DEVELOPING AN IABP TEACHING STRATEGY

CLINICAL SUPPORT SERVICES
DEVELOPING AN IABP
TEACHING STRATEGY
DATASCOPE IS NOW MAQUET CARDIOVASCULAR
Caution: U.S. Federal Law restricts this device to sale by or on the order of a physician.
Refer to package insert for current indications, warnings, contraindications, precautions and instructions for use.
Datascope is now MAQUET Cardiovascular
In early 2009, the purchase agreement between Datascope and Getinge AB was completed.
As a result, Datascope’s innovative cardiovascular product portfolio will be integrated into MAQUET
Cardiovascular, a global leader representing the Medical Systems Business area of Getinge AB.
Cardiac professionals have always relied on gold-standard Cardiac Assist products from Datascope,
helping them to feel confident that they are delivering the highest quality of care to their patients.
Now, as a part of MAQUET Cardiovascular, Datascope is even better positioned to focus on the future
advancement of Cardiac Assist products and seeks to explore the full potential of this technology
through our continued dedication to innovation, service and clinical excellence.
Quality Products:
Expect the same great quality products you have relied on over the years with names you are familiar
with like: Fidelity, Linear and Sensation IAB’s, CS300 balloon pumps, SafeGuard and StatLock.
Quality Service:
Rest assured that you will receive the same amazing service and clinical support you have become
accustomed to from Datascope. We are still here for you 24/7 with technical support, loaner
equipment and clinical help.
Worldwide:
MAQUET ranks among the leading providers of medical products, therapies and services for Surgical
Workplaces, Critical Care and Cardiovascular applications. Since its foundation more than 170 years
ago, MAQUET has stood for innovation and the advancement of patient care technologies in the field
of medicine. The portfolio of MAQUET products is extensive, providing a comprehensive solution that
is designed for efficient workflows, safety and the improvement of patient lives and outcomes.
Welcome to MAQUET Cardiovascular:
With a fresh vision of the future, this new, combined organization is committed to providing the highest
quality patient care solutions for cardiologists, interventional radiologists, cardiothoracic and vascular
surgeons, critical care clinicians and their teams.
For further information please visit www.datascope.com
Developing an IABP Teaching Strategy
Course Description
The program will provide lectures on the importance of in-house resources and specifies the important points to
incorporate into programs to ensure effectiveness. Methods for teaching the technical components of the equipment will
be demonstrated with time provided for hands-on. Support materials available from Datascope, such as presentations,
teaching manuals, etc. will be reviewed. Methods of maintaining clinical proficiency will also be discussed.
Behavioral Objectives
1. Describe the importance of strategic pre-planning for an intra-aortic balloon pump course.
2. List the three modules that comprise a complete intra-aortic balloon pump course.
3. List two components of a technical presentation of the intra-aortic balloon pump.
4. Describe two strategies for maintaining expertise.
1
Program Outline: Train the Trainer
8:30 – 9:00
Registration
9:00 – 9:15
Introduction/Program Review
9:15 – 10:30
I.
Developing an IABP Course
Pre--Program Planning
A. Pre
II. IABP Program Content: Three Modules
A. Theoretical
10:30 – 10:45
Break
10:45 – 12:30
B.
12:30 – 1:30
Technical
Lunch
C.
1:30 – 2:30
Clinical Considerations
2:30 – 3:30
III. HandsHands-on Workshop
3:30 – 3:45
Break
3:45 – 4:15
IV. Review of Support Materials
4:15 – 4:30
V.
4:30
Evaluation
Maintaining Expertise
2
I. Developing an IABP Course
A.
Pre
Pre -program Planning
1.
2.
Participants
a.
Background
b.
Attitude awareness
Institution
a.
Role of the staff with the IABP
b
Policy/procedure
c.
Usage
3
II. Program Content
A.
Theoretical
1.
Review CV anatomy/physiology
a.
Structure/position
b.
Movement of valves in response to pressure gradients
c.
Conduction system
d.
Mechanical cardiac cycle
4
e.
Pressure Waves
f. Normal Arterial Waveform
5
g.
Coronary artery origination and phasic perfusion
h.
MVO2 supply/demand determinants
Supply
Demand
1. Coronary artery anatomy
1. Heart Rate
2. Diastolic pressure
2. Afterload
MVO2
3. Diastolic time
4. 02 Extraction
a. Hgb
b. Pa02
3. Preload
4. Contractility
6
i.
Measurement of Cardiac Performance
Cardiac Output = heart rate x stroke volume
(normal – 4-6 liters/minute)
j.
LV Failure
7
2.
Theory of Intra-aortic Balloon Counterpulsation
a. Balloon structure and position
b. IAB Inflation – Primary Effects
1). Augmentation of diastolic pressure
2). Increased coronary perfusion
c. IAB Deflation – Primary Effects
1). Afterload reduction
2). Decreased left ventricular workload
3). Increased cardiac output
3.
Trigger vs. Timing
a. Trigger
b.
Timing
c.
Predictive (Conventional) vs. R-wave deflation timing
8
d.
Waveform Interpretation
1). Presence of “V”configuration between systolic and diastolic augmentation pressure
2). Diastolic augmentation ideally greater than systole
3). Reduction in aortic end diastolic pressure
4). Decreased assisted systolic pressure
5). Mean arterial pressure
e.
Secondary effects
1). CO/CI
2). HR
3). PAD/PCWP
4). SVR
5). B/P:
Systolic
Diastolic
MAP
Diastolic augmentation
f.
Systemic effects
1) Neuro
2) Renal
3) Vascular
4) Respiratory
9
g.
Indications
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
h.
Refractory Unstable Angina
Impending Infarction
Acute MI
Refractory Ventricular Failure
Complications of Acute MI
Cardiogenic Shock
Support for diagnostic, percutaneous revascularization, and interventional procedures
Ischemia related intractable ventricular arrhythmias
Septic Shock
Intraoperative pulsatile flow generation
Weaning from bypass
Cardiac support for non-cardiac surgery
Prophylactic support in preparation for cardiac surgery
Post surgical myocardial dysfunction/low cardiac output syndrome
Myocardial contusion
Mechanical bridge to other assist devices
Cardiac support following correction of anatomical defects
Contraindications
1) Severe aortic insufficiency
2) Abdominal or aortic aneurysm
3) Severe calcific aorta-iliac disease or peripheral vascular disease
4) Sheathless insertion with severe obesity, scarring of the groin, or other contraindications to
percutaneous insertion
Please Refer to the Instructions for Use Prior to Insertion of the IAB
10
B.
Technical: Intra-Aortic Balloon Catheter
Designed for sheathless or sheathed insertion
Fiberoptic IAB catheter
Conventional IAB Catheter
11
B.
T echnical:
echnical: IntraIntra-Aortic Balloon Pump
1.
Pneumatics
a.
Safety Disk/Safety Chamber (Pediatrics)
b.
Helium Supply
12
2.
Electronics
a. Monitor Display
Trigger
Heart Rate Display
Pressure Display
Systolic
Diastolic
Mean
Diastolic Augmentation
Augmentation Alarm
Helium Indicator
Battery Indicator
Alarm Messages
Advisories
ECG
Lead
Gain
Pressure Source
IAB Fill Mode
Slow Gas Alarm Status
Operation Mode
IAB Status Indicator
13
b.
CS100/CS300 IABP Key Pad Controls
Operation Mode Keys
AUTO
Semi-Auto
Manual
Zero Pressure Key
START Key and Indicator
STANDBY Key and Indicator
Trigger Source Key
ECG
Pressure
Pacer V/AV
Pacer A
Internal
IAB Frequency
IAB Augmentation
IAB Inflation Controls
IAB Deflation Controls
Alarm Mute Key
IAB Fill Key
Help Key Indicator
Menu Guide
Ref Line
Aug. Alarm
ECG/AP Sources
Pump Options
User Preferences
Inflation Interval Key
Freeze Display Key
Print Strip Key
14
c.
