Iabp

[mcline]

I was wondering if anyone had any good tips, tricks of the trade, for timing IABP's??

Thanks!

[st4304]

I can't think of any tricks of the trade, except play with one whenever you can get your hands on one! Experience is the best teacher!

We recently got rid of all our old Datascopes and replaced them with Arrows. They are "AutoCats" -- they sense and time themselves!!! They are wonderful! You still have to carefully monitor the pump and your patient, of course, but they are very nice.

Your pal,

Sherri

[NSDRN]

At our facility the datascope representative gives an inservice 2-3 times a year on the IABP. She recommends turning the IABP ratio to 1:2 to check timing. By doing this you can see the dicrotic notch during an unassisted cycle. The balloon should begin inflation on the dicrotic notch which represents the beginning of diastole. The balloon should deflate right before systole begins. The datascope has a highlighter which you can use to highlight inflation. Your IABP should have a training mode which you can use to practice. Remember, practice makes perfect;)

[Gary from Oz]

Hi, I use the reference line on the Datascope System 97 to mark the position of augmenation or offloading pressures then adjust the inflate & deflate controls to obtain the best trace and pressure values. For example mark the position of the diastolic offloading point then move the deflate slide all the way to the left - now bring it back slowly to get the lowest value, when it starts to climb from that value back off a little and you should be set to optimal offloading. It takes a little practice but works for me!

[zambezi, BSN, RN]

You can only correctly time an iabp in a mode that shows an assisted cycle and an unassisted cycle (ie: 1:2 or greater). I really like the timing guidelines that our arrow rep taught us...it makes a lot of sense to me....

Inflation: the iabp should inflate just prior to the dicrotic notch...which should result in your augmentation > than your unassisted peak systolic pressure. The goals of inflation are to produce a rise in aortic pressure thereby increasing the oxygen supply to the coronary circulation...

If inflation is early, the iab is deflated before the actual dicrotic notch and you are encroaching on systole (compare the valley between unassisted systole to the dicrotic notch, they should be about 0-2 small boxes apart.) If the valley between unassisted systole/augmentation is way above the dicrotic notch, you have early inflation.

With late inflation, the dicrotic notch is visible "in the valley" between unassisted systole and augmentation...

Deflation: The goals of deflation are to lower the aortic end diastolic pressure (afterload) thereby decreasing the work of the heart while improving the cardiac output. Your assisted end diastolic pressure

So, if you have early deflation, your assisted systole (the peak after you sew the augmented waveform in 1:2) is equal to or greater than your unassisted systole. You may see a U shape at the assisted end diastolic pressure where it should be a V shape (if timing is correct, your assisted systole should be less than your unassisted.)

If you have late deflation (another bad timing error because you are encroaching on systole) you assisted diastole is greater than your unassisted end diastolic pressure. You want your assisted end diastolic pressure to be less than or equal to your unassisted end diastolic pressure...

It is kind of confusing to read about it without being able to look at the waveform. My suggestions would be to pick a system and go with it. I usually look at inflation first, then at deflation.

Rule 1: (Inflation) diastolic augmentation > unassisted peak systole (sharp V at dicrotic notch- no U shapes or short little notches...)

Rule 2: (Deflation) Assisted end diastolic pressure

Rule 3: (Deflation) Assisted systole

Practice lots and lots...

Even if you have the arrow that times for you...make sure that you check your timing the proper way...and know why you are checking the differnt aspects...

If you have a simulator you can use it to help you with different rhythms, timing errors etc...

See if your IABP rep can come and do an inservice to your staff...

[KateM07]

A quick tip I learned on orientation regarding timing was "when in doubt fiddle to the middle". Basically make the inflation later and the deflation earlier, which means moving the dials towards the middle of the console. This avoids the worst timing errors; early inflation and late deflation. Of course the best way to perfect timing IABP is to become familiar with the waveform and practice your timing skills, but I thought that this was a helpful tip.

[Pete495]

Fiddle to the Middle. Very good Advice!!!!!

A quick tip I learned on orientation regarding timing was "when in doubt fiddle to the middle". Basically make the inflation later and the deflation earlier, which means moving the dials towards the middle of the console. This avoids the worst timing errors; early inflation and late deflation. Of course the best way to perfect timing IABP is to become familiar with the waveform and practice your timing skills, but I thought that this was a helpful tip.