IABP 101: Preparation and Insertion

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Bill– showing us the guidewire and dilator coming together…

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Editors Note:

This is a three part series- “IABP 101” designed to simply refresh or introduce the basic concepts of applying diastolic augmentation for the high risk cardiac patient.  Again, some of the concepts here will seem to be fairly rudimentary for a seasoned perfusionist, but if it’s your first day in a perfusion program- then elementary reverts to elemental- as in a prerequisite foundation for any training program delivered to perfusionists. 

This section details preperation and insertion of the IABP- more information is available at the manufacturer’s website:

 Maquet

A shout-out to Bill and Kim– who are in the lead role at this institution (in terms of managing the IABP’s as well as in-servicing the CCL staff).  Nicely done!

Have an excellent day!

Frank

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IABP:  Parts & Pieces

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inser2

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insert5

insert6

insert7

 

Guide Wires INTRODUCER

guidewire for insertion of sheath2pg

guidewire for insertion sheath

Guide Wires IABP

guidewire for insertion of iabp2

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USE ONLY for Sheathless Insertion

vessel dilator only for sheathless

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IABP- Sizing, Placement, and Insertion

 

Sheath or Sheathless?

sheathed 1

 

Sizing The IABP

sizing

 

Preparing the IABP

prep1

Flush inner lumen

Aspirate 30cc to ensure IABP is collapsed- DO NOT remove one-way valve!

 

Remove stylette

Remove stylette from inner lumen:  DO NOT replace stylette

 

sheathed 2

Place stopcock on luer port and flush with 3-5 cc NSS.  DO NOT allow air to enter!

 

Placement

t Handle at 2nd and 3rd intercostal space

Use the Blue T Handle as a marker for proper positioning- usually between the 2nd and 3rd intercostal space…

 

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Positioning2

The balloon should be located in the proximal descending aorta, just below the origin of the left subclavian artery. This ideally results in the balloon terminating just above the splanchnic vessels 3.

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Initiating the IABP

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If you have power issues- check this 1st!

 

intiate 1

intiate 2

Hook up IABP extension tubing to helium outlet

 

intiate 3

Attach Fiberoptic cable: DO NOT touch the end with your fingers!

 

intiate 4

intiate 5

Press START to auto fill, zero, and self time the IABP

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IABP timing itself…

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Slaving

slave 1a

 

Slave 2

Attach Slave cable to back of IABP

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Slave3a

Slave4

 

Zeroing Pressure When Slaving to Ext Monitor

zeroing slave1a

This is the same concept as “opening to air” when zeroing regular transducers

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zeroing slave2a

This must be done within 15 seconds of pressing the VENT button

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