Recorder
1) ECG
2)
Pressure
3)
Balloon Pressure Waveform
15
The inflation marker shows the period of inflation. Vertical timing marks located below the arterial
waveform are also available to aid with initial timing. The timing markers indicate the point at which
the inflate and deflate commands are sent.
A unique automatic timing algorithm allows effective balloon pumping even during atrial fibrillation.
Press the Inflation Interval key to observe the period of inflation while pumping. Vertical markers
located below the arterial waveform and the highlighted portion indicate the period of balloon inflation.
16
3.
Troubleshooting/CS100
a. Alarm Messages
1) Trigger Alarms
AUTO Operation Mode
a) No Trigger
b) Poor Signal Persists
SemiSemi-Auto or Manual Operation Modes
a) No Trigger
b) No Pressure Trigger
c) Check Pacer Timing
d) Trigger Interference
2) Catheter Alarms
a) Leak in IAB Circuit
b) Rapid Gas Loss
c) IAB Disconnected
d) Check IAB Catheter
e) Blood Detected
f) AutoFill Failure - No Helium
g) AutoFill Failure
h) AutoFill Required
3) Pneumatic Alarms
a) High Drive Pressure
b) Low Vacuum
4) System Surveillance Alarms
a) Electrical Test Fails Code # ________________
b) System Failure
c) Safety Disk Test Fails
b. Advisory Messages
1) Alert Messages
AUTO Operation Mode
a) Poor Signal Quality
b) No Pressure Source Available
c) Unable to Update Timing
SemiSemi-Auto or Manual Operation Modes
a) Irregular Pressure Trigger
b) Verify Proper Timing
c) ECG Detected
d) IAB not Filled
e) Manual Fill IAB
All Operation Modes
a) Prolonged time in Standby
b) Maintenance Required Code # _________________
c) No Patient Status Available
d) Low Helium
e) Low Battery
f) Low Battery [EXT]
g) Heart Rate Low
17
2)
c.
d.
e.
f.
g.
Status Messages
AUTO Operation
Op eration Mode
a) Function Unavailable in the AUTO Operation Mode
Semi--Auto and Manual Operation Modes
Semi
a) Automatic Operation Mode is Disabled
b) Gas Loss and Catheter Alarms Disabled
c) Auto R-Wave Deflate
d) R-Wave Deflate
All Operation Modes
a) System Trainer
b) System Test OK
c) Autofilling
d) Leak Testing Safety Disk
e) Slow Gas Alarm is off
f) Battery in Use
g) Battery in Use [EXT]
3) Prompt Messages
a) Unplug Disk Outlet
b) Plug Disk Outlet
c) Manual Fill IAB
Patient Conditions
1) Atrial Fibrillation
2) Ectopics
3) Cardiac Arrest
4) Cardioversion/Defibrillation
Changing Helium Tank
Safety Disk Leak Test
Manual Fill
Manual Timing
18
4.
Troubleshooting/CS300
a.
High Priority Alarms:
All Modes:
Augmentation Below Limit Set*
No Trigger
IAB Disconnected
Check IAB Catheter
Leak in IAB Circuit
Rapid Gas Loss
Blood Detected
Autofill Failure
Autofill Failure – No Helium
High Pressure Drive
Low Vacuum
AUTO Operation Mode:
Poor Signals Persist
Semi Auto or Manual Mode:
ECG Detected*
No Pressure Trigger
Trigger Interference
Check Pacer Timing
Autofill Required
Other:
Safety Disk Test Fails
* Pumping NOT suspended
b.
Medium Priority Alarms:
All Modes:
IAB Optical Sensor Failure
Low Battery
AUTO Operation Mode:
Poor Signal Quality
No Pressure Source Available
19
c.
Low Priority Alarm:
AUTO Operation Mode:
Unable to Update Timing
d.
Technical Alarms:
Electrical Test Fails Code #_____
System Failure
No Patient Status Available
e.
Informational Messages:
All Modes:
A.P. Optical Sensing Module Failure
Unable to Calibrate IAB Optical Sensor
IAB Optical Sensor Calibration Expired
No Trigger
Prolonged Time In Standby
Autofilling
Auto Zeroing
Autofilling and Zeroing
Function Not Available
Low Helium
Battery in Use (EXT)
Battery In Use
System Test OK
System Trainer
Maintenance Required Code #_____
Slow Gas Loss Alarm is OFF
Leak In IAB Circuit – Overridden
Blood Detected – Overridden
AUTO Operation Mode:
Function Unavailable in Auto Operation Mode
AUTO or SemiAuto
SemiAuto Operation Mode:
Auto R-Wave Deflate
R-Wave Deflate
SemiAuto:
Irregular Pressure Trigger
20
SemiAuto or Manual:
Verify Proper Timing
IAB Not Filled
Manual Fill IAB
Auto Operation Mode is Disabled
Gas Loss and Catheter Alarms Disabled
Manual Mode:
Manual Timing Selected – See Help
Other:
Install Safety Disk
Unplug Disk Outlet
Plug Disk Outlet
Leak Testing Safety Disk
f.
Patient Conditions
1) Atrial Fibrillation
2) Ectopics
3) Cardiac Arrest
4) Cardioversion/Defibrillation
g.
Changing Helium Tank
h.
Safety Disk Leak Test
i.
Manual Fill
j.
Manual Timing
21
5.
Factors Affecting Diastolic Augmentation
a. Patient Hemodynamics
b.
c.
1)
Heart Rate
2)
Stroke Volume
3)
Arterial Pressure
4)
System Vascular Resistance
Intra-Aortic Balloon
1)
IAB in Sheath
2)
IAB Not Unfolded
3)
IAB Position
4)
Kink in IAB Catheter
5)
IAB Leak
6)
Low Helium Concentration
IABP
1)
Timing
2)
Position of IAB Augmentation Control
22
6.
Timing errors
Early Inflation
Inflation of the IAB prior to aortic
valve closure
•
•
•
•
•
•
•
Waveform Characteristics
Inflation of IAB prior to dicrotic notch
Diastolic augmentation encroaches onto
systole (may be unable to distinguish)
Physiologic Effects:
Potential premature closure of aortic valve
Potential increase in LVEDV and LVEDP or PCWP
Increased left ventricular wall stress or afterload
Aortic Regurgitation
Increased MVO2 demand
Late Inflation
Inflation of the IAB markedly after closure
of the aortic valve
•
•
•
Waveform Characteristics:
Characteristics:
Inflation of the IAB after the dicrotic notch
Absence of sharp V
Sub-optimal diastolic augmentation
•
Physiologic Effects:
Sub-optimal coronary artery perfusion
23
Early Deflation
Premature deflation of the IAB during the diastolic phase
•
Waveform Characteristics
Chara cteristics
Deflation of IAB is seen as a sharp drop
following diastolic augmentation
Sub-optimal diastolic augmentation
Assisted aortic end diastolic pressure may be equal
to or less than the unassisted aortic end diastolic pressure
Assisted systolic pressure may rise
•
•
•
•
•
Physiologic Effects:
Sub-optimal coronary perfusion
Potential for retrograde coronary and carotid blood flow
Angina may occur as a result of retrograde coronary blood flow
Sub-optimal afterload reduction
Increased MVO2 demand
•
•
•
Late Deflation
Deflation
•
•
•
•
•
•
Waveform Characteristics:
Assisted aortic end-diastolic pressure may be equal to
the unassisted aortic end diastolic pressure
Rate of rise of assisted systole is prolonged
Diastolic augmentation may appear widened
Physiologic Effects:
Afterload reduction is essentially absent
Increased MVO2 consumption due to the left ventricle
ejecting against a greater resistance and a
prolonged isovolumetric contraction phase
IAB may impede left ventricular ejection and
increase the afterload
24
7.
Normal Balloon Pressure Waveform
25
Variations in Balloon Pressure Waveforms
Heart Rate
Bradycardia
Increased duration of plateau
due to longer diastolic phase.
Tachycardia
Decreased duration of
plateau due to shortened
diastolic phase.
