DEVELOPING AN IABP TEACHING STRATEGY - …files.sulli.us/IABP/Train_the_Trainer_Manual.pdfDeveloping...

DATASCOPE IS NOW MAQUET CARDIOVASCULAR

CLINICAL SUPPORT SERVICESDEVELOPING AN IABPTEACHING STRATEGY

Caution: U.S. Federal Law restricts this device to sale by or on the order of a physician.

Refer to package insert for current indications, warnings, contraindications, precautions and instructions for use.

Datascope is now MAQUET Cardiovascular

In early 2009, the purchase agreement between Datascope and Getinge AB was completed. As a result, Datascope’s innovative cardiovascular product portfolio will be integrated into MAQUET Cardiovascular, a global leader representing the Medical Systems Business area of Getinge AB.

Cardiac professionals have always relied on gold-standard Cardiac Assist products from Datascope, helping them to feel confident that they are delivering the highest quality of care to their patients. Now, as a part of MAQUET Cardiovascular, Datascope is even better positioned to focus on the future advancement of Cardiac Assist products and seeks to explore the full potential of this technology through our continued dedication to innovation, service and clinical excellence.

Quality Products:

Expect the same great quality products you have relied on over the years with names you are familiar with like: Fidelity, Linear and Sensation IAB’s, CS300 balloon pumps, SafeGuard and StatLock.

Quality Service:

Rest assured that you will receive the same amazing service and clinical support you have become accustomed to from Datascope. We are still here for you 24/7 with technical support, loaner equipment and clinical help.

Worldwide:

MAQUET ranks among the leading providers of medical products, therapies and services for Surgical Workplaces, Critical Care and Cardiovascular applications. Since its foundation more than 170 years ago, MAQUET has stood for innovation and the advancement of patient care technologies in the field of medicine. The portfolio of MAQUET products is extensive, providing a comprehensive solution that is designed for efficient workflows, safety and the improvement of patient lives and outcomes.

Welcome to MAQUET Cardiovascular:

With a fresh vision of the future, this new, combined organization is committed to providing the highest quality patient care solutions for cardiologists, interventional radiologists, cardiothoracic and vascular surgeons, critical care clinicians and their teams.

For further information please visit www.datascope.com

1

Developing an IABP Teaching Strategy

Course DescriptionCourse DescriptionCourse DescriptionCourse Description

The program will provide lectures on the importance of in-house resources and specifies the important points to

incorporate into programs to ensure effectiveness. Methods for teaching the technical components of the equipment will

be demonstrated with time provided for hands-on. Support materials available from Datascope, such as presentations,

teaching manuals, etc. will be reviewed. Methods of maintaining clinical proficiency will also be discussed.

Behavioral Behavioral Behavioral Behavioral ObjectivesObjectivesObjectivesObjectives

1. Describe the importance of strategic pre-planning for an intra-aortic balloon pump course.

2. List the three modules that comprise a complete intra-aortic balloon pump course.

3. List two components of a technical presentation of the intra-aortic balloon pump.

4. Describe two strategies for maintaining expertise.

2

Program Outline: Train the Trainer

8:30 – 9:00 Registration

9:00 – 9:15 Introduction/Program Review

9:15 – 10:30 I.I.I.I. Developing an IABP CourseDeveloping an IABP CourseDeveloping an IABP CourseDeveloping an IABP Course

A.A.A.A. PrePrePrePre----Program PlanningProgram PlanningProgram PlanningProgram Planning

II.II.II.II. IABP Program Content: Three ModulesIABP Program Content: Three ModulesIABP Program Content: Three ModulesIABP Program Content: Three Modules

A.A.A.A. TheoreticalTheoreticalTheoreticalTheoretical

10:30 – 10:45 Break

10:45 – 12:30 B.B.B.B. TechnicalTechnicalTechnicalTechnical

12:30 – 1:30 Lunch

1:30 – 2:30 C.C.C.C. Clinical ConsiderationsClinical ConsiderationsClinical ConsiderationsClinical Considerations

2:30 – 3:30 III.III.III.III. HandsHandsHandsHands----on Workshopon Workshopon Workshopon Workshop

3:30 – 3:45 Break

3:45 – 4:15 IV.IV.IV.IV. Review of Support MaterialsReview of Support MaterialsReview of Support MaterialsReview of Support Materials

4:15 – 4:30 V.V.V.V. Maintaining ExpertiseMaintaining ExpertiseMaintaining ExpertiseMaintaining Expertise

4:30 Evaluation

3

I. Developing an IABP Course

AAAA.... PrPrPrPreeee----program Planningprogram Planningprogram Planningprogram Planning

1. Participants

a. Background

b. Attitude awareness

2. Institution

a. Role of the staff with the IABP

b Policy/procedure

c. Usage

4

II. Program Content

A.A.A.A. TheoreticalTheoreticalTheoreticalTheoretical

1. Review CV anatomy/physiology

a. Structure/position

b. Movement of valves in response to pressure gradients

c. Conduction system

d. Mechanical cardiac cycle

5

e. Pressure Waves

f. Normal Arterial Waveform

6

1. Coronary artery anatomy 2. Diastolic pressure 3. Diastolic time 4. 02 Extraction

a. Hgb b. Pa02

Supply Demand

MVO2

1. Heart Rate 2. Afterload 3. Preload 4. Contractility

g. Coronary artery origination and phasic perfusion

h. MVO2 supply/demand determinants

7

i. Measurement of Cardiac Performance

Cardiac Output = heart rate x stroke volume

(normal – 4-6 liters/minute)

j. LV Failure

8

2. Theory of Intra-aortic Balloon Counterpulsation

a. Balloon structure and position

b. IAB Inflation – Primary Effects

1). Augmentation of diastolic pressure

2). Increased coronary perfusion

c. IAB Deflation – Primary Effects

1). Afterload reduction

2). Decreased left ventricular workload

3). Increased cardiac output

3. Trigger vs. Timing

a. Trigger

b. Timing

c. Predictive (Conventional) vs. R-wave deflation timing

9

d. Waveform Interpretation

1). Presence of “V”configuration between systolic and diastolic augmentation pressure

2). Diastolic augmentation ideally greater than systole

3). Reduction in aortic end diastolic pressure

4). Decreased assisted systolic pressure

5). Mean arterial pressure

e. Secondary effects

1). CO/CI

2). HR

3). PAD/PCWP

4). SVR

5). B/P:

Systolic

Diastolic

MAP

Diastolic augmentation

f. Systemic effects

1) Neuro

2) Renal

3) Vascular

4) Respiratory

10

g. Indications

1) Refractory Unstable Angina

2) Impending Infarction

3) Acute MI

4) Refractory Ventricular Failure

5) Complications of Acute MI

6) Cardiogenic Shock

7) Support for diagnostic, percutaneous revascularization, and interventional procedures

8) Ischemia related intractable ventricular arrhythmias

9) Septic Shock

10) Intraoperative pulsatile flow generation

11) Weaning from bypass

12) Cardiac support for non-cardiac surgery

13) Prophylactic support in preparation for cardiac surgery

14) Post surgical myocardial dysfunction/low cardiac output syndrome

15) Myocardial contusion

16) Mechanical bridge to other assist devices

17) Cardiac support following correction of anatomical defects

h. Contraindications

1) Severe aortic insufficiency

2) Abdominal or aortic aneurysm

3) Severe calcific aorta-iliac disease or peripheral vascular disease

4) Sheathless insertion with severe obesity, scarring of the groin, or other contraindications to

percutaneous insertion

Please Refer to the Instructions for Use Prior to Insertion of the IAB

11

BBBB.... Technical: Technical: Technical: Technical: Intra-Aortic Balloon Catheter

Designed for sheathless or sheathed insertion

Fiberoptic IAB catheter

Conventional IAB Catheter

12

BBBB.... TTTTechnicalechnicalechnicalechnical: Intra: Intra: Intra: Intra----Aortic Balloon PumpAortic Balloon PumpAortic Balloon PumpAortic Balloon Pump

1. Pneumatics

a. Safety Disk/Safety Chamber (Pediatrics)

b. Helium Supply

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2. Electronics

a. Monitor Display

Alarm Messages

Advisories

ECG

Lead

Gain

Pressure Source

IAB Fill Mode

Slow Gas Alarm Status

Operation Mode

IAB Status Indicator

Trigger

Heart Rate Display

Pressure Display

Systolic

Diastolic

Mean

Diastolic Augmentation

Augmentation Alarm

Helium Indicator

Battery Indicator

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b. CS100/CS300 IABP Key Pad Controls

Operation Mode Keys

AUTO

Semi-Auto

Manual

Zero Pressure Key START Key and Indicator

STANDBY Key and Indicator

Trigger Source Key

ECG

Pressure

Pacer V/AV

Pacer A

Internal

IAB Frequency

IAB Augmentation

IAB Inflation Controls

IAB Deflation Controls

Alarm Mute Key

IAB Fill Key

Help Key Indicator

Menu Guide

Ref Line

Aug. Alarm

ECG/AP Sources

Pump Options

User Preferences

Inflation Interval Key

Freeze Display Key

Print Strip Key

15

c. Recorder

1) ECG

2) Pressure

3) Balloon Pressure Waveform

16

The inflation marker shows the period of inflation. Vertical timing marks located below the arterial

waveform are also available to aid with initial timing. The timing markers indicate the point at which

the inflate and deflate commands are sent.

