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Discussion

IABP removal

So I just began working in the CVICU about a month ago. One of the cardiologists newer to the facility came to remove the IABP of one of my pts. Me and my preceptor attempted to stop him d/t the Heparin gtt that was still going. HOWEVER, he went ahead to try and do it because he says he pulls the balloon THROUGH the sheath and leaves the sheath in for a couple hours. Now from my understanding, that increases the risk for a clot to dislodge by forcing the balloon (that could have small clots attached) through the sheath. My preceptor tried explaining this and even got a clinical leader to come speak with him AND had him speak on the phone to one of our cardiothoracic surgeons. All of the consulted people said that it was not the way it should be done. The cardiologist said he had done it that way several times and went ahead and pulled it leaving the sheath in!!!:eek:

Later, we called the Datascope company and they gave us the same info that the balloon should be pulled with the sheath and for the same reason in which we had said.

Do any of you know of any other cardiologists that pull IABPs with this technique? Also, how long do you all leave the heparin off before pulling the sheath normally?

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    We don't pull the balloon through the sheath, they should come out together, and then let it ooze a bit, then apply pressure. We also stop the heparin gtt re-check in about 30 minutes to an hour for a normal (or close to normal) ptt before D/C'ing the balloon/sheath.

    Just because he's done it before doesn't mean it's correct.

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    Ditto the above poster. Never seen the balloon pulled out without the sheath, and NEVER with a heparin gtt running. Yeesh.

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    I've seen it pulled through the sheath once. Cardiologist wanted to angio-seal at the bedside because the lady had severe aortic stenosis and also had a tendancy to vagal easily. I thought this seemed appropriate since a vasovagal reaction could be fatal in somone with severe AS where as a small clot showering down towards the foot would probably be minor.

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    Pull them together.

    Hold heparin, wait 45 mins and check an ACT. If normal, then pull IABP.

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    . The cardiologist said he had done it that way several times and went ahead and pulled it leaving the sheath in!!!:eek:

    What a dumba**! Good for you for standing your ground and trying to go above him. All you can do at that point is document what you did and what he said. Kudos to you!

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    I think I would have gotten fired this day b/c there is no way I will I will allow this until I called Datascope (MAQUET) & taken out the hospital policy to explain to the Cardiologist I question his method.

    We are using the new fiber-optic technology & the it's clearly recommending the sheath & the balloon is removed as a whole. Any anticoagulants should be shut off for 4-8hrs & a fem-stop is used.

    My hospital is a teaching facility & there is no issues when a heart nurse questions a MD & pulls out policy, calls the CNS & supervisor involved.

    We don't play out with IABP or ECMO.....

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