Rhythm
Varying R-R intervals result in irregular plateau durations.
Blood Pressure
Hypertension
Increased height or
amplitude of the waveform.
Hypotension
Decreased height or
amplitude of the waveform.
26
Gas Loss
Leak in the closed system causing the balloon pressure
waveform to fall below zero baseline. This may be due to a
loose connection, a leak in the IAB catheter, H2O
condensation in the external tubing, or a patient who is
tachycardic and febrile which causes increased gas diffusion
through the IAB membrane.
Catheter Kink
Rounded balloon pressure waveform, loss of plateau resulting
from a kink or obstruction of shuttle gas. This may be caused
by a kink in the catheter tubing, improper IAB catheter
position, sheath not being pulled back to allow inflation of the
IAB, the IAB is too large for the aorta, the IAB is not fully
unwrapped, or H2O condensation in the external tubing.
Sustained Inflation
Theoretical possibility if the IAB remains inflated longer than
2 seconds. The Datascope intra-aortic balloon pumps will
activate the System Failure alarm and deflate the IAB.
27
DATASCOPE IABP PERFORMANCE CHECKLIST – CS 100
Name:
Date ____________________
Hospital policy and procedures review:
Date __________ Initials ______
Basic Intra - aortic balloon pump course:
Date __________ Initials ______
Technical Seminar / Advanced Troubleshooting:
Date(s) ________/________ Initials ________
Challenge Exam (if applicable):
Date __________
Score: __________ ( P / F )
Directions for Instructor: Place your initials next to the skills the participant is able to perform. Leave blank the skills
requiring repeat performance. Clarify learning needs if necessary in the comment section. The “Clinical Setting” column
is an optional checklist for use by a preceptor or resource person for reinforcement of skills acquired on system trainer.
Skills
System Trainer
INITIAL SET UP
• Establish Power: Main power switch & IABP On/Off switch ⇒ ON
• Open helium tank and verify helium pressure
• Establish ECG and Pressure connections
ZERO TRANSDUCER
• Open the transducer
• Press the zero pressure key for 2 seconds
• Close the transducer
CONFIRM OPERATION MODE – AUTO
INITIATE PUMPING
• Attach IAB catheter & appropriate extender to safety disk
• Press the Start key and observe the Auto Filling message
• Verify optimal diastolic augmentation
• If desired, IAB deflation can be fine tuned using the IAB deflation
control.
VERIFY AUG. ALARM
• Verify Aug. Alarm setting is approximately 10mmHg less than the
patient’s augmented diastolic pressure
• Adjust, if necessary by pressing Aug. Alarm key and using the up
and down arrow keys, in the navigation circle, to change value
displayed on the screen
ASSESS HEMODYNAMIC BENEFITS
• Ensure optimal augmentation
• Ensure optimal afterload reduction
RECORD PRESSURES: ASSISTED & UNASSISTED
• Press Print Strip key to record waveforms
• Use Printer Menu in User Preferences to change printer settings
28
Clinical Setting
DATASCOPE IABP PERFORMANCE CHECKLIST – CS 100
Skills
System Trainer
Clinical Setting
AUTO OPERATION MODE
• Describe ECG and pressure source selection
• Describe Trigger source selection
• Describe automatic timing and CardioSync 2 with R-Trac
SEMI-AUTO OPERATION MODE
• Describe ECG and pressure source selection
• Describe Trigger source selection
• Describe automatic timing and CardioSync 2 with R-Trac
TROUBLESHOOTING
System Trainer Clinical Setting
DEMONSTRATES ABILITY TO IDENTIFY VARIABLE TRIGGER SELECTION CRITERIA AND APPROPRIATE USE OF EACH TRIGGER
• Atrial Fibrillation
• Demand Ventricular Pacemaker, Rate 60
• AV sequential pacemaker, demand mode
• Unobtainable ECG signal, regular rhythm, BP 100/50
• Cardiac arrest with good chest compressions
• Sinus Tachycardia
• Sinus Rhythm with frequent PVC'S
• Fixed rate AV sequential pacemaker
• Atrial pacemaker - 100% paced
EVALUATES SITUATIONS THAT MAY CAUSE AN IAB CATHETER ALARM AND DESCRIBES APPROPRIATE INTERVENTION
• Kink in the catheter or tubing
• Patient sitting straight up in bed
• IAB has not exited the sheath
IDENTIFIES AND RECOMMENDS APPROPRIATE ACTION FOR POTENTIAL LOSS OF HELIUM (“GAS LOSS”)
• Blood in the IAB catheter shuttle gas tubing
• IAB catheter disconnected from the console
DISCUSSES THE FOLLOWING ALARM AND ADVISORY MESSAGES
• Poor Signal Quality
• Poor Signal Persists
• No Pressure Source Available
• Unable to Update Timing
29
DATASCOPE IABP PERFORMANCE CHECKLIST – CS 100
Skills
System Trainer Clinical Setting
DISCUSSES THE HEMODYNAMIC RELATIONSHIP BETWEEN THE PATIENT AND IABP THERAPY IN REGARDS TO DIASTOLIC
AUGMENTATION
• Increased heart rate
• Decrease in patient stroke volume
• Ectopy
• Increase in patient BP
• Decreased SVR
DEMONSTRATES APPROPRIATE INTERVENTION FOR THE FOLLOWING ERRORS IN TIMING AND VERBALIZES POTENTIAL
CLINICAL IMPLICATIONS
• Early inflation
• Late inflation
• Early deflation
• Late deflation
PORTABLE OPERATION
• Initiates and terminates portable operation
• Identifies location of battery charge light
INTERFACE (SLAVE) CABLES ( IF APPLICABLE):
• Identifies location and use of ECG and/or pressure cables
• Describes proper use of ECG slave cable in the presence of
pacemakers
30
DATASCOPE IABP PERFORMANCE CHECKLIST – CS300
Name: ________________________________________ Date ____________________
Hospital policy and procedures review:
Date __________ Initials ______
Basic Intra - aortic balloon pump course:
Date __________ Initials ______
Technical Seminar / Advanced Troubleshooting:
Date(s) ________/________ Initials ________
Challenge Exam (if applicable):
Date __________
Score: __________ ( P / F )
Directions for Instructor: Place your initials next to the skills the participant is able to perform. Leave blank the skills requiring repeat
performance. Clarify learning needs if necessary in the comment section. The “Clinical Setting” column is an optional checklist for use
by a preceptor or resource person for reinforcement of skills acquired on system trainer.
Skills
System Trainer
INITIAL SET UP
• Establish Power: Main power switch & IABP On/Off switch ⇒ ON
• Open helium tank and verify helium pressure
• Establish ECG and Pressure connections
If using a sensor IAB:
• Ensure the IAB Sensor Cable is connected to the sensor module
and clipped to helium extender tubing
If using conventional IAB/Transducer:
• Open transducer to air
• Press zero pressure key for 2 seconds
• Close transducer
CONFIRM OPERATION MODE – AUTO
INITIATE PUMPING
• Attach IAB catheter & appropriate extender to safety disk
• Press the Start key
If using a sensor IAB:
• Observe for the “Autofilling & Zeroing” message
If using conventional IAB/ transducer:
• Observe for the “Autofilling” message
• Verify optimal diastolic augmentation
VERIFY AUG. ALARM
• Verify Aug. Alarm setting is approximately 10mmHg less than
the patient’s augmented diastolic pressure
• Adjust, if necessary by pressing Aug. Alarm key and using the up
and down arrow keys, in the navigation circle, to change value
displayed on the screen
ASSESS HEMODYNAMIC BENEFITS
• Ensure optimal augmentation
• Ensure optimal afterload reduction
• If desired, IAB deflation can be fine tuned using the IAB deflation
control.