A unique automatic timing algorithm allows effective balloon pumping even during atrial fibrillation.

Press the Inflation Interval key to observe the period of inflation while pumping. Vertical markers

located below the arterial waveform and the highlighted portion indicate the period of balloon inflation.

17

3. Troubleshooting/CS100

a. Alarm Messages

1) Trigger Alarms

AUTO Operation ModeAUTO Operation ModeAUTO Operation ModeAUTO Operation Mode

a) No Trigger

b) Poor Signal Persists

SemiSemiSemiSemi----Auto or Manual Operation ModesAuto or Manual Operation ModesAuto or Manual Operation ModesAuto or Manual Operation Modes

a) No Trigger

b) No Pressure Trigger

c) Check Pacer Timing

d) Trigger Interference

2) Catheter Alarms

a) Leak in IAB Circuit

b) Rapid Gas Loss

c) IAB Disconnected

d) Check IAB Catheter

e) Blood Detected

f) AutoFill Failure - No Helium

g) AutoFill Failure

h) AutoFill Required

3) Pneumatic Alarms

a) High Drive Pressure

b) Low Vacuum

4) System Surveillance Alarms

a) Electrical Test Fails Code # ________________

b) System Failure

c) Safety Disk Test Fails

b. Advisory Messages

1) Alert Messages

AUTO Operation ModeAUTO Operation ModeAUTO Operation ModeAUTO Operation Mode

a) Poor Signal Quality

b) No Pressure Source Available

c) Unable to Update Timing

SemiSemiSemiSemi----Auto or Manual Operation ModesAuto or Manual Operation ModesAuto or Manual Operation ModesAuto or Manual Operation Modes

a) Irregular Pressure Trigger

b) Verify Proper Timing

c) ECG Detected

d) IAB not Filled

e) Manual Fill IAB

All Operation ModesAll Operation ModesAll Operation ModesAll Operation Modes

a) Prolonged time in Standby

b) Maintenance Required Code # _________________

c) No Patient Status Available

d) Low Helium

e) Low Battery

f) Low Battery [EXT]

g) Heart Rate Low

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2) Status Messages

AUTO OpAUTO OpAUTO OpAUTO Operation Modeeration Modeeration Modeeration Mode

a) Function Unavailable in the AUTO Operation Mode

SemiSemiSemiSemi----Auto and Manual Operation ModesAuto and Manual Operation ModesAuto and Manual Operation ModesAuto and Manual Operation Modes

a) Automatic Operation Mode is Disabled

b) Gas Loss and Catheter Alarms Disabled

c) Auto R-Wave Deflate

d) R-Wave Deflate

All Operation ModesAll Operation ModesAll Operation ModesAll Operation Modes

a) System Trainer

b) System Test OK

c) Autofilling

d) Leak Testing Safety Disk

e) Slow Gas Alarm is off

f) Battery in Use

g) Battery in Use [EXT]

3) Prompt Messages

a) Unplug Disk Outlet

b) Plug Disk Outlet

c) Manual Fill IAB

c. Patient Conditions

1) Atrial Fibrillation

2) Ectopics

3) Cardiac Arrest

4) Cardioversion/Defibrillation

d. Changing Helium Tank

e. Safety Disk Leak Test

f. Manual Fill

g. Manual Timing

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4. Troubleshooting/CS300

a. High Priority Alarms:

All Modes:All Modes:All Modes:All Modes:

Augmentation Below Limit Set*

No Trigger

IAB Disconnected

Check IAB Catheter

Leak in IAB Circuit

Rapid Gas Loss

Blood Detected

Autofill Failure

Autofill Failure – No Helium

High Pressure Drive

Low Vacuum

AUTO Operation Mode:AUTO Operation Mode:AUTO Operation Mode:AUTO Operation Mode:

Poor Signals Persist

Semi Auto or Manual Mode:Semi Auto or Manual Mode:Semi Auto or Manual Mode:Semi Auto or Manual Mode:

ECG Detected*

No Pressure Trigger

Trigger Interference

Check Pacer Timing

Autofill Required

Other:Other:Other:Other:

Safety Disk Test Fails

* Pumping NOT suspended

b. Medium Priority Alarms:


IAB Optical Sensor Failure

Low Battery


Poor Signal Quality

No Pressure Source Available

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c. Low Priority Alarm:


Unable to Update Timing

d. Technical Alarms:

Electrical Test Fails Code #_____

System Failure

No Patient Status Available

e. Informational Messages:


A.P. Optical Sensing Module Failure

Unable to Calibrate IAB Optical Sensor

IAB Optical Sensor Calibration Expired

No Trigger

Prolonged Time In Standby

Autofilling

Auto Zeroing

Autofilling and Zeroing

Function Not Available

Low Helium

Battery in Use (EXT)

Battery In Use

System Test OK

System Trainer

Maintenance Required Code #_____

Slow Gas Loss Alarm is OFF

Leak In IAB Circuit – Overridden

Blood Detected – Overridden


Function Unavailable in Auto Operation Mode

AUTO or SemiAutAUTO or SemiAutAUTO or SemiAutAUTO or SemiAuto Operation Mode:o Operation Mode:o Operation Mode:o Operation Mode:

Auto R-Wave Deflate

R-Wave Deflate

SemiAuto:SemiAuto:SemiAuto:SemiAuto:

Irregular Pressure Trigger

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SemiAuto or Manual:SemiAuto or Manual:SemiAuto or Manual:SemiAuto or Manual:

Verify Proper Timing

IAB Not Filled

Manual Fill IAB

Auto Operation Mode is Disabled

Gas Loss and Catheter Alarms Disabled

Manual Mode:Manual Mode:Manual Mode:Manual Mode:

Manual Timing Selected – See Help

Other:Other:Other:Other:

Install Safety Disk

Unplug Disk Outlet

Plug Disk Outlet

Leak Testing Safety Disk

f. Patient Conditions

1) Atrial Fibrillation

2) Ectopics

3) Cardiac Arrest

4) Cardioversion/Defibrillation

g. Changing Helium Tank

h. Safety Disk Leak Test

i. Manual Fill

j. Manual Timing

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5. Factors Affecting Diastolic Augmentation

a. Patient Hemodynamics

1) Heart Rate

2) Stroke Volume

3) Arterial Pressure

4) System Vascular Resistance

b. Intra-Aortic Balloon

1) IAB in Sheath

2) IAB Not Unfolded

3) IAB Position

4) Kink in IAB Catheter

5) IAB Leak

6) Low Helium Concentration

c. IABP

1) Timing

2) Position of IAB Augmentation Control

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6. Timing errors

Early InflationEarly InflationEarly InflationEarly Inflation

Inflation of the IAB prior to aortic

valve closure

Waveform CharacteristicsWaveform CharacteristicsWaveform CharacteristicsWaveform Characteristics

• Inflation of IAB prior to dicrotic notch

• Diastolic augmentation encroaches onto

systole (may be unable to distinguish)

Physiologic Effects:Physiologic Effects:Physiologic Effects:Physiologic Effects:

