Cardiology in Critical Care
Intraaortic Balloon Pump
Intra-Aortic Balloon Catheter
|18 gauge angio needle set
|J-tipped guide wires X 2
|Percutaneous Introducer Sheath
|3 way stopcock
|60 cc Syringe
|Male Leur Cap
|One way valve
|basin filled with sterile normal
|ECG electrodes and cables
|Pressure monitoring set-up
- Establish ECG (directly or slaved) and prepare the
insertion site for sterile draping. Hyper-extend the hip.
This will permit better accessibility to the common
femoral artery site. This site is located approximately 1.5
to 2 fingers breadths caudal to the inguinal ligament.
- Upon locating of the femoral artery, insert the finder/angio-needle
into the artery at a shallow angle to allow for
- Measure the length of J-wire needed to be inserted to
reach a point distal to the left subclavian artery.
- Remove the stylet of the needle and insert the guide-wire
into the artery.
- Leaving the guide-wire in place remove the angio-needle
from the artery.
- Extend the puncture site on the skin with the scalpel.
- Flush the Percutaneous Introducing Sheath with
heparinized saline. Close all side-port stopcocks. Insert
the dilator into the sheath.
- Match the dilator to the guide-wire and slide it over the
wire and into the insertion site, gently dilating the
artery. A gentle rotation of the dilator will help
minimize vessel trauma.
- Control Bleeding with appropriate pressure, keeping the
guide-wire and sheath in place, remove the dilator.
- Wipe wire with sponge.
- Flush the central lumen of the IAB catheter (IABC) with
heparinized saline or saline. Attach the one-way valve to
the balloon port of the IABC. Attach the 60 cc syringe to
the one-way valve. Evacuate the syringe until resistance
is felt and leave the one-way valve attached remove the
- Remove the IAB from the tray by pulling it in a
horizontal and straight direction. Leaving the IAB
retainers in the tray. DO NOT LIFT the IAB Catheter OUT
of the TRAY!
- Measure the length needed of IABC to reach a point just
distal ( 1-2 cm) to the Left Subclavian Artery.
- Match the tip of the IABC to the guide-wire and slide it
over to the skin line.
- Advance the IABC into the sheath maintaining guide-wire
control and gently turning the catheter into the sheath.
- Once the measured point is reached. Remove the one-way
valve from the balloon port. Attach the connector tubing
to this port and the other end to the IAB Pump pulsatile
chamber or safety chamber.
- Remove guide-wire from central lumen and keep sterile.
Attach a fluid filled catheter transducer to the central
lumen port for pressure monitoring.
- Ensure you have a discernable ECG. Set IABP to 1:2. Fill
the IAB with helium. (using autofill)
- Initiate balloon pumping with proper Timing and
- Evaluate patient for excessive bleeding and peripheral
- Restrain catheter movement by suture.
- Verify position of catheter by Xray .
1. Christenson, J.T., et al, Optimal timing of preoperative
intraaortic balloon pump support in high risk coronary patients,
Annals of Thoracic Surgery 1999; 68:934-939.
2. Christenson, J.T., et al, Preoperative intraaortic balloon
pump therapy in high risk coronary patients - impact on post
operative ionotropic drug use, Today's Therapeutic Trends 17(3);217-225,
3. Christenson, J.T., et al, European Journal of Cardiothoracic
4. Christenson, J.T., et al, Annals of Thoracic Surgery 1997; 64:
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