RECORD PRESSURES: ASSISTED & UNASSISTED
• Press Print Strip key to record waveforms
• Use Printer Menu in User Preferences to change printer settings
31
Clinical Setting
DATASCOPE IABP PERFORMANCE CHECKLIST – CS300
Skills
AUTO OPERATION MODE
System Trainer
Clinical Setting
• Describe ECG and pressure source selection
• Describe Trigger source selection
• Describe automatic timing and CardioSync 2 with R-Trac
SEMI-AUTO OPERATION MODE
• Describe ECG and pressure source selection
• Describe Trigger source selection
• Describe automatic timing and CardioSync 2 with R-Trac
PRESSURE SOURCE - Describes understanding of how pressure source is
originated and calibrated
• Fiberoptics
• Conventional IAB/Transducer
TROUBLESHOOTING
System Trainer Clinical Setting
DEMONSTRATES ABILITY TO IDENTIFY VARIABLE TRIGGER SELECTION CRITERIA AND APPROPRIATE USE OF EACH TRIGGER
• Atrial Fibrillation
• Demand Ventricular Pacemaker, Rate 60
• AV sequential pacemaker, demand mode
• Unobtainable ECG signal, regular rhythm, BP 100/50
• Cardiac arrest with good chest compressions
• Sinus Tachycardia
• Sinus Rhythm with frequent PVC'S
• Fixed rate AV sequential pacemaker
• Atrial pacemaker - 100% paced
EVALUATES SITUATIONS THAT MAY CAUSE AN IAB CATHETER ALARM AND DESCRIBES APPROPRIATE INTERVENTION
• Kink in the catheter or tubing
• Patient sitting straight up in bed
• IAB has not exited the sheath
IDENTIFIES AND RECOMMENDS APPROPRIATE ACTION FOR POTENTIAL LOSS OF HELIUM (“GAS LOSS”)
• Blood in the IAB catheter shuttle gas tubing
• IAB catheter disconnected from the console
DISCUSSES THE FOLLOWING ALARM AND INFORMATIONAL MESSAGES
• Poor Signal Quality
• Poor Signals Persist
• No Pressure Source Available
• Unable to Update Timing
• IAB Optical Sensor Failure
• AP Optical Sensing Module Failure
• Unable to Calibrate IAB Optical Sensor
• IAB Optical Sensor Calibration Expired
32
DATASCOPE IABP PERFORMANCE CHECKLIST – CS300
SKILLS
System Trainer Clinical Setting
DISCUSSES THE HEMODYNAMIC RELATIONSHIP BETWEEN THE PATIENT AND IABP THERAPY IN REGARDS TO DIASTOLIC
AUGMENTATION
• Increased heart rate
• Decrease in patient stroke volume
• Ectopy
• Increase in patient BP
• Decreased SVR
DEMONSTRATES APPROPRIATE INTERVENTION FOR THE FOLLOWING ERRORS IN TIMING AND VERBALIZES POTENTIAL
CLINICAL IMPLICATIONS
• Early inflation
• Late inflation
• Early deflation
• Late deflation
PORTABLE OPERATION
• Initiates and terminates portable operation
• Identifies location of battery charge light
INTERFACE (SLAVE) CABLES (IF APPLICABLE):
• Identifies location and use of ECG and/or pressure slave cables
• Describes proper use of ECG slave cable in the presence of
pacemakers
LOW LEVEL OUTPUT CABLE (IF APPLICABLE):
• Identifies location and use of low level output cable
33
8.
Frequently asked questions
a. What adjustments do I need to make with:
sinus tachycardia
ventricular tachycardia
atrial fibrillation
pacemakers
asystole
b.
Can I alter weaning settings if a patient’s condition deteriorates?
c.
What happens with a balloon leak?
d.
Where are the helium tanks stored and who is responsible for changing them?
e.
How can we bring in ECG and pressure signals from our monitor?
f.
How does the modem work?
g.
How do I change the recorder paper and where is extra paper stored?
h.
When can I view the help screens?
i.
Other questions?
34
C.
Clinical Considerations
Goal: Stress the similarities between the IABP patient and the critical cardiovascular patient while highlighting
the differences
differences.
1. Potential side effects/complications
a.
Limb ischemia
b.
Excessive bleeding from insertion site
c.
Thrombocytopenia
d.
Immobility of balloon catheter
e.
Balloon leak
f.
Infection
g.
Aortic dissection
h.
Compartment syndrome (may develop after IAB removed)
2.
Review of care plan for the IABP patient
3.
Care of the inner lumen
4.
Weaning and removal
5.
Transport
35
III. Hands-On Workshop
SetSet -up and use of the Datascope IntraIntra-Aortic Balloon Pump Trainer
•
•
•
•
•
•
Trainer plugs into the direct ECG and Pressure input connectors on back of pump.
The short phono plug cable connected to the trainer plugs into the Trainer Input jack on back of pump.
Pump must be turned on in order for trainer to function.
The SYSTEM TRAINER message will appear in the upper left corner of the monitor screen.
Not all alarms and trainer simulations are listed.
Trainer iiss NOT to be used while pump is being used for patient therapy.
Functions
To Simulate
Zeroing - Conventional IAB
Press the “Pressure” key on trainer until “Vent” is highlighted, then press the “Zero”
button on IABP keypad for 2 seconds. Once zeroed, press the “Pressure” key on
trainer until “Normal” is highlighted.
Zeroing - Fiberoptic IAB
If a Sensation catheter is connected to the fiber-optic sensor module, calibration is
automatic on start-up and every 2 hours thereafter. To initiate a calibration anytime
after start-up, WHILE PUMPING simply press the “Zero” button on the IABP keypad
for 2 seconds. The message “Auto Zeroing” will be displayed in the advisory section
of the monitor.
Loss of arterial pressure
waveform
Press the “Pressure” key until “Vent” is highlighted to simulate the loss of the
pressure waveform (doesn’t require user to zero again). Can also press the “BP
Disconnect” key once. Press again and pressure waveform will reappear (user will
have to zero again). In Auto Operation Mode, the message “No Pressure Source
Available” will be displayed.
ECG artifact
While in Auto Operation Mode, press the “Noisy ECG” key. Pump will cycle through all
available leads, then switch to pressure trigger. Press the “Noisy ECG” key again and
artifact will disappear. Pump will switch back to ECG trigger in 2 min. if rhythm is
regular, 1 min. if rhythm is A-fib. While in Semi-Auto Operation Mode, the pump will
NOT automatically make changes. To return to ECG Trigger more quickly, press the
“Pressure” key on the trainer until “Vent” is highlighted and pump will return to ECG
Trigger.
ECG lead disconnect
While in Auto Operation Mode, press the “ECG Lead Fault” key once and a flat line
ECG will appear and pump will switch to Pressure Trigger. Press “ECG Lead Fault” key
again and rhythm will reappear and pump will switch back to ECG Trigger. While in
Semi-Auto Operation Mode and in ECG Trigger, this will cause a “No Trigger” alarm.
Sinus Rhythm
Normal Sinus Rhythm with a heart rate of 80 is the default “Mode”.
Heart rate changes
When “Sinus Rhythm” mode is selected, press the “Rate” key to simulate various
heart rates: the choices are 60, 80, 100, and 130 when highlighted.
Atrial fibrillation
Press the “Mode” key until “Atrial Fib” is highlighted. Press the “Mode” key twice to
return to Sinus Rhythm.
36
Functions
To Simulate
100% V paced rhythm
Press the “Mode” key until “Pacer Fixed 80bpm” is highlighted.
Various pacer settings
First, press the “Mode” key until “Pacer Fixed 80bpm” is highlighted. Next, press the
“Pacer” key, which will allow you to cycle through the following choices: V paced, A-V
paced, A paced, and A-V demand pacing. To stop simulating any of the paced
rhythms, press the “Mode” key once to return to Sinus Rhythm.
Ventricular arrhythmias
First, make sure you are in Sinus Rhythm (any rate is fine). Next, press the “Ventric.
Rhythms” key, which will allow you to cycle through the following choices: PVC (1 PVC
every 6 to 10 beats), Couplets (1 couplet every 10 to 12 beats), Bigeminy (short run of
bigeminy every 10 to 12 beats), and V-Tach (15 beat run of v-tach every 15 to 20
beats). To stop simulating any of the arrhythmias, press the “Mode” key once.