• Potential premature closure of aortic valve

• Potential increase in LVEDV and LVEDP or PCWP

• Increased left ventricular wall stress or afterload

• Aortic Regurgitation

• Increased MVO2 demand

Late InflationLate InflationLate InflationLate Inflation

Inflation of the IAB markedly after closure

of the aortic valve

Waveform CharacteristiWaveform CharacteristiWaveform CharacteristiWaveform Characteristics:cs:cs:cs:

• Inflation of the IAB after the dicrotic notch

• Absence of sharp V

• Sub-optimal diastolic augmentation


• Sub-optimal coronary artery perfusion

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Early DeflationEarly DeflationEarly DeflationEarly Deflation

Premature deflation of the IAB during the diastolic phase

Waveform CharaWaveform CharaWaveform CharaWaveform Characteristicscteristicscteristicscteristics

• Deflation of IAB is seen as a sharp drop

following diastolic augmentation

• Sub-optimal diastolic augmentation

• Assisted aortic end diastolic pressure may be equal

to or less than the unassisted aortic end diastolic pressure

• Assisted systolic pressure may rise


• Sub-optimal coronary perfusion

• Potential for retrograde coronary and carotid blood flow

• Angina may occur as a result of retrograde coronary blood flow

• Sub-optimal afterload reduction

• Increased MVO2 demand

Late DeflatLate DeflatLate DeflatLate Deflationionionion

Waveform Characteristics:Waveform Characteristics:Waveform Characteristics:Waveform Characteristics:

• Assisted aortic end-diastolic pressure may be equal to

the unassisted aortic end diastolic pressure

• Rate of rise of assisted systole is prolonged

• Diastolic augmentation may appear widened


• Afterload reduction is essentially absent

• Increased MVO2 consumption due to the left ventricle

ejecting against a greater resistance and a

prolonged isovolumetric contraction phase

• IAB may impede left ventricular ejection and

increase the afterload

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7. Normal Balloon Pressure Waveform

26

Variations in Balloon Pressure WaveformsVariations in Balloon Pressure WaveformsVariations in Balloon Pressure WaveformsVariations in Balloon Pressure Waveforms

Heart RateHeart RateHeart RateHeart Rate

BradycardiaBradycardiaBradycardiaBradycardia

Increased duration of plateau

due to longer diastolic phase.

TachycardiaTachycardiaTachycardiaTachycardia

Decreased duration of

plateau due to shortened

diastolic phase.

RhythmRhythmRhythmRhythm

Varying R-R intervals result in irregular plateau durations.

Blood PressureBlood PressureBlood PressureBlood Pressure

HypertensionHypertensionHypertensionHypertension

Increased height or

amplitude of the waveform.

Hypotension Hypotension Hypotension Hypotension

Decreased height or

amplitude of the waveform.

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Gas LossGas LossGas LossGas Loss

Leak in the closed system causing the balloon pressure

waveform to fall below zero baseline. This may be due to a

loose connection, a leak in the IAB catheter, H2O

condensation in the external tubing, or a patient who is

tachycardic and febrile which causes increased gas diffusion

through the IAB membrane.

Catheter KinkCatheter KinkCatheter KinkCatheter Kink

Rounded balloon pressure waveform, loss of plateau resulting

from a kink or obstruction of shuttle gas. This may be caused

by a kink in the catheter tubing, improper IAB catheter

position, sheath not being pulled back to allow inflation of the

IAB, the IAB is too large for the aorta, the IAB is not fully

unwrapped, or H2O condensation in the external tubing.

Sustained InflationSustained InflationSustained InflationSustained Inflation

Theoretical possibility if the IAB remains inflated longer than

2 seconds. The Datascope intra-aortic balloon pumps will

activate the System Failure alarm and deflate the IAB.

28

DATASCOPE IABP PERFORMANCE CHECKLIST – CS 100 Name: Date ____________________

Hospital policy and procedures review: Date __________ Initials ______

Basic Intra - aortic balloon pump course: Date __________ Initials ______

Technical Seminar / Advanced Troubleshooting: Date(s) ________/________ Initials ________

Challenge Exam (if applicable): Date __________ Score: __________ ( P / F )

Directions for Instructor: Place your initials next to the skills the participant is able to perform. Leave blank the skills

requiring repeat performance. Clarify learning needs if necessary in the comment section. The “Clinical Setting” column

is an optional checklist for use by a preceptor or resource person for reinforcement of skills acquired on system trainer.

Skills System Trainer Clinical Setting

INITIAL SET UP

• Establish Power: Main power switch & IABP On/Off switch ⇒ ON

• Open helium tank and verify helium pressure

• Establish ECG and Pressure connections

ZERO TRANSDUCER

• Open the transducer

• Press the zero pressure key for 2 seconds

• Close the transducer

CONFIRM OPERATION MODE – AUTO

INITIATE PUMPING

• Attach IAB catheter & appropriate extender to safety disk

• Press the Start key and observe the Auto Filling message

• Verify optimal diastolic augmentation

• If desired, IAB deflation can be fine tuned using the IAB deflation

control.

VERIFY AUG. ALARM

• Verify Aug. Alarm setting is approximately 10mmHg less than the

patient’s augmented diastolic pressure

• Adjust, if necessary by pressing Aug. Alarm key and using the up

and down arrow keys, in the navigation circle, to change value

displayed on the screen

ASSESS HEMODYNAMIC BENEFITS

• Ensure optimal augmentation

• Ensure optimal afterload reduction

RECORD PRESSURES: ASSISTED & UNASSISTED

• Press Print Strip key to record waveforms

• Use Printer Menu in User Preferences to change printer settings

29

DATASCOPE IABP PERFORMANCE CHECKLIST – CS 100


AUTO OPERATION MODE

• Describe ECG and pressure source selection

• Describe Trigger source selection

• Describe automatic timing and CardioSync 2 with R-Trac

SEMI-AUTO OPERATION MODE




TROUBLESHOOTING System Trainer Clinical Setting

DEMONSTRATES ABILITY TO IDENTIFY VARIABLE TRIGGER SELECTION CRITERIA AND APPROPRIATE USE OF EACH TRIGGER

• Atrial Fibrillation

• Demand Ventricular Pacemaker, Rate 60

• AV sequential pacemaker, demand mode

• Unobtainable ECG signal, regular rhythm, BP 100/50

• Cardiac arrest with good chest compressions

• Sinus Tachycardia

• Sinus Rhythm with frequent PVC'S

• Fixed rate AV sequential pacemaker

• Atrial pacemaker - 100% paced

EVALUATES SITUATIONS THAT MAY CAUSE AN IAB CATHETER ALARM AND DESCRIBES APPROPRIATE INTERVENTION

• Kink in the catheter or tubing

• Patient sitting straight up in bed

• IAB has not exited the sheath

IDENTIFIES AND RECOMMENDS APPROPRIATE ACTION FOR POTENTIAL LOSS OF HELIUM (“GAS LOSS”)

• Blood in the IAB catheter shuttle gas tubing

• IAB catheter disconnected from the console

DISCUSSES THE FOLLOWING ALARM AND ADVISORY MESSAGES

• Poor Signal Quality

• Poor Signal Persists

• No Pressure Source Available

• Unable to Update Timing

30

DATASCOPE IABP PERFORMANCE CHECKLIST – CS 100


DISCUSSES THE HEMODYNAMIC RELATIONSHIP BETWEEN THE PATIENT AND IABP THERAPY IN REGARDS TO DIASTOLIC AUGMENTATION

• Increased heart rate

• Decrease in patient stroke volume

• Ectopy

• Increase in patient BP

• Decreased SVR

DEMONSTRATES APPROPRIATE INTERVENTION FOR THE FOLLOWING ERRORS IN TIMING AND VERBALIZES POTENTIAL CLINICAL IMPLICATIONS

• Early inflation

• Late inflation

• Early deflation

• Late deflation

PORTABLE OPERATION

• Initiates and terminates portable operation

• Identifies location of battery charge light

INTERFACE (SLAVE) CABLES ( IF APPLICABLE):

• Identifies location and use of ECG and/or pressure cables

• Describes proper use of ECG slave cable in the presence of

pacemakers

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DATASCOPE IABP PERFORMANCE CHECKLIST – CS300

Name: ________________________________________ Date ____________________

Hospital policy and procedures review: Date __________ Initials ______

Basic Intra - aortic balloon pump course: Date __________ Initials ______

Technical Seminar / Advanced Troubleshooting: Date(s) ________/________ Initials ________

Challenge Exam (if applicable): Date __________ Score: __________ ( P / F )

Directions for Instructor: Place your initials next to the skills the participant is able to perform. Leave blank the skills requiring repeat performance. Clarify learning needs if necessary in the comment section. The “Clinical Setting” column is an optional checklist for use by a preceptor or resource person for reinforcement of skills acquired on system trainer.


