Page 92 - Critical Care Notes

4223_Tab02_045-106 29/08/14 10:00 AM Page 86

CV

Indications
■ Complement to cardiopulmonary bypass and low cardiac output after cardiac
surgery
■ Bridge to VAD, CABG, or cardiac transplant
■ AMI with cardiogenic shock
■ Decompensated heart failure
■ Acute mitral valve insufficiency or regurgitation
■ Ventricular septal defect or papillary muscle ruptures
■ Severe unstable or intractable angina
■ Septic shock
Timing
■ Balloon should inflate at or slightly above the dicrotic notch.
■ A crisp V shape should appear on inflation.
■ Diastolic augmentation peak > preceding systolic peak.
■ The following systolic peak (assisted systole) < preceding systole (unassisted
systole).
■ The IABP should be set on a 1:2 augmentation to assess timing and then
1:1 or 1: 3 augmentation after timing has been optimized.
■ Avoid early or late inflation and deflation.
Management
■ Routine critical care nursing practices are followed.
■ Instruct patient not to sit up, bend knee, or flex hip >45°. Keep HOB <45°.
■ Provide continuous ECG monitoring.
■ Arterial line and pulmonary artery catheter are in place.
■ Assess insertion site for bleeding and infection.
Complications
■ Balloon leakage, rupture, or entrapment. The catheter can migrate and
occlude subclavian artery.
■ Lower limb ischemia and compartment syndrome of cannulated extremity.
■ Arterial occlusion → mesenteric infarction.
■ Catheter-associated infection.

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