No augmentation
Press the “Pressure” key until “No Aug.” is highlighted. The IABP monitor screen will
display an arterial pressure waveform with no augmentation.
Cardiac arrest
While in Auto Operation Mode, press the “ECG Lead Fault” key, then press the
“Pressure” key until “Vent” is highlighted. The pump will stop pumping and alarm
“No Trigger”. Press the “Pressure” key until “Normal” is highlighted, which will bring
back the arterial pressure waveform (this demonstrates that the CS100/300 will start
pumping automatically when an adequate arterial pressure waveform appears, which
is similar to what would happen if adequate chest compressions are being done in a
code).
Alarm: “Augmentation
Below Limit Set”
Set the Aug. Alarm to a level higher than current augmentation pressure or decrease
the IAB Augmentation control setting.
Alarm:
“IAB Disconnected”
Disconnect the catheter extender tubing from the safety disk while pumping.
Alarm:
“Rapid Gas Loss”
While pumping, slowly loosen the extender tubing where it connects to the catheter
(may be difficult to simulate).
Alarm:
“Leak in IAB circuit”
While pumping, slowly loosen the extender tubing where it connects to the catheter.
(may be difficult to simulate).
Alarm:
“Check IAB Catheter”
While pumping, kink the extender tubing.
Alarm:
“No Trigger”
While in Auto Operation Mode, the ECG and Pressure signal are lost by pressing the
“ECG Lead Fault” key and “Pressure” key until “Vent” is highlighted.
Alarm:
“No Pressure Source
Available”
While in Auto Operation Mode with an adequate ECG signal, press the “BP
Disconnect” key.
Alarm: CS300
“No Pressure Source
Available”
If a Sensation catheter is connected to the fiber-optic sensor module, remove the
sensor connector from the fiber-optic sensor module while pressing the “BP
Disconnect” key. To resume pressure waveform, reconnect sensor connector to
sensor module and press “BP Disconnect” key once. CS300 will auto-calibrate after 1
min. or WHILE PUMPING simply press the “Zero” button on the IABP keypad for 2
seconds.
37
Functions
To Simulate
Alarm:
“Poor Signal Quality”
While in Auto Operation Mode, press the “Pressure” key until “Vent” is highlighted,
then press the “Noisy ECG” key. This will alarm once a minute for 3 minutes while the
CS100/CS300 continues to pump.
Alarm:
“Poor Signals Persist”
While in Auto Operation Mode, after the “Poor Signal Quality” alarm has been
displayed for 3 minutes, the “Poor Signals Persist” alarm will sound and the
CS100/CS300 will stop pumping.
Alarm:
“Unable to Update Timing”
While in Auto Operation Mode while pumping, press the “Semi-Auto” Operation Mode
key on the IABP keypad, then press “ECG Lead Fault” and “No Aug.” on the trainer.
Next, switch to Auto Operation Mode on the IABP keypad, then press the “Start” key.
The alarm will sound in approximately 30 seconds.
Alarm:
“Irregular Pressure Trigger”
While in Semi-Auto Operation Mode in Pressure Trigger, press the “Mode” key until
“Atrial Fib” is highlighted.
Alarm:
“ECG Detected”
While in Semi-Auto Operation Mode, establish an adequate ECG signal while in
Internal Trigger.
Alarm:
“Autofill Failure”
If already pumping, put the pump on standby, disconnect the extender tubing from
the safety disk, then push the “Start” key. The CS100/CS300 will automatically
attempt to perform an autofill and will fail since the catheter is not connected.
Alarm:
“Autofill Failure – No
Helium”
Close the helium tank and then attempt to perform an autofill. This may take 3 or 4
autofills to simulate because there will be residual helium in the line.
Alarm:
“Sensor IAB Failure”
If a non-functional sensor connector is connected to the fiber-optic sensor module
while pumping, completely disconnect the trainer from the back of the pump. The
alarm will go away when the trainer is re-connected.
38
IV. Review of Support Materials
Pre-inservice Self-Study Guide*
Course Outlines*
Theory CD
Website / E-learning modules*
Abbreviated Operator’s Guides*
Timing Pocket Reference Guide*
Case Studies
Performance Checklist
Inservice Videos
IAB catheter insertion
IABP operation
PowerPoint presentations
Journal article reprints
Policies and Procedures*
Transport Protocols*
* Denotes files available on the Datascope website: http://www.datascope.com/ca/ed_resources.html
39
V. Maintaining Expertise
A.
Suggested Resources
B. Inservice Videos
C.
Theory CD-ROM
D. E-Learning Modules
E.
Hands on with performance checklist
F.
Case studies
G. Website
H. Written Test
I.
Combination of all of the above
40
REFERENCE LIST
Barron HV, Bowlby LJ, Breen T, et al. Use of reperfusion therapy for acute myocardial infarction in the United States
- data from the National Registry of Myocardial Infarction 2. Circulation 1998;97(12):11.
Barron HV, Every NR, Parsons LS, et al. The use of intra-aortic balloon counterpulsation in patients with cardiogenic
shock complicating acute myocardial infarction: Data from the National Registry of Myocardial Infarction 2. American
Heart Journal 2001;141:933–9.
Benchmark Counterpulsation Outcomes Registry 2005.
Christenson JT, Licker M, Kalangos A. The role of intra-aortic counterpulsation in high-risk OPCAB surgery: a
prospective randomized study. Journal of Cardiovascular Surgery 2003 Jul-Aug;18(4):286-94.
Christenson JT, Cohen M, Ferguson JJ III, et al. Trends in intraaortic balloon counterpulsation complications and
outcomes in cardiac surgery. Annals of Thoracic Surgery 2002 Oct;74(4):1086-91.
Christenson JT, Simonet F, Schmuziger M. Economic impact of preoperative intraaortic balloon pump therapy in
high-risk coronary patients. Annals of Thoracic Surgery 2000 Aug;70:510-5.
Christenson JT, Simonet F, Badel P, Schmuziger M. Optimal timing of preoperative intraaortic balloon pump support
in high-risk coronary patients. Annals of Thoracic Surgery 1999 Sep;68(3):934-9.
Christenson JT, Schmuziger M. Preoperative intra-aortic balloon pump therapy in high-risk coronary patients - impact
on postoperative inotropic drug use. Today's Therapeutic Trends 1999;17(3):217-225.
Christenson JT, Simonet F, Badel P, Schmuziger M. Evaluation of preoperative intra-aortic balloon pump support in
high risk coronary patients. European Journal of Cardiothoracic Surgery 1997 Jun;11(6):1097-1103; discussion
1104.
Christenson JT, Simonet F, Schmuziger M. The effect of preoperative intra-aortic balloon pump support in high risk
patients requiring myocardial revascularization. Journal of Cardiovascular Surgery 1997 Aug;38(34):397-402.
Claflin, N, guest editor. AACN Clinical Issues in Critical Care Nursing - Standards and Quality Assurance. Vol. 2,
No. 1 J.B. Lippincott Company Philadelphia February 1991.
Craver JM, Murrah CP. Elective intraaortic balloon counterpulsation for high-risk off-pump coronary artery bypass
operations. Annals of Thoracic Surgery 2001 Apr;71(4):1220-3.
Gould KA. Mechanical assist for the failing heart. Critical Care Nursing Clinics of North America WB Saunders
Company Philadelphia 1989.
Guyton AC. Textbook of Medical Physiology. Seventh Edition; WB Saunders Company Philadelphia 1986.
Hasdai D, Califf RM, Thompson TD, et al. Predictors of cardiogenic shock after thrombolytic therapy for acute
myocardial infarction. Journal of the American College of Cardiology 2000 Jan; 35(1):136-43.
Hasdai D, Holmes DR Jr, Califf RM, et al. Cardiogenic shock complicating acute myocardial infarction: predictors of
death. American Heart Journal 1999 Jul;138(1 Pt 1):21-31.
