How could you save life through Intra-aortic balloon pump ( cardiac balloon pump ) Insertion techniques ,triggering ,timing and weaning ?

INSERTION TECHNIQUES

In the early years of IABP - therapy, insertion of the balloon through an incision was made to the femoral. After longitudinal incision in the groin, the femoral arteries were identified and controlled. A vascular graft was then sewn to the femoral artery in one way end-to-side. The balloon was inserted into the artery through the graft and well placed in the thoracic aorta and the graft securely connected to the distal balloon catheter. Finally, the skin incision was closed. 


Remove the ball needs a second operation.

Since 1979, offers a percutaneous placement of ITC through the femoral artery using a modified Seldinger a quick and easy introduction to most situations. After puncturing the femoral artery guide wire in the shape of J is inserted at the aortic arch, then the needle is withdrawn. The arterial puncture side is enlarged by successive placement of a dilator combination 8 to 10.5 Fr / sheath. Only the removal dilator.

Continuing, the balloon is threaded over the guidewire into the descending aorta just below the left subclavian artery. The jacket is slightly pulled back in the thick cuff over the balloon hub, ideally so that the vagina is absent of all light pressure to reduce the risk of ischemic complications of the distal end. Recently, insertion sheathless kits are available. Removal of a percutaneous IAB may be either by surgery or closed technique. There are alternative routes for balloon insertion. In patients with extremely severe peripheral vascular disease or in pediatric patients the ascending aorta or aortic arch may be responsible for inserting the balloon. Other forms of access are subclavian, axillary or iliac artery.

CONTROL OF INTRA-AORTIC BALLOON PUMP .

TRIGGERING .

The optimal effect of counterpulsation, inflation and deflation is timely for the patient's heart. This is done through the use of the ECG signal of the patient, the artery of a patient or extension pump wave. The most common way to start the IAB has come from the R wave of the ECG signal of the patient. Mainly balloon inflation is set to start automatically at the center of the T wave, and remains before the end of the QRS complex. Tachyarrhythmias, pacemaker function and poor ECG signals may cause difficulties in obtaining synchronization when the ECG mode is used. In this case, the waveform of arterial intervention threshold may be used.

TIMING AND WEANING .

It is important that the IAB inflation is happening at the beginning of diastole, marked dicrotic notch in arterial waveform. Deflation, the balloon must take place immediately before the climb blood. Balloon synchronization usually starts in relation to maybe 1:02. This relationship allows for a comparison of the patient's own ventricular beats, and win the set was completed by an ideal time IABP. Errors in timing of IABP may lead to different characteristics of the waveform and a number of different physiological effects.