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1. Intra-aortic Balloon Pump
(IABP)

2. content
Introduction.
Indications & Contraindications.
Basic mechanism.
Complications: 1- During insertion.
2- During use.
3- During or following
removal.
Nursing Interventions.

3. Introduction:-
The Intra-Aortic Balloon Pump (IABP) is a
mechanical device that increases blood
flow to the heart muscle and decreases
the heart’s workload through a process
called counter-pulsation.
The IABP is placed in the aorta, which is
the main artery that carries oxygen-rich
blood to the rest of the body.

4. The IABP consists of a balloon
attached to the end of a
catheter which is inserted into
the femoral artery in the groin.
This can be done under a
local anesthetic in the
Intensive Care Unit or Cardiac
Catheterization Lab or during
the heart surgery.
The IABP catheter is inserted
into the iliac artery in the
operating room. The initial
incision is made in the
extreme lower left or right
quadrant of the abdomen.

5. The balloon sits in the aorta
and opens and closes in
response to the hearts
contractions. After the heart
contracts and propels oxygen-
rich blood into the aorta, the
balloon rapidly opens up and
propels some of the oxygen-
rich blood back toward the
coronary arteries. Just before
the hearts next contraction, the
balloon rapidly deflates
creating a lower pressure in
the aorta so the heart does not
have to work as hard to pump
the blood out.

6. The primary goals of IABP treatment are
to increase myocardial oxygen supply and
decrease myocardial oxygen demand.
Secondary, improvement of cardiac output
(CO), ejection fraction (EF), an increase of
coronary perfusion pressure, systemic
perfusion and a decrease of heart rate,
pulmonary capillary wedge pressure and
systemic vascular resistance occur.

7. Basic mechanism
placed in the thoracic aorta
balloon inflated during
diastole, thus increasing
aortic pressure during
diastole and increasing
coronary blood flow
balloon deflated prior to
and during early left
ventricular ejection thus
reducing aortic pressure
and thus afterload

8. How does the IABP work?
The IABP is a long tube (catheter) with a
collapsed, 8-inch, sausage-shaped
plastic balloon at its tip. The catheter is
inserted in an artery in the groin. Patient
will be given a shot to numb the area
where the tube is inserted, but he will
remain awake. The patient may have
some minor discomfort, but the
procedure is mostly painless. The doctor
directs the tube through the artery and
positions it in the aorta. A pump is
attached to the hub end of the catheter.
The balloon is rapidly inflated and
deflated using the heartbeat as a trigger.

9. Indications
Heart failure.
Myocardial infarction.
Cardiogenic shock
Left ventricular failure.
If the heart cannot pump well enough to circulate the
blood.
To help the heart of severely ill people who are awaiting
a heart transplant.
To improve blood flow to the heart while you await
surgery or angioplasty for severe blockage of the heart
arteries
Acute heart attack during or after cardiac surgery to help
remove the patient from the heart-lung bypass machine

10. Contraindications
Aortic insufficiency
Aortic dissection
Prosthetic graft in thoracic aorta.

11. Complications
During insertion
1- Failure to advance catheter beyond ilio-
femoral system because of atherosclerotic
disease (most common complication).
2- Aortic dissection and arterial perforation.

12. During use
Limb ischemia most common. Sufficiently severe
to require removal of balloon in 11-27%
Sepsis. Relatively unusual but associated with
high mortality. Positive blood cultures require
prompt removal and culture of IAB and treatment
with antibiotics
Small perforation in balloon membrane may
allow small leak of blood into balloon lumen. Dry
helium desiccates the collected blood which
then forms a hard pellet which may prevent
removal of balloon except by surgical aortotomy.

13. During or following removal
haematoma
false aneurysm
AV fistula

14. The most common insertion site for the
IABP catheter is the femoral artery.
However, the IABP catheter has also been
inserted through indwelling supra-inguinal
bypass grafts, the ascending aorta, the
axillary artery, the subclavian artery, and
the common iliac artery.

15. The femoral approach is advantageous because
the catheter can be inserted percutaneously at
the patient's bedside.
Unfortunately, this approach requires the patient
to remain on bed rest with the head of the bed
elevated no more than 30 degrees. If prolonged,
circulatory support is needed, complications
associated with immobility can occur.

16. Complications that occur as a result of
prolonged bed rest, and immobility can be
avoided by inserting the IABP catheter through
the iliac artery, because patients are allowed to
sit, stand, and walk during counter-pulsation.
Thus, iliac placement of the IABP catheter helps
prevent deconditioning and the undesirable
consequences of immobility.
The iliac artery has a larger diameter than does
the femoral artery,

17. Nursing Interventions
The Nurse/Patient ratio for a patient with
an IABP is 1:1.
Nurses must ensure that the stay sutures
are intact. This observation is made at
least once a shift and before and after the
patient exercises

18. Nsg. intervention cont.
In order to prevent infection, the exit site of the
IABP catheter is cleansed with povidone-iodine
(Betadine) and alcohol and covered with a
sterile dressing every other day
During dressing changes, nurses must monitor
the exit site of the catheter for redness,
inflammation, and purulent drainage. Elevations
in patients' body temperature and white blood
cell count also may indicate infection.

19. Nsg. intervention cont.
Evaluate Cardiac Output within 1 hour of
any change in the assist interval, To
assess whether the change is tolerated.
Nurses should also observe patients for
bleeding complications.

20. Nsg. intervention cont.
Assess capillary refill and
pedal pulses q1h.
Assess capillary refill and
left radial pulse at the
start of each shift and
q1h.
Notify the physician of
any change from the
previous hour. Document
on flow sheet and nursing
note.
The balloon catheter or
thrombus can obstruct
flow to the distal
extremities.
If the balloon migrates too
high, it can obstruct flow
to the left subclavian
artery.

21. Nsg. intervention cont.
Maintain HOB 30
degrees.
Avoid hip flexion.
Raising the head of
the bed can shorten
the aorta and permit
migration of the IABP
catheter
Hip flexion can put
strain on the insertion
site and cause
vascular trauma.

22. Nsg. intervention cont.
Provide chest vibration to
promote secretion
clearance q4h - 6h and
prn.
Measure urinary output
q1h.
Immobility and sternal
pain predispose patient to
secretions and
atelectasis.
Decreased urine
production can occur as a
result of low cardiac
output, balloon placement
that is too low, prerenal
failure from a thrombus,
or hypotensive shock

23. conclusion
As the IABP inflates and deflates it allows an
increase in oxygen supply to the myocardium,
decreases workload of the left ventricle and
increases cardiac output and perfusion of the
vital organs. The device is designed to inflate
and deflate with each heart beat. The balloon
will inflate during diastole causing blood to be
forced back toward the extremities as well as
into the coronary arteries and main branches of
the aortic arch. Before systole the balloon will
deflate resulting in decreased pressure within
the aorta. This action result in less work for the
left ventricle, to expel blood during contraction.