Hochman JS. Cardiogenic shock complicating acute myocardial infarction. Expanding the paradigm. Circulation
2003;107:2998–3002.
41
Hochman JS, Sleeper LA, Godfrey E, et al. SHould we emergently revascularize Occluded Coronaries for cardiogenic
shocK: an international randomized trial of emergency PTCA/CABG-trial design. American Heart Journal 1999
Feb;127(2):313-21.
Hollenberg SM, Kavinsky CJ, Parrillo JE. Cardiogenic shock. Annals of Internal Medicine 1999 Jul 6;131(1):47-59.
Hudson MP, Granger CB, Stebbins AL, et al. Cardiogenic shock survival and use of intraaortic balloon
counterpulsation: results from the GUSTO I and III trials - Abstract #1942. Circulation 1999 Nov;100 Suppl(18):I370.
Kahn JK. Intra-Aortic Balloon Pumping/Theory and Clinical Applications in the 21st Century. A Monograph for the
Clinician Datascope Corp. December 2004.
Kim KB, Lim C, Ahn H, Yang JK. Intraaortic balloon pump therapy facilitates posterior vessel off-pump coronary
artery bypass grafting in high-risk patients. Annals of Thoracic Surgery 2001 Jun;71(6):1964-8.
Kinney MR, Dear CB, Packa DR, Voorman DN. AACN's Clinical Reference for Critical Care Nursing. Fourth Edition
McGraw Hill Book Company 2001.
Kovack PJ, Rasak MA, Bates ER, et al. Thrombolysis plus aortic counterpulsation: Improved survival in patients who
present to community hospitals with cardiogenic shock. Journal of the American College of Cardiology 1997
Jun;29(7):1454-8.
Millar S, Sampson LK, Soukup M. AACN Procedure Manual for Critical Care. WB Saunders Company Philadelphia
1985.
Mishra S, Chu WW, Torguson R, et al. Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing
percutaneous coronary intervention. American Journal of Cardiology 2006 Sep 1;98(5):608-12. Epub 2006 Jun 30.
Ohman EM. Counterpulsation and thrombolysis together improve survival after cardiogenic shock – the TACTICS
nd
results. Presented at the 22 Congress of European Society of Cardiology on August 27, 2000 in Amsterdam, the
Netherlands.
Quaal SJ. Comprehensive Intra-aortic Balloon Pumping. CV Mosby Company St. Louis 2nd Edition 1993.
Quaal SJ, guest editor. AACN Clinical Issues in Critical Care Nursing - Cardiac Assist Devices Vol 2, No. 3, JB
Lippincott Company Philadelphia August 1991.
Ryan EW, Foster E. Images in cardiovascular medicine. Augmentation of coronary blood flow with intra-aortic balloon
pump counter-pulsation. Circulation 2000 Jul 18;102(3):364-5.
Sanborn TA, Sleeper LA, Bates ER, et al. Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and
their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial
Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? Journal of the American
College of Cardiology 2000 Sep;36(3 Suppl A):1123-9.
Stone GW, Ohman EM, Miller MF, et al. Contemporary utilization and outcomes of intra-aortic balloon
counterpulsation in acute myocardial infarction. Journal of the American College of Cardiology 2003
Jun 4;41(11):1940-45. Comment in: Journal of the American College of Cardiology 2003 Jun 4;41(11):1946-7.
Suzuki T, Okabe M, Handa M, et al. Usefulness of preoperative intraaortic balloon pump therapy during off-pump
coronary artery bypass grafting in high-risk patients. Annals of Thoracic Surgery 2004 Jun;77(6):2056-9; discussion
2059-60.
Underhill Sl, Wood SL, Sivarajan ES, Halpenny CJ. Cardiac Nursing. Second Edition. JB Lippincott Philadelphia
1989.
42
Vazquez M, Engman Lazear S, Larson EL. Critical Care Nursing. Second Edition WB Saunders Company Philadelphia
1992.
Vender JS, guest ed. Intensive care monitoring. Critical Care Clinics WB Saunders Company Philadelphia 1989.
Wolvek S. The evolution of the intra-aortic balloon: The Datascope contribution. Journal of Biomaterials Applications
1989 April; 3:527-542
43
BIBLIOGRAPHY
THEORY
Bolooki H. Clinical Application of Intra-aortic Balloon Pump. Third Edition. Futura Publishing Company Inc, 1998.
Cadwell CA, Quaal SJ. Intra-aortic balloon counterpulsation timing, American Journal of Critical Care. July 1996;
5(4):254-261.
Donelli A, Jansen JRC, Hoeksel B, et al. Performance of a real-time dicrotic notch detection and prediction algorithm
in arrhythmic human aortic pressure signals. Journal of Clinical Monitoring and Computing 2002;17:181–5.
Joseph D, Bates S. Intra-aortic balloon pumping - How to stay on course. American Journal of Nursing 1990 Sep;
90(9):42-47.
Maccioli GA, Ed. Intra-aortic balloon pump therapy. Baltimore Williams & Wilkins 1997.
Maccioli GA, Lucas WJ, Norfleet EA. The intra-aortic balloon pump: A review. Journal of Cardiothoracic Anesthesia
1988;2:365-373.
Mahaffey KW, Kruse KR, Ohman EM. Perspectives on the use of intra-aortic balloon counterpulsation in the 1990s.
In: Topol EJ, ed. Textbook of Interventional Cardiology St. Louis WB Saunders 1996:303-321.
Quaal SJ, guest ed. Critical Care Nursing Clinics of North America. Philadelphia WB Saunders December 1996;8(4).
Shinn AE, Joseph D. Concepts of intraaortic balloon counterpulsation. Journal of Cardiovascular Nursing 1994;
8(2):45-60.
Takeuchi M, Nohtomi Y, Yoshitani H, et al. Enhanced coronary flow velocity during intra-aortic balloon pumping
assessed by transthoracic Doppler echocardiography. Journal of the American College of Cardiology. 2004;43:368–
76.
Whitman G. Intra-aortic balloon pumping and cardiac mechanics: A programmed lesson. Heart and Lung 1978;
7(6):1034-1050.
INDICATIONS
Anwar A, Mooney MR, Stertzer SH. Intra-aortic balloon counterpulsation support for elective coronary angioplasty in
the setting of poor left ventricular function: A two center experience. The Journal of Invasive Cardiology 1990
July/August;1(4):175-180.
Arafa OE, Geiran OR, Anderson K, et al. Intra-aortic balloon pumping after predominantly right ventricular failure
after heart transplantation. Annals of Thoracic Surgery 2000;70:1587–93.
Baskett RJF, Ghali WA, Maitland A, Hirsch GM. The intra-aortic balloon pump in cardiac surgery. Annals of Thoracic
Surgery 2002;74:1276–87.
Baskett RJF, O’Connor GT, Hirsch GM, et al. A multicenter comparison of intra-aortic balloon pump utilization in
isolated coronary artery bypass graft surgery. Annals of Thoracic Surgery 2003;76:1988–92.
Bates ER, Stomel RJ, Hochman JS, Ohman EM. The use of intra-aortic balloon counterpulsation as an adjunct to
reperfusion therapy in cardiogenic shock. International Journal of Cardiology 1998;65(Suppl 1):S37–42.
44
Bolooki H. Emergency cardiac procedures in patients in cardiogenic shock due to complications in coronary artery
disease, Circulation 1989 June;79(6)(Suppl I):I-137-I-147.
Briguori C, Sarais C, Pagnotta P, et al. Elective versus provisional intra-aortic balloon pumping in high-risk
percutaneous transluminal coronary angioplasty. American Heart Journal 2003;145:700–707.
Califf, R.M.; Ohman, E.M., Reocclusion after thrombolytic therapy and percutaneous transluminal coronary
angioplasty. Cardiac Assists 1990 March; 5(2).
David JS, Gueugniaud PY, Hepp A, et al. Severe heart failure secondary to 5-fluorouracil and low doses of folinic
acid: Usefulness of an intra-aortic balloon pump. Critical Care Medicine 2000;28:3358–60.
