Cardiology in Critical Care

Intraaortic Balloon Pump

IABP

 

Intra-Aortic Balloon Catheter Insertion

Components:

18 gauge angio needle set
J-tipped guide wires X 2
Dilator
Percutaneous Introducer Sheath 
3 way stopcock
60 cc Syringe
Male Leur Cap
One way valve
Connector Tubing
IAB catheter
basin filled with sterile normal saline
Xylocaine
Scalpel
ECG electrodes and cables
Pressure monitoring set-up
Slave cables

Insertion:

  1. 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.
  2. Upon locating of the femoral artery, insert the finder/angio-needle into the artery at a shallow angle to allow for percutaneous insertion.
  3. Measure the length of J-wire needed to be inserted to reach a point distal to the left subclavian artery.
  4. Remove the stylet of the needle and insert the guide-wire into the artery.
  5. Leaving the guide-wire in place remove the angio-needle from the artery.
  6. Extend the puncture site on the skin with the scalpel.
  7. Flush the Percutaneous Introducing Sheath with heparinized saline. Close all side-port stopcocks. Insert the dilator into the sheath.
  8. 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.
  9. Control Bleeding with appropriate pressure, keeping the guide-wire and sheath in place, remove the dilator.
  10. Wipe wire with sponge.
  11. 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 syringe.
  12. 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!
  13. Measure the length needed of IABC to reach a point just distal ( 1-2 cm) to the Left Subclavian Artery.
  14. Match the tip of the IABC to the guide-wire and slide it over to the skin line.
  15. Advance the IABC into the sheath maintaining guide-wire control and gently turning the catheter into the sheath.
  16. 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.
  17. Remove guide-wire from central lumen and keep sterile. Attach a fluid filled catheter transducer to the central lumen port for pressure monitoring.
  18. Ensure you have a discernable ECG. Set IABP to 1:2. Fill  the IAB with helium. (using autofill)
  19. Initiate balloon pumping with proper Timing and Augmentation.
  20. Evaluate patient for excessive bleeding and peripheral pulses.
  21. Restrain catheter movement by suture.
  22. Verify position of catheter by Xray .
  23. References:

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, 1999.
3. Christenson, J.T., et al, European Journal of Cardiothoracic Surgery;11 (1997):1097-1103.
4. Christenson, J.T., et al, Annals of Thoracic Surgery 1997; 64: 1237-1244.

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