INITIAL SET UP

• Establish Power: Main power switch & IABP On/Off switch ⇒ ON

• Open helium tank and verify helium pressure

• Establish ECG and Pressure connections

If using a sensor IAB:

• Ensure the IAB Sensor Cable is connected to the sensor module and clipped to helium extender tubing

If using conventional IAB/Transducer:

• Open transducer to air

• Press zero pressure key for 2 seconds

• Close transducer

CONFIRM OPERATION MODE – AUTO

INITIATE PUMPING

• Attach IAB catheter & appropriate extender to safety disk

• Press the Start key

If using a sensor IAB:

• Observe for the “Autofilling & Zeroing” message

If using conventional IAB/ transducer:

• Observe for the “Autofilling” message

• Verify optimal diastolic augmentation

VERIFY AUG. ALARM

• Verify Aug. Alarm setting is approximately 10mmHg less than the patient’s augmented diastolic pressure

• Adjust, if necessary by pressing Aug. Alarm key and using the up and down arrow keys, in the navigation circle, to change value displayed on the screen

ASSESS HEMODYNAMIC BENEFITS

• Ensure optimal augmentation

• Ensure optimal afterload reduction

• If desired, IAB deflation can be fine tuned using the IAB deflation control.

RECORD PRESSURES: ASSISTED & UNASSISTED

• Press Print Strip key to record waveforms

• Use Printer Menu in User Preferences to change printer settings

32



AUTO OPERATION MODE




SEMI-AUTO OPERATION MODE




PRESSURE SOURCE - Describes understanding of how pressure source is originated and calibrated

• Fiberoptics

• Conventional IAB/Transducer

TROUBLESHOOTING System Trainer Clinical Setting

DEMONSTRATES ABILITY TO IDENTIFY VARIABLE TRIGGER SELECTION CRITERIA AND APPROPRIATE USE OF EACH TRIGGER • Atrial Fibrillation

• Demand Ventricular Pacemaker, Rate 60

• AV sequential pacemaker, demand mode

• Unobtainable ECG signal, regular rhythm, BP 100/50

• Cardiac arrest with good chest compressions

• Sinus Tachycardia

• Sinus Rhythm with frequent PVC'S

• Fixed rate AV sequential pacemaker

• Atrial pacemaker - 100% paced

EVALUATES SITUATIONS THAT MAY CAUSE AN IAB CATHETER ALARM AND DESCRIBES APPROPRIATE INTERVENTION • Kink in the catheter or tubing

• Patient sitting straight up in bed

• IAB has not exited the sheath

IDENTIFIES AND RECOMMENDS APPROPRIATE ACTION FOR POTENTIAL LOSS OF HELIUM (“GAS LOSS”) • Blood in the IAB catheter shuttle gas tubing

• IAB catheter disconnected from the console

DISCUSSES THE FOLLOWING ALARM AND INFORMATIONAL MESSAGES • Poor Signal Quality

• Poor Signals Persist

• No Pressure Source Available • Unable to Update Timing

• IAB Optical Sensor Failure

• AP Optical Sensing Module Failure

• Unable to Calibrate IAB Optical Sensor

• IAB Optical Sensor Calibration Expired

33


SKILLS System Trainer Clinical Setting

DISCUSSES THE HEMODYNAMIC RELATIONSHIP BETWEEN THE PATIENT AND IABP THERAPY IN REGARDS TO DIASTOLIC AUGMENTATION

• Increased heart rate

• Decrease in patient stroke volume

• Ectopy

• Increase in patient BP

• Decreased SVR

DEMONSTRATES APPROPRIATE INTERVENTION FOR THE FOLLOWING ERRORS IN TIMING AND VERBALIZES POTENTIAL CLINICAL IMPLICATIONS

• Early inflation

• Late inflation

• Early deflation

• Late deflation

PORTABLE OPERATION

• Initiates and terminates portable operation

• Identifies location of battery charge light

INTERFACE (SLAVE) CABLES (IF APPLICABLE):

• Identifies location and use of ECG and/or pressure slave cables

• Describes proper use of ECG slave cable in the presence of pacemakers

LOW LEVEL OUTPUT CABLE (IF APPLICABLE): • Identifies location and use of low level output cable

34

8. Frequently asked questions

a. What adjustments do I need to make with:

sinus tachycardia

ventricular tachycardia

atrial fibrillation

pacemakers

asystole

b. Can I alter weaning settings if a patient’s condition deteriorates?

c. What happens with a balloon leak?

d. Where are the helium tanks stored and who is responsible for changing them?

e. How can we bring in ECG and pressure signals from our monitor?

f. How does the modem work?

g. How do I change the recorder paper and where is extra paper stored?

h. When can I view the help screens?

i. Other questions?

35

C.C.C.C. Clinical ConsiderationsClinical ConsiderationsClinical ConsiderationsClinical Considerations

Goal: Stress the similaritiessimilaritiessimilaritiessimilarities between the IABP patient and the critical cardiovascular patient while highlighting

the differencesdifferencesdifferencesdifferences.

1. Potential side effects/complications

a. Limb ischemia

b. Excessive bleeding from insertion site

c. Thrombocytopenia

d. Immobility of balloon catheter

e. Balloon leak

f. Infection

g. Aortic dissection

h. Compartment syndrome (may develop after IAB removed)

2. Review of care plan for the IABP patient

3. Care of the inner lumen

4. Weaning and removal

5. Transport

36

III. Hands-On Workshop

SetSetSetSet----up and useup and useup and useup and use of the Datascope Intra of the Datascope Intra of the Datascope Intra of the Datascope Intra----Aortic Balloon Pump TrainerAortic Balloon Pump TrainerAortic Balloon Pump TrainerAortic Balloon Pump Trainer

• Trainer plugs into the direct ECG and Pressure input connectors on back of pump.

• The short phono plug cable connected to the trainer plugs into the Trainer Input jack on back of pump.

• Pump must be turned on in order for trainer to function.

• The SYSTEM TRAINER message will appear in the upper left corner of the monitor screen.

• Not all alarms and trainer simulations are listed.

• Trainer iTrainer iTrainer iTrainer is NOT to be used while pump is being used for patient therapy.s NOT to be used while pump is being used for patient therapy.s NOT to be used while pump is being used for patient therapy.s NOT to be used while pump is being used for patient therapy.

Functions Functions Functions Functions To SimulateTo SimulateTo SimulateTo Simulate

Zeroing - Conventional IAB

Press the “Pressure” key on trainer until “Vent” is highlighted, then press the “Zero”

button on IABP keypad for 2 seconds. Once zeroed, press the “Pressure” key on

trainer until “Normal” is highlighted.

Zeroing - Fiberoptic IAB

If a Sensation catheter is connected to the fiber-optic sensor module, calibration is

automatic on start-up and every 2 hours thereafter. To initiate a calibration anytime

after start-up, WHILE PUMPING simply press the “Zero” button on the IABP keypad

for 2 seconds. The message “Auto Zeroing” will be displayed in the advisory section

of the monitor.

Loss of arterial pressure

waveform

Press the “Pressure” key until “Vent” is highlighted to simulate the loss of the

pressure waveform (doesn’t require user to zero again). Can also press the “BP

Disconnect” key once. Press again and pressure waveform will reappear (user will

have to zero again). In Auto Operation Mode, the message “No Pressure Source

Available” will be displayed.

ECG artifact

While in Auto Operation Mode, press the “Noisy ECG” key. Pump will cycle through all

available leads, then switch to pressure trigger. Press the “Noisy ECG” key again and

artifact will disappear. Pump will switch back to ECG trigger in 2 min. if rhythm is

regular, 1 min. if rhythm is A-fib. While in Semi-Auto Operation Mode, the pump will

NOT automatically make changes. To return to ECG Trigger more quickly, press the

“Pressure” key on the trainer until “Vent” is highlighted and pump will return to ECG

Trigger.