Demas C, Flancbaum L, Scott G. The intra-aortic balloon pump as an adjunctive therapy for severe myocardial
contusion. American Journal of Emergency Medicine 1987;5:499–502.
Dietl CA, Berkheimer MD, Woods EL, et al. Efficacy and cost effectiveness of preoperative IABP in patients with
ejection fraction of 0.25 or less. Annals of Thoracic Surgery 1996;62:401-409.
Emmerman CL, Pinchak AC, Hagen JF. Hemodynamic effects of the intra-aortic balloon pump during experimental
cardiac arrest. American Journal of Emergency Medicine 1989 July;7:373-383.
Emery RW, Eales F, Joyce LD. Mechanical circulatory assistance after heart transplantation. Annals of Thoracic
Surgery 1991; 51:43-7.
Ferguson JJ, Cohen M, Freedman RJ Jr, et al. The current practice of intra-aortic balloon counterpulsation: Results
from the Benchmark Registry. Journal of the American College of Cardiology 2001;38:1456–1462.
Freedman RJ Jr. Myoconservation in cardiogenic shock - The use of intra-aortic balloon pumping and other
treatment modalities. Cardiac Assists 1992 January;6(2).
Freedman RJ Jr. The intra-aortic balloon pump system: Current roles and future directions. Journal of Applied
Cardiology 1991;6:313-318.
George BS. Thrombolysis and intra-aortic balloon pumping following acute myocardial infarction - Experience in four
TAMI studies. Cardiac Assists 1988 October;4(3).
Georgen RF, Dietrick JA, Pifarre R. Placement of intra-aortic balloon pump allows definitive biliary surgery in patients
with severe cardiac disease. Surgery 1989 September;106(4):808-814.
Goodwin M, Hartman J, McKeever L, et al. Safety of intra-aortic balloon counterpulsation in patients with acute
myocardial infarction receiving streptokinase intravenously. The American Journal of Cardiology 1989; 64:937-938.
Grotz RL, Yeston NS. Intra-aortic balloon counterpulsation in high-risk cardiac patients undergoing non-cardiac
surgery. Surgery 1989 July;106(1):1-5.
Gunnar RM, Bourdillon PDV, Dixon DW. Guidelines for the early management of patients with acute myocardial
infarction. American College of Cardiology 1990 August;16(2):249-292.
Gurbel PA, Anderson RD, MacCord CS, et al. Arterial diastolic pressure augmentation by intra-aortic balloon
counterpulsation enhances the onset of coronary artery reperfusion by thrombolytic therapy, Circulation 1994;
89(1):361-365.
Gutfinger DE, Ott RA, Miller M, et al. Aggressive preoperative use of intra-aortic balloon pump in elderly patients
undergoing coronary artery bypass grafting. Annals of Thoracic Surgery 1999;67:610–613.
45
Hochman JS, Buller CE, Sleeper LA, et al. Cardiogenic shock complicating acute myocardial infarction--etiologies,
management and outcome: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded
Coronaries for cardiogenic shocK? Journal of the American College of Cardiology 2000 Sep;36(3 Suppl A):1063-70.
Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by
cardiogenic shock. New England Journal of Medicine 1999 Aug; 341(9):625-34.
Hochman JS, Boland J, Sleeper LA, et al. Current spectrum of cardiogenic shock and effect of early revascularization
on mortality. Results of an international registry. Circulation 1995 Feb 1;91(3):873-881. Comment in: Circulation.
1995 Sep 1;92(5):1349-50.
Ishihara M, Sato H, Tateishi H, et al. Intra-aortic balloon pumping as the postangioplasty strategy in acute myocardial
infarction. American Heart Journal August 1991;122(2):385-389.
Kahn JK, Rutherford BD, McConahay DR. Supported "high risk" coronary angioplasty using intraaortic balloon pump
counterpulsation. Journal of the American College of Cardiology 1990 April;15:1151-5.
Kern MJ, Aguirre F, Bach R, et al. Augmentation of coronary blood flow by intra-aortic balloon pumping in patients
after coronary angioplasty. Circulation 1993 Feb;87(2):500-511.
Kern MJ, Aguirre FV, Tatineni S, et al. Enhanced coronary blood flow velocity during intraaortic balloon
counterpulsation in critically ill patients. Journal of the American College of Cardiology 1993 Feb;21(2):359-368.
Kern MJ. Intra-aortic balloon pumping post-angioplasty - Documentation of increased coronary blood flow. Cardiac
Assists 1992 June;6:1-5.
Kern MJ. Intra-aortic balloon counterpulsation. Coronary Artery Disease August 1991;2(6):649-660.
Lane AS, Woodward AC, Goldman MR. Massive propranolol overdose poorly responsive to pharmacologic therapy:
Use of the intra-aortic balloon pump. Annals of Emergency Medicine 1987 Dec;16(12):1381-1383.
Lazar HL, Yang XM, Rivers S, et al. Role of percutaneous bypass in reducing infarct size after revascularization for
acute coronary insufficiency. Circulation 1991;84(Suppl III):III-416-III-421.
Mangano DT, Browner WS, Hollenberg M. Association of perioperative myocardial ischemia with cardiac morbidity
and mortality in men undergoing noncardiac surgery. The New England Journal of Medicine 1990 Dec 27;
323(26):1781-8.
Marra C, de Santo LS, Amarelli C, et al. Coronary bypass grafting in patients with severe left ventricular dysfunction:
A prospective randomized study in timing of perioperative intra-aortic balloon pump support. International Journal of
Artificial Organs 2002;25:141–6.
Masaki E, Takinami M, Kurata Y, et al. Anesthetic management of high-risk cardiac patients undergoing noncardiac
surgery under the support of intra-aortic balloon pump. Journal of Clinical Anesthesia 1999;11:342–5.
McNamara NS, Wharton WP, La Rochelle T, Deboard D. Use of intra-aortic counterpulsation in patients with acute
myocardial infarction who present to community hospitals. Critical Pathways in Cardiology 2002;1:159–179.
Mercer D, Doris P, Salerno TA. Intra-aortic balloon counterpulsation in septic shock. The Canadian Journal of
Surgery 1981 Nov;24(6):643-645.
Ohman EM, George BS, White CJ, et al. Use of aortic counterpulsation to improve sustained coronary artery patency
during acute myocardial infarction. Results of a randomized trial. Circulation 1994 Aug;90(2):792-799.
Ohman EM, Califf RM, George BS, et al. The use of intra-aortic balloon pumping as an adjunct to reperfusion therapy
in acute myocardial infarction. American Heart Journal 1991 Mar;121(3):895-901.
46
Reiss N, el-Banayosy A, Posival H, et al. Transport of hemodynamically unstable patients by a mobile mechanical
circulatory support team. Artificial Organs 1996;20:959–63.
Ryan TJ, Antman EM, Brooks N, et al. 1999 Update: ACC/AHA guidelines for the management of patients with acute
myocardial infarction: Executive summary and recommendations: A report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute
Myocardial Infarction). Circulation 1999;100:1016–1030.
Schreiber TL, Kodali UR, O’Neill WW, et al. Comparison of acute results of prophylactic intra-aortic balloon pumping
with cardiopulmonary support for percutaneous transluminal coronary angioplasty (PTCA). Catheterization and
Cardiovascular Diagnosis 1998;45:115–119.
Schreiber TL, Miller DH, Zola B. Management of myocardial infarction shock: Current status. American Heart Journal
1989 Feb;117(2):435-443.
Siu SC, Kowalchuk GJ, Welty FK, et al. Intra-aortic counterpulsation support in the high-risk cardiac patient
undergoing urgent noncardiac surgery. Chest 1991 Jun;99(6):1342-1345.
Stomel RJ, Rasak M, Bates ER. Treatment strategies for acute myocardial infarction complicated by cardiogenic
shock in a community hospital. Chest 1994;105(4):997-1002.
