Who does your IABPs

hellonurse36 · Jul 29, 2006

Our IABP are inserted in the cath lab by MDs. I work in CICU and the RNs manage the IABP. I can not imagine RT managing the pump. They are busy enough with vents/breathing treatments/extubations/intubations/bipab/transporting pts on vents etc. I think since they are not at the pt's bedside for enough of the day to keep a real close eye on things it is better for the pt if the RN manages the pump. It is important for the RN who is caring for the pt to be responsible for the pump as is it is a VERY important part of that pt's care/management. When it is time to pull an IABP, an MD does it.

As for vents, we are not allowed to touch settings either, although if a pt is in respiratory distress an increase in FiO2 while waiting for RT to respond to a page is done if in pt's best interest - of course you would be sure to relay that info to the RT when he/she arrives.

Terri Finney

NC

CardioTrans, BSN, RN · Jul 29, 2006

Our IABP's are placed by MDs in the cath lab as well. We manage it at the bedside.

As for our vents, we can change FIO2, but thats it. RT or the MD change the other settings.

Dinith88 · Jul 29, 2006

nurses do our iabp's...an rt managing the pump is a silly notion (in my opinion). Where i work, rt's are very territorial as well, however we do adjust fio2 (and occaisionally other vent settings) but we have to inform the rt's or they get their panties in a bunch. no-one's ever gotten in trouble for doing it.

hrtprncss · Jul 29, 2006

We also "manage" our IABP's ourselves, thur orders and protocols. Inserted either in the CC or OR, but rarely can be inserted in the Unit when the patient is way too unstable to be moved about. I believe that an RT is capable of taking care of an IABP, given the inservices and all, but like everyone has said, you practically should have someone be there AAT. What I mean is yes, putting an IABP on auto and letting the machine manage its own timing is what we pretty much do all the time, but sometimes there are other factors that go with it such as adjusting gtt's and stuff, using pacer or ur pressure for trigger, going to CT with the balloon, and other things like that. My question is, why would this done at other places? Do you guys think it's a way for administration to be able to justify not having an IABP patient as 1:1? That because RT ''manages'' the balloon, does that mean the pt's acuity is lowered?

With regards to insertion, personally I've never heard of an RT inserting an IABP. Meaning, if a certain patient needs an IABP placed, you can basically pretty much bet that the cardiologist would be there because the patient is sick. Maybe what RT's do at these institutions are pretty much the same as what the RN's do when they come in, meaning checking the machine, you know enough helium and such, the right ratio on the balloon, and maybe zeroing the aline.

My concern about this is that most of the RT's I've worked with have enormous patient loads already and they bounce from unit to unit, how would they able to manage the other vents. Even if you have an RT dedicated in the ICU, you still have multiple vents in the unit which would make this a bit hard for them.

Quick question for you guys, are you guys allowed to draw blood from the balloon line at ur facility? Some places I've worked at allow it and some don't. There are times when you might have a TLC and an extra Aline, but the TLC pretty much is full and you can't really disconnect what's going there cuz they could be pressors and the patient is unstable, or you have that extra Aline but it won't draw blood, are you then allowed to put the balloon on stand by and draw blood instead of peripherally sticking the patient?

TennRN2004 · Jul 29, 2006

I agree totally on the RTs with IABPs (they are busy, big pt loads, not always at the bedside,etc), that's why I said in the OP that I was suprised to hear it happened some places. I may have misstated, as I do not think RTs actually insert the IABP-they just manage it after it is in.

As far as drawing from the IABP I can honestly say I've seen it happen once b/c we had no other alternative, the patient was extremely unstable s/p heart surgery, she went acidotic and was so clamped down anesthesia was not able to get an aline in her-multiple MDs tried. She was on tons of gtts and absolutely could not have any of them paused for lab draws. She had terrible veins and lab could not stick her, plus we were getting labs very frequently b/c of her being so sick.

The concensus among the RNs working that night was it is totally not preferrable and we would not use the IABP given any other alternative, but even anesthesia said there really wasn't any other way to get labs. Ultimately, we decided it is basically a sheath with the IABP catheter going through it, so the nurse did carefully get lab draws from it during the night until anesthesia was finally able to place an aline on the day shift. I'm not sure if we have a policy on it or not, but I bet the nurse actually wrote it as an order that it was okay to use the IABP line for lab draws-I know I would have to cover myself and document in the notes why it was necessary.

