The right or left common femoral artery often serve as access sites of choice; on rare occasions, the left brachial access can be considered (Figure 15.1A). The balloon is inflated to open the blood vessel and improve blood flow. Pass to the Respiratory Therapist, the tubing and the orange cable and connect to Console. Its "counterpulsation" action causes inflation in diastole, which increases coronary perfusion via retrograde flow, while deflation during systole reduces afterload and increases forward blood flow [2]. The percutaneous method of insertion of an intra-aortic balloon pump (IABP) through the femoral artery was introduced in 19791 and is performed usually in a cardiac catheterization laboratory, where optimal placement can be guided by fluoroscopy.2,3 Indications and contraindications for the procedure are outlined in Tables 15.1 and 15.2, accordingly. A 60-mL syringe is connected to the balloon port, and the plunger of the syringe is slowly and completely withdrawn to create a vacuum within the balloon in order to minimize its bulk at insertion. Intraaortic balloon pump insertion is traditionally performed through the femoral artery in the groin. "Resolution of Shock-Induced Aortic Regurgitation With an Intraaortic Balloon Pump." The balloon size is based on patient’s height: Patients taller than 183 cm receive 50-mL balloons, patients less than 162 cm receive 30-mL balloons, and all other patients receive 40-mL balloons. Key Words: counterpulsation, intra-aortic balloon pump, mechanical support, cardiogenic shock The intra-aortic balloon pump (IABP) is currently the most widely used circulatory assist device for the treatment of cardiogenic shock, a condition which remains associated with high mortality rates1,2. Assistant: Remove balloon portion of the catheter from blue holder by pulling blue plastic cover off. An IABP is attached to a tube called a catheter. Dotted lines indicate the LSCA take-off (top) and the level of the inferior border of the transverse arch (bottom). Introduction: Although there is no cure for heart failure, placement of an intra-aortic balloon pump (IABP) can act as temporary treatment. In general, the procedure has the following steps: You’ll first receive some anesthesia. Assistant: Place One-way-Valve (already on the syringe), onto Balloon Catheter aspirate the syringe removing any trapped air. Intra-aortic balloon pump (IABP) is a cylindrical polyethylene device inserted into the descending thoracic aorta, which increases myocardial oxygen delivery and cardiac output [1]. There should be no resistance to passing the balloon. Steps for removal of the Balloon Catheter from the tray are listed and displayed in picture below. Note that the tip is 1 to 2 cm from the left subclavian artery (LSCA) take-off. When adjusting timing of the balloon inflation and deflation, the operator places the balloon on a 1:2 counterpulsation sequence and observes the arterial waveforms of augmented and unaugmented beats from the catheter’s central lumen. 5 case question available Q: What does the lucency to the left of the spinal column, with a radiopaque marker at its tip represent? As the tip of the needle is in the lumen of the common femoral artery, the 0.030-inch or 0.032-inch, J-tip guidewire is inserted and advanced through the needle into the descending aorta. Prepare IABP. The potential for … Panel E: Abnormal aortic blood pressure tracing with late deflation of the IABP. Assistant: Disconnect the syringe from the One-Way-Valve, leaving One-Way-Valve on the Balloon pump white connector (arrow). Abstract 10175: The Impact of Anticoagulation During Intra-Aortic Balloon Counterpulsation Pump Placement on In-Hospital Outcomes in 18,875 Patients Undergoing Cardiac Revascularization. Intra-Aortic Balloon Pump (IABP) Placement The percutaneous method of insertion of an intra-aortic balloon pump (IABP) through the femoral artery was introduced in 1979 1 and is performed usually in a cardiac catheterization laboratory, where optimal placement can be guided by fluoroscopy. Dotted lines indicate the LSCA take-off (top) and the level of the inferior border of the transverse arch (bottom). Archives of Surgery 126.5 (1991): 621. Approach to Complex Cases in Cardiac Catheterization, Coronary, Renal, and Mesenteric Angiography, Pocket Guide to Diagnostic Cardiac Catheterization, •Large thoracic or thoracoabdominal aneurysm, •Large abdominal aortic aneurysm (relative, can still use left brachial access in patients with focal infrarenal AAA), •Severe bilateral low extremity peripheral vascular disease (relative, can still use left brachial access). Surgeon: Inserts Balloon Catheter, keeping One-Way-Valve connected during insertion. 3.6. Disconnect Syringe. Editor—An intra-aortic balloon pump (IABP) is frequently used to support patients with haemodynamic instability, such as that associated with cardiogenic shock, ischaemic heart disease, postsurgical myocardial dysfunction, or septic shock. The balloon is capable of being inflated or deflated. The tip should lie distal to origin of the left subclavian artery so as not to occlude it. Assistant: Remove Balloon Catheter from tray, leaving Blue Sheath on Balloon, and One-Way-Valve connected, need Picture of IABP with Blue Sheath removed. However, this restricts the patient to bed rest, and prolonged implantation can be associated with infections in the groin crease. FIGURE 15.2Timing of inflation/deflation of the IABP (see text for details). Balloon deflation should be set to occur immediately prior to the aortic valve opening, which usually coincides with the “R” wave on the ECG tracing. The intra-aortic balloon pump (IABP) remains the most commonly utilised haemodynamic support system for patients with severe coronary artery disease, acute heart failure and cardiogenic shock. Unilateral Headache Status after Intra-Aortic Balloon Pump Placement GarretM.Weber,1 AlanL.Gass,2 andShalviB.Parikh1 1DepartmentofAnesthesiology,WestchesterMedicalCenter,Valhalla,NY10595,USA ... balloon pump counterpulsation for refractory symptomatic The intraaortic balloon pump (IABP) is frequently used in the management of cardiac failure in the setting of myocardial infarction or as a bridge for coronary revascularisation surgery. While the balloon is in position, the patient remains on strict bed rest with no hip flexion beyond 20 degrees. Typical balloon lengths are 22 to 26 cm, according to manufacturers' data. When all these steps are completed, counterpulsation is initiated. 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