COMPLICATIONS
Arceo A, Urban P, Dorsaz PA, et al. In-hospital complications of percutaneous intra-aortic balloon counterpulsation.
Angiology 2003;54:577–85.
Barnett MG, Swartz MT, Peterson GJ, et al. Vascular complications from intraaortic balloons: Risk analysis. Journal of
Vascular Surgery 1994 Jan;19(1):81-89.
Brodell GK, Tuzcu EM, Weiss SJ. Intra-aortic balloon pump rupture and entrapment. Cleveland Clinic Journal of
Medicine 1989 Oct;56(7):740-742.
Cohen M, Ferguson JJ, Freedman RJ Jr, et al. Comparison of outcomes after 8 vs. 9.5 French size intra-aortic
balloon counterpulsation catheters based on 9,332 patients in the prospective Benchmark Registry. Catheterization
and Cardiovascular Interventions 2002;56(2):200–206.
Eltchaninoff H, Dimas AP, Whitlow PL. Complications associated with percutaneous placement and use of intraaortic
balloon counterpulsation. American Journal of Cardiology 1993 Feb;71:328-332.
Funk M, Gleason J, Foell D. Lower limb ischemia related to use of the intra-aortic balloon pump. Heart and Lung
1989;18:542-552.
Goran SF. Vascular complications of the patient undergoing intra-aortic balloon pumping. Critical Care Nursing
Clinics of North America 1989 Sep;1(3):459-467.
Gottlieb SO, Brinker JA, Borken AM, et al. Identification of patients at high risk for complications of intra-aortic
balloon counterpulsation: A multivariate risk factor analysis. American Journal of Cardiology 1984; 53:1135-1139.
Kantrowitz A, Wasfie T, Freed PS, et al. Intra-aortic balloon pumping 1967 through 1982: Analysis of complications
in 733 patients. American Journal of Cardiology 1986;57(11):976-983.
Kvilekval KH, Mason RA, Newton GB, et al. Complications of percutaneous intra-aortic balloon pump Use in patients
with peripheral vascular disease. Archives of Surgery 1991 May;126:621-623.
47
Lazar JM, Ziady GM, Dummer SJ, et al. Outcome and complications of prolonged intraaortic balloon counterpulsation
in cardiac patients. American Journal of Cardiology 1992,Apr;69:955-958.
Robicsek F, Holleman JH, Roush TS, et al. Peri-operative intra-aortic balloon assist, decreasing complications to the
minimum. Thoracic and Cardiovascular Surgeon 2003;51:115–125.
Schecter D, Murali S, Uretsky BF. Vascular entrapment of intra-aortic balloon after short term balloon
counterpulsation. Catheterization and Cardiovascular Diagnosis 1991;22:174-176.
Stahl KD, Tortolani AJ, Nelson RL, et al, Intra-aortic balloon rupture. ASAIO Journal 1988;XXXIV:496-499.
Velez CA, Kahn JK. Compartment syndrome from balloon pump. Catheterization and Cardiovascular Interventions
2000;51:217–219.
INSERTION
Gorton ME, Soltanzadeh H. Easy removal of surgically placed intra-aortic balloon pump catheter. Annals of Thoracic
Surgery 1991;51:325-6.
Heebler RF. Simplified technique for open placement and removal of intra-aortic balloon. Annals of Thoracic Surgery
1989;48:134-6.
Nash IS, Lorell BH, Fishman RF, et al. A new technique for sheathless percutaneous intra-aortic balloon catheter
insertion. Catheterization and Cardiovascular Interventions 1991 May;23(1):57-60.
Phillips SJ, Tannenbaum M, Zeff RH, et al. Sheathless insertion of the percutaneous intra-aortic balloon pump: An
alternate method. Annals of Thoracic Surgery 1992; 53:162.
Shahian DM, Jewell ER. Intra-aortic balloon pump placement through dacron aortofemoral grafts. Journal of Vascular
Surgery 1988 Jun;7:795-7.
PEDIATRICS
Anella J, McCloskey A, Vieweg C. Nursing dynamics of pediatric intra-aortic balloon pumping. Critical Care Nurse
1990 Apr;10(4):24-28.
del Nido PJ, Benson LN, Bohn D, et al. Successful use of intra-aortic balloon pumping in a 2-kilogram infant. Annals
of Thoracic Surgery 1988 Nov;46:574-576.
Dunn JM. The use of intra-aortic balloon pumping in pediatric patients. Cardiac Assists 1989 June; 5(1).
Nawa S, Sugawara E, Murakami T, et al. Efficacy of intra-aortic balloon pumping for failing fontan circulation. Chest
1988 Mar;93(3):599-603.
Pinkney KA, Minich LL, Tani LY, et al. Current results with intra-aortic balloon pumping in infants and children.
Annals of Thoracic Surgery 2002;73:887–91.
Veasy LG, Blalock RC, Orth J. Intra-aortic balloon pumping in infants and children. Circulation
1983;68(5):1095-1100.
Webster H, Veasy LG. Intra-aortic balloon pumping in children. Heart and Lung 1985;14(6):548-555.
48
TRANSPORT
Bellinger RL, Califf RM, Mark DB. Helicopter transport of patients during acute myocardial infarction. American
Journal of Cardiology 1988 Apr;61:718-722.
Gottlieb SO, Chew PH, Chandra N. Portable intra-aortic balloon counterpulsation: Clinical experience and guidelines
for use. Catheterization and Cardiovascular Diagnosis 1986;12:18-22.
Kramer RP Jr. Helicopter-transported intra-aortic balloon pumping: advanced technology made airborne. Cardiac
Assists 1988 Jun;4(2).
Mertlich G, Quaal SJ. Air transport of the patient requiring intra-aortic balloon pumping. Critical Care Nursing Clinics
of North America 1989 Sep;1(3):443-458.
NURSING CARE
Bavin TK, Self MA. Weaning from intra-aortic balloon pump support. American Journal of Nursing 1991 Oct;91(10):
54-59.
Patacky MG, Garvin BJ, Schwirian PM. Intra-aortic balloon pumping and stress in the coronary care unit. Heart and
Lung 1985 Mar;14(2):142-8.
Quaal SJ, guest ed. Critical Care Clinics of North America. Philadelphia WB Saunders 1996 Dec;8(4).
Shoulders O. Managing the challenge of IABP therapy. Critical Care Nurse 1991 Feb;11(2):60-76.
Weinberg LA. Buying time with an intra-aortic balloon pump. Nursing 1988 Sep;18(9):44-49.
49
50
PROGRAM AND SPEAKER EVALUATION
Developing an IABP Teaching Strategy
Program Code 07
Date:
Please rate the program and speaker items by placing a mark in the appropriate
column.
Program Evaluation
1.
2.
3.
4.
5.
6.
7.
1
Poor
2
Fair
3
Good
4
Very
Good
5
Excellent
1
Poor
2
Fair
3
Good
4
Very
Good
5
Excellent
Program met the stated objectives
Content covered topic adequately
Overall quality of this program
Overall quality of speaker(s)
Quality of the program facilities
Program met my personal objectives
I can incorporate program content
into my practice
Speaker Name:
Speaker Evaluation
1. Objectives – Stated learning
objectives met
2. Audiovisual – Contributed to
presentation
3. Content – Relevance of content to
objectives
4. Presentation – Speaker qualified and
held interest
5. Effectiveness – Speaker was
organized and effective
6. Practice – Validated and/or changed
practice
Comments:
Participant Name:
51
For local contact:
Please visit our Website
www.datascope.com
www.maquet.com
PN: 0002-08-0908 R1
® MAQUET Registered Trademark of MAQUET GmbH & Co. KG · Copyright MAQUET Cardiovascular LLC or its affiliates. All rights reserved. 06/09.
Caution: U.S. Federal Law restricts this device to sale by or on the order of a physician. Refer to package insert for current indications, warnings, contraindications, precautions and instructions for use. 06/09
Datascope Corp.
Cardiac Assist Division
15 Law Drive
Fairfield, NJ 07004
Tel. 1.973.244.6100