ECG lead disconnect

While in Auto Operation Mode, press the “ECG Lead Fault” key once and a flat line

ECG will appear and pump will switch to Pressure Trigger. Press “ECG Lead Fault” key

again and rhythm will reappear and pump will switch back to ECG Trigger. While in

Semi-Auto Operation Mode and in ECG Trigger, this will cause a “No Trigger” alarm.

Sinus Rhythm Normal Sinus Rhythm with a heart rate of 80 is the default “Mode”.

Heart rate changes When “Sinus Rhythm” mode is selected, press the “Rate” key to simulate various

heart rates: the choices are 60, 80, 100, and 130 when highlighted.

Atrial fibrillation Press the “Mode” key until “Atrial Fib” is highlighted. Press the “Mode” key twice to

return to Sinus Rhythm.

37


100% V paced rhythm Press the “Mode” key until “Pacer Fixed 80bpm” is highlighted.

Various pacer settings

First, press the “Mode” key until “Pacer Fixed 80bpm” is highlighted. Next, press the

“Pacer” key, which will allow you to cycle through the following choices: V paced, A-V

paced, A paced, and A-V demand pacing. To stop simulating any of the paced

rhythms, press the “Mode” key once to return to Sinus Rhythm.

Ventricular arrhythmias

First, make sure you are in Sinus Rhythm (any rate is fine). Next, press the “Ventric.

Rhythms” key, which will allow you to cycle through the following choices: PVC (1 PVC

every 6 to 10 beats), Couplets (1 couplet every 10 to 12 beats), Bigeminy (short run of

bigeminy every 10 to 12 beats), and V-Tach (15 beat run of v-tach every 15 to 20

beats). To stop simulating any of the arrhythmias, press the “Mode” key once.

No augmentation Press the “Pressure” key until “No Aug.” is highlighted. The IABP monitor screen will

display an arterial pressure waveform with no augmentation.

Cardiac arrest

While in Auto Operation Mode, press the “ECG Lead Fault” key, then press the

“Pressure” key until “Vent” is highlighted. The pump will stop pumping and alarm

“No Trigger”. Press the “Pressure” key until “Normal” is highlighted, which will bring

back the arterial pressure waveform (this demonstrates that the CS100/300 will start

pumping automatically when an adequate arterial pressure waveform appears, which

is similar to what would happen if adequate chest compressions are being done in a

code).

Alarm: “Augmentation

Below Limit Set”

Set the Aug. Alarm to a level higher than current augmentation pressure or decrease

the IAB Augmentation control setting.

Alarm:

“IAB Disconnected” Disconnect the catheter extender tubing from the safety disk while pumping.

Alarm:

“Rapid Gas Loss”

While pumping, slowly loosen the extender tubing where it connects to the catheter

(may be difficult to simulate).

Alarm:

“Leak in IAB circuit”

While pumping, slowly loosen the extender tubing where it connects to the catheter.

(may be difficult to simulate).

Alarm:

“Check IAB Catheter” While pumping, kink the extender tubing.

Alarm:

“No Trigger”

While in Auto Operation Mode, the ECG and Pressure signal are lost by pressing the

“ECG Lead Fault” key and “Pressure” key until “Vent” is highlighted.

Alarm:

“No Pressure Source

Available”

While in Auto Operation Mode with an adequate ECG signal, press the “BP

Disconnect” key.

Alarm: CS300

“No Pressure Source

Available”

If a Sensation catheter is connected to the fiber-optic sensor module, remove the

sensor connector from the fiber-optic sensor module while pressing the “BP

Disconnect” key. To resume pressure waveform, reconnect sensor connector to

sensor module and press “BP Disconnect” key once. CS300 will auto-calibrate after 1

min. or WHILE PUMPING simply press the “Zero” button on the IABP keypad for 2

seconds.

38


Alarm:

“Poor Signal Quality”

While in Auto Operation Mode, press the “Pressure” key until “Vent” is highlighted,

then press the “Noisy ECG” key. This will alarm once a minute for 3 minutes while the

CS100/CS300 continues to pump.

Alarm:

“Poor Signals Persist”

While in Auto Operation Mode, after the “Poor Signal Quality” alarm has been

displayed for 3 minutes, the “Poor Signals Persist” alarm will sound and the

CS100/CS300 will stop pumping.

Alarm:

“Unable to Update Timing”

While in Auto Operation Mode while pumping, press the “Semi-Auto” Operation Mode

key on the IABP keypad, then press “ECG Lead Fault” and “No Aug.” on the trainer.

Next, switch to Auto Operation Mode on the IABP keypad, then press the “Start” key.

The alarm will sound in approximately 30 seconds.

Alarm:

“Irregular Pressure Trigger”

While in Semi-Auto Operation Mode in Pressure Trigger, press the “Mode” key until

“Atrial Fib” is highlighted.

Alarm:

“ECG Detected”

While in Semi-Auto Operation Mode, establish an adequate ECG signal while in

Internal Trigger.

Alarm:

“Autofill Failure”

If already pumping, put the pump on standby, disconnect the extender tubing from

the safety disk, then push the “Start” key. The CS100/CS300 will automatically

attempt to perform an autofill and will fail since the catheter is not connected.

Alarm:

“Autofill Failure – No

Helium”

Close the helium tank and then attempt to perform an autofill. This may take 3 or 4

autofills to simulate because there will be residual helium in the line.

Alarm:

“Sensor IAB Failure”

If a non-functional sensor connector is connected to the fiber-optic sensor module

while pumping, completely disconnect the trainer from the back of the pump. The

alarm will go away when the trainer is re-connected.

39

IV. Review of Support Materials

Pre-inservice Self-Study Guide*

Course Outlines*

Theory CD

Website / E-learning modules*

Abbreviated Operator’s Guides*

Timing Pocket Reference Guide*

Case Studies

Performance Checklist

Inservice Videos

IAB catheter insertion

IABP operation

PowerPoint presentations

Journal article reprints

Policies and Procedures*

Transport Protocols*

* Denotes files available on the Datascope website: http://www.datascope.com/ca/ed_resources.html

40

V. Maintaining Expertise

A. Suggested Resources

B. Inservice Videos

C. Theory CD-ROM

D. E-Learning Modules

E. Hands on with performance checklist

F. Case studies

G. Website

H. Written Test

I. Combination of all of the above

41

REFERENCE LIST

Barron HV, Bowlby LJ, Breen T, et al. Use of reperfusion therapy for acute myocardial infarction in the United States

- data from the National Registry of Myocardial Infarction 2. Circulation 1998;97(12):11.

Barron HV, Every NR, Parsons LS, et al. The use of intra-aortic balloon counterpulsation in patients with cardiogenic

shock complicating acute myocardial infarction: Data from the National Registry of Myocardial Infarction 2. American

Heart Journal 2001;141:933–9.

Benchmark Counterpulsation Outcomes Registry 2005.

Christenson JT, Licker M, Kalangos A. The role of intra-aortic counterpulsation in high-risk OPCAB surgery: a

prospective randomized study. Journal of Cardiovascular Surgery 2003 Jul-Aug;18(4):286-94.

Christenson JT, Cohen M, Ferguson JJ III, et al. Trends in intraaortic balloon counterpulsation complications and

outcomes in cardiac surgery. Annals of Thoracic Surgery 2002 Oct;74(4):1086-91.

Christenson JT, Simonet F, Schmuziger M. Economic impact of preoperative intraaortic balloon pump therapy in

high-risk coronary patients. Annals of Thoracic Surgery 2000 Aug;70:510-5.

Christenson JT, Simonet F, Badel P, Schmuziger M. Optimal timing of preoperative intraaortic balloon pump support

in high-risk coronary patients. Annals of Thoracic Surgery 1999 Sep;68(3):934-9.

Christenson JT, Schmuziger M. Preoperative intra-aortic balloon pump therapy in high-risk coronary patients - impact

on postoperative inotropic drug use. Today's Therapeutic Trends 1999;17(3):217-225.

Christenson JT, Simonet F, Badel P, Schmuziger M. Evaluation of preoperative intra-aortic balloon pump support in

high risk coronary patients. European Journal of Cardiothoracic Surgery 1997 Jun;11(6):1097-1103; discussion

1104.

Christenson JT, Simonet F, Schmuziger M. The effect of preoperative intra-aortic balloon pump support in high risk

patients requiring myocardial revascularization. Journal of Cardiovascular Surgery 1997 Aug;38(34):397-402.

