip, then change it back. Probably 10 seconds max. Of course we also pause them briefly to ascultate heart/lungs, and make sure to allow a couple of minutes between these two exercises in order to let the patient rebound.

If they can't tolerate that, there's gotta be something else going on...

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
There has been a new revision to our IABP policy that states the following:

  1. RN assessments completed and documented every hour include the following:

Pumping frequency (1:1, 1:2).

Position of augmentation control (Is it at maximum? If not, why not?).

Mean arterial pressure.

Augmented diastolic pressure.

Assisted systolic pressure.

Unassisted systolic pressure.

Assisted end diastolic pressure.

Unassisted end diastolic pressure.

Now we all know that Unassisted SBP and Unassisted DBP only display if the IABP is on 1:2. What the powers that be are saying is that even if the patient is ordered to be in a 1:1 ratio that we are to put the IABP on 1:2 q1h and document the IABP numbers.

This would be fine if the patient is ordered to be in 1:2, but charting numbers in 1:2 one minute when the IABP is on 1:1 the other 59 minutes of the hour IMHO doe not accurately reflect the patients true state. The reason being is that for the minute you document numbers on 1:2 you have increased afterload and decreased coronary perfusion. It would be like turning your inotropes down 50% charting vitals then putting the inotropes back up.

The reason I'm putting this out there is that I teach IABP class and having to teach this goes against my common sense right now and I am starting to experience some dissonance teaching something I don't believe to be the right thing to do.

So therefore I put it out there to the masses. Do you do this at your facility? I guess if this is the currently accpepted practice then I will accept it, shut up, and teach it.

Where I have worked this has been the practice for years...and I mean YEARS....it was the preference of the MD's that 1:2 timing be checked q 1 hour ( IF tolerated by the patient) these moments are brief and documented every shift with a strip.
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Specializes in Critical care.

I've done as described for 10+ years in different facilities. The docs ask for 1:2 values to "see how much the balloon's helping them".

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Specializes in CVICU, CCU, Heart Transplant.
Yes. You have to go to 1:2 in order to assess the IABP timing .... you only have to go to 1:2 for a few seconds, get one screen worth of complexes, freeze it, and return to 1:1 pumping.

This is my practice for checking timing. We do not document the unassisted bps when the pt is on 1:1- we leave them blank.

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