IABP

justanurse · Sep 6, 2000

In our CCU we were given an 8 hour instruction course in caring for our patients with IABP. We only get a few each year, so it takes each nurse several hours to get back in the swing of caring for these patients every time we have one. True, they can be a life-saver for patients. But, don't let your employer put you or your patients in an unsafe situation. Our cath lab nurses assist with the insertions, it is not done at the bedside. And, our patients always have a perfusionist in house that can be called anytime the machine acts up. Now, the cath lab nurses are trained with the machines and know them inside out, us bedside nurses do not. We manage the patient, the perfusionist manages the machine, even though you have to understand what it's doing.

Remember, IABP's should always be on 1:1 nursing. NO MATTER WHAT!!!! The nurse expected to care for the patient on the IABP should never be expected to give primary care to another patient, I don't care how easy they are.

How far is your facility located from the nearest hospital you would transfer them to? If it is not too far, would it not be better to just transfer the patients promptly, rather than to delay their transfer while placing the IABP?

For those of you who were not given an opportunity to complete the classes, demand that you be allowed to retake the entire class. Put it in terms that you would like the whole process to succeed and that you can't help if you haven't been given the full opportunity to be trained.

GOOD LUCK!!!

oramar · Sep 7, 2000

JustANurses just wrote a very good post, she is lucky to work somewhere where they have a perfusion tech on duty at all times. Many of these small instituions try to get by with merely having a tech on call, that can really be stressful. One other potential problem, I used to be a transport nurse, there are many thing that can go wrong when a person on a pump is moved by a bunch of inexperienced people. I found out about most of them the hard way. Things like an ambulance with no electrical outlets or a small ambulance in which a pump does not fit. There is a good chance you will be moving several IV infusion pumps and the batteries on the can go dead on long trips. There is also the problem of on call techs not being easy to reach when they are supposed to be avaliable, like a fool I used to pack the pump up and take it with out a tech but I want you to refuse to do that.

AnnieRN · Sep 11, 2000

Thank for your responses! My concerns continue to run deep about introducing these invasive proceedure to our hospital. Number one is our staffing. Realizing that these patients truely require 1:1 nursing presents many problems. We are currently working with only 10 full time nurses. 10! We can barely cover sick calls. This weekend we were staffed with 2 Rn's for six patients which was manageable only because these people were not all vented and swaned. Coupled with the fact that I will feel like I will be getting on the job training with this proceedure. Most of these patients could be shipped to the city where they have balloon pump teams in the the time it takes me to read the owners manual to operate the pump. My manager is not dealing with the reality of this and is unapproachable. I have gone to the medical doctors and the chairman of the medical staff expressing my concerns. The cardiologist who is also our ICU medical director is the little maniac who wants the pump. What a mess. Thanks for listening to me ramble.

ccnurse · Sep 20, 2000

Our CCU has 8 beds and we take care of IABPs on a regular basis. The problem comes in with not having them on a regular basis, as well as not enough training to start with. We had a 4 hour class on them, but also have at least one nurse on each shift that has good expierience with them. IABP pts used to be a 1:1 pt for us, but not anymore. It the pt is bad enough, we can insist on it being a 1:1 and will usually get our way. One thing I always do is to keep info on the balloon pump available at work and each time I have a pt on one, I make myself review during the shift. We have good info available at work for troubleshooting and all. And no, we don't have a perfusionist available to us either. Stand your ground and don't risk your license because if something happens, guess who they are gonna blame?

micurn2 · Jan 3, 2011

I work in a 12 bed MICU (noc shift) short staffed so more often than not we have 3:1 ratio. we get CVVHD alot and the occasional IABP, alot of intubated,sedated pts with their various requirements of standards of care that they need. IABP and CVVHD pts were always 1:1 pts but as they say "not anymore"....our IABP class was one eight hr day and each year we receive updated inservices which "qualifies" assignment to the pt. My first experience with CVVHD was "on the job" training by the dialysis nurse who thought it was funny that we hadn't been told that we had to take care of the machine and the pt etc etc...now CVVHD comes with "bigger" bags that don't have to be changed as often so our nurse manager feels they don't have to be 1:1 so we now get second pt. We don't get as many IABP pts because the more critical ones actually get transported to another hospital ( can't wait for my first inexperience on transporting) so each time we keep on a little longer I go get my books and "refresh" myself. I can call the MICU resident if I have problems; who may or may not know that much about IABP or I can call the cardiologist on-call.