What about IABPs placed preop? We have one surgeon in particular who will put an IABP in for 24 hours preop if the patient has a low EF-usually 20-30% range to help support the pump/let the heart rest before surgery. It is supposed to improve outcomes with these patients postop, but I haven't actually looked at the research myself. The surgeon will come put them in at the bedside in the ICU, leave it in until the patient goes for preop, and then all the lines are placed as usual for heart surgery-swan, aline, TLC if not already in place. I myself would like to see swan numbers before and after heart surgery ie what did the CI look like before the IABP is put in, once it is put in, what is your baseline CI with IABP preop and how does it compare after CAB. I was suprised the first one I took care of that the MD didn't want the swan in also before.

mced · Jul 30, 2006

Thats interesting TennRN2004, I have never heard of an RT running or for that matter even having anything to do with an IABP. I do not think it would be that difficult to explain and teach to an RT, but I have never even seen one take any interest in them. In the OHR I work in we manage all the IABP's and other toys. The vents are run by both the RN's and RT's. If the patient is ready to be extubated we sometimes call RT, other times we just do it ourselves. No one seems to really care. The RT's usually have such a large assignment that they are not always available when paged.

ZASHAGALKA, RN · Jul 30, 2006

RTs that handle pumps aren't functioning as an 'RT' but as a dual role as a 'balloon pump tech'. At least where I work, they have to be cross-trained and in-house 'certified' in that role. Not all RTs are 'balloon pump techs'.

In the old days, the RTs --- balloon pump techs --- 'sat the pump'. And yes, that was designed to make IABPs not 1:1 for the nurse. But, at least, there was always someone watching the pump and the pt's circulation, etc.

Now, RTs are in such short supply that the 'pump' is just another machine to monitor, along with whatever 'vent's are on 'the row'. But, still not 1:1 for the nurse. I'm pushing for a change to that.

It does bother me that RTs are on 'my pump'. But, since they are no longer 'sitting the pumps', I normally time it like I want after they leave. We are getting the Arrow auto-pilots in a few months. We'll have to see if they live up to their promise. But, they can claim all the territory they want when it comes to vents, my pump is MY PUMP.

I've worked where IABPs WERE 1:1. To me, those were awesome shifts. Just give me a good pump with lots of drips and leave me be!!!

~faith,

Timothy.

hrtprncss · Jul 30, 2006

I've worked where IABPs WERE 1:1. To me, those were awesome shifts. Just give me a good pump with lots of drips and leave me be!!!
~faith,
Timothy.

LOL I second that, those kinds of assignments are just heaven...

TennRN2004 · Jul 30, 2006

LOL I second that, those kinds of assignments are just heaven...

ours are always 1:1 when they roll from the OR. The only time they are not is (a) staffing sucks and they have to be 1:2, although if they're sick enough the charge RN will take them and someone else will be tripled up (b) they have the pump but MD is gonna pull it on the day shift so that nurse will sometimes get two patients

We have one surgeon who only uses the arrows timothy-they're awesome (the fiberoptic automatic pumps). We also use the datascopes on the auto pilot mode.

ZASHAGALKA, RN · Jul 30, 2006

ours are always 1:1 when they roll from the OR. The only time they are not is (a) staffing sucks and they have to be 1:2, although if they're sick enough the charge RN will take them and someone else will be tripled up (b) they have the pump but MD is gonna pull it on the day shift so that nurse will sometimes get two patients
We have one surgeon who only uses the arrows timothy-they're awesome (the fiberoptic automatic pumps). We also use the datascopes on the auto pilot mode.

We have the older datascopes where 'auto-pilot' is to move the timing slide bars all the way over until it, for lack of a better word, 'clicks' at the end.

IMHO, I'm a better timer than THAT. Everytime I have tried that, nothing but problems. But, in 9 yrs, surely the tech has come further.

I have heard from several people that supposedly the newer pumps are, as you say, awesome. I'll be excited to see it in action.

If I'd of known we were moving to arrows, I'd of checked them out at the trade/exposition show when I was at NTI.

~faith,

Timothy.

TennRN2004 · Jul 30, 2006

We have the older datascopes where 'auto-pilot' is to move the timing slide bars all the way over until it, for lack of a better word, 'clicks' at the end.
IMHO, I'm a better timer than THAT. Everytime I have tried that, nothing but problems. But, in 9 yrs, surely the tech has come further.
I have heard from several people that supposedly the newer pumps are, as you say, awesome. I'll be excited to see it in action.
If I'd of known we were moving to arrows, I'd of checked them out at the trade/exposition show when I was at NTI.
~faith,
Timothy.

The arrows are the only ones the surgeon I originally mentioned will use. The only catch to them is with the fiberoptics, if perfusion is not dead on when they set them in the OR, you'll still have good augmentation b/c the pump is doing its job, but your numbers will be crap and there's nothing you can do to fix it.

Our datascopes in the auto modes are the ones I was talking about the manufacturer stating that the machine does a better job than human manipulation. We've played with enough of them that I believe it. We've got nurses with over 20 years heart experience and I've yet to see one that by us playing with it could beat the machine in regards to timing.