Claflin, N, guest editor. AACN Clinical Issues in Critical Care Nursing - Standards and Quality Assurance. Vol. 2,

No. 1 J.B. Lippincott Company Philadelphia February 1991.

Craver JM, Murrah CP. Elective intraaortic balloon counterpulsation for high-risk off-pump coronary artery bypass

operations. Annals of Thoracic Surgery 2001 Apr;71(4):1220-3.

Gould KA. Mechanical assist for the failing heart. Critical Care Nursing Clinics of North America WB Saunders

Company Philadelphia 1989.

Guyton AC. Textbook of Medical Physiology. Seventh Edition; WB Saunders Company Philadelphia 1986.

Hasdai D, Califf RM, Thompson TD, et al. Predictors of cardiogenic shock after thrombolytic therapy for acute

myocardial infarction. Journal of the American College of Cardiology 2000 Jan; 35(1):136-43.

Hasdai D, Holmes DR Jr, Califf RM, et al. Cardiogenic shock complicating acute myocardial infarction: predictors of

death. American Heart Journal 1999 Jul;138(1 Pt 1):21-31.

Hochman JS. Cardiogenic shock complicating acute myocardial infarction. Expanding the paradigm. Circulation

2003;107:2998–3002.

42

Hochman JS, Sleeper LA, Godfrey E, et al. SHould we emergently revascularize Occluded Coronaries for cardiogenic

shocK: an international randomized trial of emergency PTCA/CABG-trial design. American Heart Journal 1999

Feb;127(2):313-21.

Hollenberg SM, Kavinsky CJ, Parrillo JE. Cardiogenic shock. Annals of Internal Medicine 1999 Jul 6;131(1):47-59.

Hudson MP, Granger CB, Stebbins AL, et al. Cardiogenic shock survival and use of intraaortic balloon

counterpulsation: results from the GUSTO I and III trials - Abstract #1942. Circulation 1999 Nov;100 Suppl(18):I370.

Kahn JK. Intra-Aortic Balloon Pumping/Theory and Clinical Applications in the 21st Century. A Monograph for the

Clinician Datascope Corp. December 2004.

Kim KB, Lim C, Ahn H, Yang JK. Intraaortic balloon pump therapy facilitates posterior vessel off-pump coronary

artery bypass grafting in high-risk patients. Annals of Thoracic Surgery 2001 Jun;71(6):1964-8.

Kinney MR, Dear CB, Packa DR, Voorman DN. AACN's Clinical Reference for Critical Care Nursing. Fourth Edition

McGraw Hill Book Company 2001.

Kovack PJ, Rasak MA, Bates ER, et al. Thrombolysis plus aortic counterpulsation: Improved survival in patients who

present to community hospitals with cardiogenic shock. Journal of the American College of Cardiology 1997

Jun;29(7):1454-8.

Millar S, Sampson LK, Soukup M. AACN Procedure Manual for Critical Care. WB Saunders Company Philadelphia

1985.

Mishra S, Chu WW, Torguson R, et al. Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing

percutaneous coronary intervention. American Journal of Cardiology 2006 Sep 1;98(5):608-12. Epub 2006 Jun 30.

Ohman EM. Counterpulsation and thrombolysis together improve survival after cardiogenic shock – the TACTICS

results. Presented at the 22nd

Congress of European Society of Cardiology on August 27, 2000 in Amsterdam, the

Netherlands.

Quaal SJ. Comprehensive Intra-aortic Balloon Pumping. CV Mosby Company St. Louis 2nd Edition 1993.

Quaal SJ, guest editor. AACN Clinical Issues in Critical Care Nursing - Cardiac Assist Devices Vol 2, No. 3, JB

Lippincott Company Philadelphia August 1991.

Ryan EW, Foster E. Images in cardiovascular medicine. Augmentation of coronary blood flow with intra-aortic balloon

pump counter-pulsation. Circulation 2000 Jul 18;102(3):364-5.

Sanborn TA, Sleeper LA, Bates ER, et al. Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and

their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial

Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? Journal of the American

College of Cardiology 2000 Sep;36(3 Suppl A):1123-9.

Stone GW, Ohman EM, Miller MF, et al. Contemporary utilization and outcomes of intra-aortic balloon

counterpulsation in acute myocardial infarction. Journal of the American College of Cardiology 2003

Jun 4;41(11):1940-45. Comment in: Journal of the American College of Cardiology 2003 Jun 4;41(11):1946-7.

Suzuki T, Okabe M, Handa M, et al. Usefulness of preoperative intraaortic balloon pump therapy during off-pump

coronary artery bypass grafting in high-risk patients. Annals of Thoracic Surgery 2004 Jun;77(6):2056-9; discussion

2059-60.

Underhill Sl, Wood SL, Sivarajan ES, Halpenny CJ. Cardiac Nursing. Second Edition. JB Lippincott Philadelphia

1989.

43

Vazquez M, Engman Lazear S, Larson EL. Critical Care Nursing. Second Edition WB Saunders Company Philadelphia

1992.

Vender JS, guest ed. Intensive care monitoring. Critical Care Clinics WB Saunders Company Philadelphia 1989.

Wolvek S. The evolution of the intra-aortic balloon: The Datascope contribution. Journal of Biomaterials Applications

1989 April; 3:527-542

44

BIBLIOGRAPHY

THEORYTHEORYTHEORYTHEORY

Bolooki H. Clinical Application of Intra-aortic Balloon Pump. Third Edition. Futura Publishing Company Inc, 1998.

Cadwell CA, Quaal SJ. Intra-aortic balloon counterpulsation timing, American Journal of Critical Care. July 1996;

5(4):254-261.

Donelli A, Jansen JRC, Hoeksel B, et al. Performance of a real-time dicrotic notch detection and prediction algorithm

in arrhythmic human aortic pressure signals. Journal of Clinical Monitoring and Computing 2002;17:181–5.

Joseph D, Bates S. Intra-aortic balloon pumping - How to stay on course. American Journal of Nursing 1990 Sep;

90(9):42-47.

Maccioli GA, Ed. Intra-aortic balloon pump therapy. Baltimore Williams & Wilkins 1997.

Maccioli GA, Lucas WJ, Norfleet EA. The intra-aortic balloon pump: A review. Journal of Cardiothoracic Anesthesia

1988;2:365-373.

Mahaffey KW, Kruse KR, Ohman EM. Perspectives on the use of intra-aortic balloon counterpulsation in the 1990s.

In: Topol EJ, ed. Textbook of Interventional Cardiology St. Louis WB Saunders 1996:303-321.

Quaal SJ, guest ed. Critical Care Nursing Clinics of North America. Philadelphia WB Saunders December 1996;8(4).

Shinn AE, Joseph D. Concepts of intraaortic balloon counterpulsation. Journal of Cardiovascular Nursing 1994;

8(2):45-60.

Takeuchi M, Nohtomi Y, Yoshitani H, et al. Enhanced coronary flow velocity during intra-aortic balloon pumping

assessed by transthoracic Doppler echocardiography. Journal of the American College of Cardiology. 2004;43:368–

76.

Whitman G. Intra-aortic balloon pumping and cardiac mechanics: A programmed lesson. Heart and Lung 1978;

7(6):1034-1050.

INDICATIONSINDICATIONSINDICATIONSINDICATIONS

Anwar A, Mooney MR, Stertzer SH. Intra-aortic balloon counterpulsation support for elective coronary angioplasty in

the setting of poor left ventricular function: A two center experience. The Journal of Invasive Cardiology 1990

July/August;1(4):175-180.

Arafa OE, Geiran OR, Anderson K, et al. Intra-aortic balloon pumping after predominantly right ventricular failure

after heart transplantation. Annals of Thoracic Surgery 2000;70:1587–93.

Baskett RJF, Ghali WA, Maitland A, Hirsch GM. The intra-aortic balloon pump in cardiac surgery. Annals of Thoracic

Surgery 2002;74:1276–87.

Baskett RJF, O’Connor GT, Hirsch GM, et al. A multicenter comparison of intra-aortic balloon pump utilization in

isolated coronary artery bypass graft surgery. Annals of Thoracic Surgery 2003;76:1988–92.

Bates ER, Stomel RJ, Hochman JS, Ohman EM. The use of intra-aortic balloon counterpulsation as an adjunct to

reperfusion therapy in cardiogenic shock. International Journal of Cardiology 1998;65(Suppl 1):S37–42.