We tried standing our ground but we lost to management because unfortunately we don't have a policy covering either the CVVHD or IABP. IS there anyone out there who could help me help keep my pt(s) safe and provide the BEST care possible???

micurn2 · Jan 3, 2011

Does anyone have a policy for CVVHD or IABP???

auro · Jan 3, 2011

Hi there, I am working in a 27 ICU at a Spanish Hospital. Usually we have a 3:1 ratio even with more than 40 % intubated patients. I try to convince to my boss to decrease our ratio which only happens when we have an outbreak. The problem is that when the outbreak is controlled the ratio increases again. I am studying scores that can be associated to nurse work. Do you use Omega or TISS score in your ICU?

Thanks a lot,

Auro

michelleh · Jan 3, 2011

to all icu nurses;
how much training did you recieve before you were expected to be able to safely care for a patient with a balloon pump? I work in a community hospital that has decided to be the premier community hospital that will be using the balloon as a "bridge" to stablize our patients and ready them for transfer to a tertiary care center. We are a young staff in terms of critical care experience and none of us has ever worked with a pump. We are also extemely short staffed. Our unit is often staffed with two rn's, one who may only have been in icu for less than six months. We have seven beds open but often must hold the census due to staffing issues. Now they want to intrduce the balloon pump. So far the training has consisted of one eight hour class..some of us were not privelged enough to even finish the class because we were expected to work. We also had a two hour mock insertion with the sales rep. I do not feel this is adequate. Am i being unrealistic to think that we we need more training??

i have been in critical care for 30 yrs.my hosp is a 18 bed.we make ours a 1:1 pt.if they are sick enough for a pump,than they need the trained nuse.perhaps you all could go to a hosp with the iabp in use an do so many hrs of hands on. A preceptor shift.i would not want to risk my license. You can harm pt if u do not correct time...

LuckyoneRN · Jan 6, 2011

I work in a unit where we frequently get balloon pumps and no matter what they are 1:1 staffed. Doesn't matter if they are vented or not, few gtts or many, HD or cvvh...still 1:1. That line is tricky and the nurse caring for that pt needs to be focused on that machine and that pt only. Especially with the staffing you describe, sounds like a dicey proposition. Good luck to you and your unit!

aCRNAhopeful · Jan 13, 2011

I don't think it should be a mandatory 1 on 1 but it is in my unit. I have had some EASY shifts taking care of my stable 1 on 1 IABP patient waiting for a CABG the next day. Pretty sweet deal. If the balloon is placed for cardiogenic shock then thats a different situation and most likely they'd need a 1:1 ratio.

guest239592 · Jan 18, 2011

I work in a 30 bed CVICU, largest CV unit in Wisconsin that takes the highest risk patients in the state. We see IABP A LOT (I'll be trained in March, can't wait!)

Our training is 1 8 hr class. When ppl are newer at machines (CVVH, IABP, LVAD) or are new transplant nurses, our charge nurses try to get us in those assignments right away to get us used to those pts/machines (the charge nurses have a list in their binder of who is new to what machines etc.) This helped me a lot when I became a CVVH nurse, I had almost 3 weeks straight of CVVH and now I feel like very comfortable with it just from repetition.

Our pt's on IABP are ALWAYS 1:1 (and honestly other than our pre-vad pt's that we put a balloon in the night before surgery, all of our balloons are VERY sick)

Like others have said, adequate staffing is pretty key.