cvicxena

Bella -- I do suspect that was why. Don't forget when you have a patient on the pump and you have questions like this . . you can also call the 1-800 number on the balloon pump to ask them questions too.

Bella I can see why you are confused with the way you have to document. In my head (and I'm a balloon pump educator) afterload reduction would be documented as a (-) Negative number and increase in afterload would be documented as a (+) positive number. Maybe you should try to find the policy on IABP for your facility to help you clarify how you document. No matter how you have to document: You are correct in your understanding that assisted pressures are ideally lower than unassisted pressures. If the assisted pressures are higher than unassisted pressures afterload has been increased. When you notice there is an increase in afterload it is usually due to a deflation (late) timing error. You may also see this sometimes if the patient is in an irregular rhythm and the balloon pump is in "A-Fib" mode or "Auto R Wave Deflation" (depending on the manufacturer of pump) because deflation is automatically adjusted to occur later than it typically occurs.

I agree with everything clementinern has said, she has given you great advice! I will tell you that in my varied experience with IABPs . . . unfortunately many physicians themselves are not comfortable with the assisted/unassisted/augmented pressure interpretations either. Many times the in-house perfusionists or the people on the other end of the 1-800 are the best resources - - especially if you should encounter any IABP alarms you aren't familiar with troubleshooting.

As someone who teaches IABP classes some of my best advice to you is that if you don't understand what you are reading and are curious as to why the numbers aren't as expected is the call the IABP company's 1-800 number. They will always be more helpful than physicians who are many times not as comfortable interpreting those numbers as you would imagine them to be . . . The clinicians on the other end of the 1-800 number are trained health care professionals and experts on the IABP. Assisted pressures are always ideally lower than unassisted and that is how you verify that you are reducing the patient's afterload. If they are higher it is likely that you should consider adjusting the deflation timing to attempt to reduce them. Changing the frequency as they physician instructed you . . . will not make the assisted numbers lower. Augmented diastolic pressures are the diastolic numbers that should be higher, but not the assisted. So you were right in your initial assessment that something wasn't quite right.