45

Bolooki H. Emergency cardiac procedures in patients in cardiogenic shock due to complications in coronary artery

disease, Circulation 1989 June;79(6)(Suppl I):I-137-I-147.

Briguori C, Sarais C, Pagnotta P, et al. Elective versus provisional intra-aortic balloon pumping in high-risk

percutaneous transluminal coronary angioplasty. American Heart Journal 2003;145:700–707.

Califf, R.M.; Ohman, E.M., Reocclusion after thrombolytic therapy and percutaneous transluminal coronary

angioplasty. Cardiac Assists 1990 March; 5(2).

David JS, Gueugniaud PY, Hepp A, et al. Severe heart failure secondary to 5-fluorouracil and low doses of folinic

acid: Usefulness of an intra-aortic balloon pump. Critical Care Medicine 2000;28:3358–60.

Demas C, Flancbaum L, Scott G. The intra-aortic balloon pump as an adjunctive therapy for severe myocardial

contusion. American Journal of Emergency Medicine 1987;5:499–502.

Dietl CA, Berkheimer MD, Woods EL, et al. Efficacy and cost effectiveness of preoperative IABP in patients with

ejection fraction of 0.25 or less. Annals of Thoracic Surgery 1996;62:401-409.

Emmerman CL, Pinchak AC, Hagen JF. Hemodynamic effects of the intra-aortic balloon pump during experimental

cardiac arrest. American Journal of Emergency Medicine 1989 July;7:373-383.

Emery RW, Eales F, Joyce LD. Mechanical circulatory assistance after heart transplantation. Annals of Thoracic

Surgery 1991; 51:43-7.

Ferguson JJ, Cohen M, Freedman RJ Jr, et al. The current practice of intra-aortic balloon counterpulsation: Results

from the Benchmark Registry. Journal of the American College of Cardiology 2001;38:1456–1462.

Freedman RJ Jr. Myoconservation in cardiogenic shock - The use of intra-aortic balloon pumping and other

treatment modalities. Cardiac Assists 1992 January;6(2).

Freedman RJ Jr. The intra-aortic balloon pump system: Current roles and future directions. Journal of Applied

Cardiology 1991;6:313-318.

George BS. Thrombolysis and intra-aortic balloon pumping following acute myocardial infarction - Experience in four

TAMI studies. Cardiac Assists 1988 October;4(3).

Georgen RF, Dietrick JA, Pifarre R. Placement of intra-aortic balloon pump allows definitive biliary surgery in patients

with severe cardiac disease. Surgery 1989 September;106(4):808-814.

Goodwin M, Hartman J, McKeever L, et al. Safety of intra-aortic balloon counterpulsation in patients with acute

myocardial infarction receiving streptokinase intravenously. The American Journal of Cardiology 1989; 64:937-938.

Grotz RL, Yeston NS. Intra-aortic balloon counterpulsation in high-risk cardiac patients undergoing non-cardiac

surgery. Surgery 1989 July;106(1):1-5.

Gunnar RM, Bourdillon PDV, Dixon DW. Guidelines for the early management of patients with acute myocardial

infarction. American College of Cardiology 1990 August;16(2):249-292.

Gurbel PA, Anderson RD, MacCord CS, et al. Arterial diastolic pressure augmentation by intra-aortic balloon

counterpulsation enhances the onset of coronary artery reperfusion by thrombolytic therapy, Circulation 1994;

89(1):361-365.

Gutfinger DE, Ott RA, Miller M, et al. Aggressive preoperative use of intra-aortic balloon pump in elderly patients

undergoing coronary artery bypass grafting. Annals of Thoracic Surgery 1999;67:610–613.

46

Hochman JS, Buller CE, Sleeper LA, et al. Cardiogenic shock complicating acute myocardial infarction--etiologies,

management and outcome: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded

Coronaries for cardiogenic shocK? Journal of the American College of Cardiology 2000 Sep;36(3 Suppl A):1063-70.

Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by

cardiogenic shock. New England Journal of Medicine 1999 Aug; 341(9):625-34.

Hochman JS, Boland J, Sleeper LA, et al. Current spectrum of cardiogenic shock and effect of early revascularization

on mortality. Results of an international registry. Circulation 1995 Feb 1;91(3):873-881. Comment in: Circulation.

1995 Sep 1;92(5):1349-50.

Ishihara M, Sato H, Tateishi H, et al. Intra-aortic balloon pumping as the postangioplasty strategy in acute myocardial

infarction. American Heart Journal August 1991;122(2):385-389.

Kahn JK, Rutherford BD, McConahay DR. Supported "high risk" coronary angioplasty using intraaortic balloon pump

counterpulsation. Journal of the American College of Cardiology 1990 April;15:1151-5.

Kern MJ, Aguirre F, Bach R, et al. Augmentation of coronary blood flow by intra-aortic balloon pumping in patients

after coronary angioplasty. Circulation 1993 Feb;87(2):500-511.

Kern MJ, Aguirre FV, Tatineni S, et al. Enhanced coronary blood flow velocity during intraaortic balloon

counterpulsation in critically ill patients. Journal of the American College of Cardiology 1993 Feb;21(2):359-368.

Kern MJ. Intra-aortic balloon pumping post-angioplasty - Documentation of increased coronary blood flow. Cardiac

Assists 1992 June;6:1-5.

Kern MJ. Intra-aortic balloon counterpulsation. Coronary Artery Disease August 1991;2(6):649-660.

Lane AS, Woodward AC, Goldman MR. Massive propranolol overdose poorly responsive to pharmacologic therapy:

Use of the intra-aortic balloon pump. Annals of Emergency Medicine 1987 Dec;16(12):1381-1383.

Lazar HL, Yang XM, Rivers S, et al. Role of percutaneous bypass in reducing infarct size after revascularization for

acute coronary insufficiency. Circulation 1991;84(Suppl III):III-416-III-421.

Mangano DT, Browner WS, Hollenberg M. Association of perioperative myocardial ischemia with cardiac morbidity

and mortality in men undergoing noncardiac surgery. The New England Journal of Medicine 1990 Dec 27;

323(26):1781-8.

Marra C, de Santo LS, Amarelli C, et al. Coronary bypass grafting in patients with severe left ventricular dysfunction:

A prospective randomized study in timing of perioperative intra-aortic balloon pump support. International Journal of

Artificial Organs 2002;25:141–6.

Masaki E, Takinami M, Kurata Y, et al. Anesthetic management of high-risk cardiac patients undergoing noncardiac

surgery under the support of intra-aortic balloon pump. Journal of Clinical Anesthesia 1999;11:342–5.

McNamara NS, Wharton WP, La Rochelle T, Deboard D. Use of intra-aortic counterpulsation in patients with acute

myocardial infarction who present to community hospitals. Critical Pathways in Cardiology 2002;1:159–179.

Mercer D, Doris P, Salerno TA. Intra-aortic balloon counterpulsation in septic shock. The Canadian Journal of

Surgery 1981 Nov;24(6):643-645.

Ohman EM, George BS, White CJ, et al. Use of aortic counterpulsation to improve sustained coronary artery patency

during acute myocardial infarction. Results of a randomized trial. Circulation 1994 Aug;90(2):792-799.

Ohman EM, Califf RM, George BS, et al. The use of intra-aortic balloon pumping as an adjunct to reperfusion therapy

in acute myocardial infarction. American Heart Journal 1991 Mar;121(3):895-901.

47

Reiss N, el-Banayosy A, Posival H, et al. Transport of hemodynamically unstable patients by a mobile mechanical

circulatory support team. Artificial Organs 1996;20:959–63.

Ryan TJ, Antman EM, Brooks N, et al. 1999 Update: ACC/AHA guidelines for the management of patients with acute

myocardial infarction: Executive summary and recommendations: A report of the American College of

Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute

Myocardial Infarction). Circulation 1999;100:1016–1030.

Schreiber TL, Kodali UR, O’Neill WW, et al. Comparison of acute results of prophylactic intra-aortic balloon pumping

with cardiopulmonary support for percutaneous transluminal coronary angioplasty (PTCA). Catheterization and

Cardiovascular Diagnosis 1998;45:115–119.

Schreiber TL, Miller DH, Zola B. Management of myocardial infarction shock: Current status. American Heart Journal

1989 Feb;117(2):435-443.

Siu SC, Kowalchuk GJ, Welty FK, et al. Intra-aortic counterpulsation support in the high-risk cardiac patient

undergoing urgent noncardiac surgery. Chest 1991 Jun;99(6):1342-1345.

Stomel RJ, Rasak M, Bates ER. Treatment strategies for acute myocardial infarction complicated by cardiogenic

shock in a community hospital. Chest 1994;105(4):997-1002.

COMPLICATIONSCOMPLICATIONSCOMPLICATIONSCOMPLICATIONS

Arceo A, Urban P, Dorsaz PA, et al. In-hospital complications of percutaneous intra-aortic balloon counterpulsation.

Angiology 2003;54:577–85.

Barnett MG, Swartz MT, Peterson GJ, et al. Vascular complications from intraaortic balloons: Risk analysis. Journal of

Vascular Surgery 1994 Jan;19(1):81-89.

Brodell GK, Tuzcu EM, Weiss SJ. Intra-aortic balloon pump rupture and entrapment. Cleveland Clinic Journal of

Medicine 1989 Oct;56(7):740-742.

Cohen M, Ferguson JJ, Freedman RJ Jr, et al. Comparison of outcomes after 8 vs. 9.5 French size intra-aortic

balloon counterpulsation catheters based on 9,332 patients in the prospective Benchmark Registry. Catheterization

and Cardiovascular Interventions 2002;56(2):200–206.

Eltchaninoff H, Dimas AP, Whitlow PL. Complications associated with percutaneous placement and use of intraaortic

balloon counterpulsation. American Journal of Cardiology 1993 Feb;71:328-332.

Funk M, Gleason J, Foell D. Lower limb ischemia related to use of the intra-aortic balloon pump. Heart and Lung

1989;18:542-552.

Goran SF. Vascular complications of the patient undergoing intra-aortic balloon pumping. Critical Care Nursing

Clinics of North America 1989 Sep;1(3):459-467.

Gottlieb SO, Brinker JA, Borken AM, et al. Identification of patients at high risk for complications of intra-aortic

balloon counterpulsation: A multivariate risk factor analysis. American Journal of Cardiology 1984; 53:1135-1139.

Kantrowitz A, Wasfie T, Freed PS, et al. Intra-aortic balloon pumping 1967 through 1982: Analysis of complications

in 733 patients. American Journal of Cardiology 1986;57(11):976-983.

Kvilekval KH, Mason RA, Newton GB, et al. Complications of percutaneous intra-aortic balloon pump Use in patients

with peripheral vascular disease. Archives of Surgery 1991 May;126:621-623.

48

Lazar JM, Ziady GM, Dummer SJ, et al. Outcome and complications of prolonged intraaortic balloon counterpulsation

in cardiac patients. American Journal of Cardiology 1992,Apr;69:955-958.

Robicsek F, Holleman JH, Roush TS, et al. Peri-operative intra-aortic balloon assist, decreasing complications to the

minimum. Thoracic and Cardiovascular Surgeon 2003;51:115–125.

Schecter D, Murali S, Uretsky BF. Vascular entrapment of intra-aortic balloon after short term balloon

counterpulsation. Catheterization and Cardiovascular Diagnosis 1991;22:174-176.

Stahl KD, Tortolani AJ, Nelson RL, et al, Intra-aortic balloon rupture. ASAIO Journal 1988;XXXIV:496-499.

Velez CA, Kahn JK. Compartment syndrome from balloon pump. Catheterization and Cardiovascular Interventions

2000;51:217–219.

INSERTIONINSERTIONINSERTIONINSERTION

Gorton ME, Soltanzadeh H. Easy removal of surgically placed intra-aortic balloon pump catheter. Annals of Thoracic

Surgery 1991;51:325-6.

Heebler RF. Simplified technique for open placement and removal of intra-aortic balloon. Annals of Thoracic Surgery

1989;48:134-6.

Nash IS, Lorell BH, Fishman RF, et al. A new technique for sheathless percutaneous intra-aortic balloon catheter

insertion. Catheterization and Cardiovascular Interventions 1991 May;23(1):57-60.

Phillips SJ, Tannenbaum M, Zeff RH, et al. Sheathless insertion of the percutaneous intra-aortic balloon pump: An

alternate method. Annals of Thoracic Surgery 1992; 53:162.

Shahian DM, Jewell ER. Intra-aortic balloon pump placement through dacron aortofemoral grafts. Journal of Vascular

Surgery 1988 Jun;7:795-7.

PEDIATRICSPEDIATRICSPEDIATRICSPEDIATRICS

Anella J, McCloskey A, Vieweg C. Nursing dynamics of pediatric intra-aortic balloon pumping. Critical Care Nurse

1990 Apr;10(4):24-28.

del Nido PJ, Benson LN, Bohn D, et al. Successful use of intra-aortic balloon pumping in a 2-kilogram infant. Annals

of Thoracic Surgery 1988 Nov;46:574-576.

Dunn JM. The use of intra-aortic balloon pumping in pediatric patients. Cardiac Assists 1989 June; 5(1).

Nawa S, Sugawara E, Murakami T, et al. Efficacy of intra-aortic balloon pumping for failing fontan circulation. Chest

1988 Mar;93(3):599-603.

Pinkney KA, Minich LL, Tani LY, et al. Current results with intra-aortic balloon pumping in infants and children.

Annals of Thoracic Surgery 2002;73:887–91.

Veasy LG, Blalock RC, Orth J. Intra-aortic balloon pumping in infants and children. Circulation

1983;68(5):1095-1100.

Webster H, Veasy LG. Intra-aortic balloon pumping in children. Heart and Lung 1985;14(6):548-555.

49

TRANSPORTTRANSPORTTRANSPORTTRANSPORT

Bellinger RL, Califf RM, Mark DB. Helicopter transport of patients during acute myocardial infarction. American

Journal of Cardiology 1988 Apr;61:718-722.

Gottlieb SO, Chew PH, Chandra N. Portable intra-aortic balloon counterpulsation: Clinical experience and guidelines

for use. Catheterization and Cardiovascular Diagnosis 1986;12:18-22.

Kramer RP Jr. Helicopter-transported intra-aortic balloon pumping: advanced technology made airborne. Cardiac

Assists 1988 Jun;4(2).

Mertlich G, Quaal SJ. Air transport of the patient requiring intra-aortic balloon pumping. Critical Care Nursing Clinics

of North America 1989 Sep;1(3):443-458.

NURSING CARENURSING CARENURSING CARENURSING CARE

Bavin TK, Self MA. Weaning from intra-aortic balloon pump support. American Journal of Nursing 1991 Oct;91(10):

54-59.

Patacky MG, Garvin BJ, Schwirian PM. Intra-aortic balloon pumping and stress in the coronary care unit. Heart and

Lung 1985 Mar;14(2):142-8.

Quaal SJ, guest ed. Critical Care Clinics of North America. Philadelphia WB Saunders 1996 Dec;8(4).

Shoulders O. Managing the challenge of IABP therapy. Critical Care Nurse 1991 Feb;11(2):60-76.

Weinberg LA. Buying time with an intra-aortic balloon pump. Nursing 1988 Sep;18(9):44-49.

PROGRAM AND SPEAKER EVALUATION Developing an IABP Teaching Strategy Date: Program Code 07 Please rate the program and speaker items by placing a mark in the appropriate column. Program Evaluation 1

Poor 2

Fair 3

Good 4

Very Good

5 Excellent

1. Program met the stated objectives 2. Content covered topic adequately 3. Overall quality of this program 4. Overall quality of speaker(s) 5. Quality of the program facilities 6. Program met my personal objectives 7. I can incorporate program content

into my practice

Speaker Name: Speaker Evaluation 1

Poor 2

Fair 3

Good 4

Very Good

5 Excellent

1. Objectives – Stated learning objectives met

2. Audiovisual – Contributed to presentation

3. Content – Relevance of content to objectives

4. Presentation – Speaker qualified and held interest

5. Effectiveness – Speaker was organized and effective

6. Practice – Validated and/or changed practice

Comments: Participant Name:

51

Datascope Corp.Cardiac Assist Division15 Law DriveFairfield, NJ 07004Tel. 1.973.244.6100

For local contact: Please visit our Websitewww.datascope.comwww.maquet.com

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