CLINICAL SUPPORT SERVICES DEVELOPING AN IABP PRECEPTOR STRATEGY
IABP Timing & Fidelity - SULLIfiles.sulli.us/IABP/IABP_timing_pocket_ref_guide.pdf · US timing...
12
Pocket Reference Guide IABP Timing & Fidelity ™
Transcript of IABP Timing & Fidelity - SULLIfiles.sulli.us/IABP/IABP_timing_pocket_ref_guide.pdf · US timing...
Pocket Reference Guide
IABP Timing & Fidelity™
US timing guide 5/5/05 3:31 PM Page 1
Correct IABP Timing
A
B
C D
E
F
P
Q
R
S
T
A = One complete cardiac cycle
B = Unassisted aortic end diastolic pressure
C = Unassisted systolic pressure
D = Diastolic augmentation
E = Reduced aortic end diastolic pressure
F = Reducedsystolic pressure
US timing guide 5/5/05 3:31 PM Page 2
At the onset of diastole, IAB inflation occurs, giving rise to sharp “V” on arterial waveform.
Effect: • Increased coronary perfusion
Occurs at end of diastole prior to systole resulting in reduction of aortic end-diastolic and systolic pressures.
Effects:• Decreased afterload
• Decreased cardiac work
• Decreased myocardial oxygen consumption
• Increased cardiac output
I N F L AT I O N
D E F L AT I O N
Please Note:
• R-Wave deflation may provide more effective support for patients experiencing arrhythmias
US timing guide 5/5/05 3:31 PM Page 3
Incorrect IABP TimingEARLY INFLATION
Inflation of the IAB prior to aortic valve closure.
Waveform Characteristics:
• Inflation of IAB prior to dicrotic notch.
• Diastolic augmentation encroaches onto systole, (may be unable to distinguish).
Physiologic effects:
• Potential premature closure of the aortic valve.
• Potential increase in LVEDV and LVEDP or PCWP.
• Increased left ventricular wall stress or afterload.
• Aortic regurgitation.
• Increased MV02 demand.
Unassisted systole
Assisted Aortic End Diastolic Pressure
Diastolic Augmentation
Assisted Systole
US timing guide 5/5/05 3:31 PM Page 4
LATE INFLATION
Inflation of the IAB markedly after closure of the aortic valve.
Waveform Characteristics:
• Inflation of IAB after the dicrotic notch.
• Absence of sharp V.
Physiologic Effects:
• Sub-optimal coronary artery perfusion.Dicrotic Notch
Diastolic Augmentation
Assisted Systole
Assisted Aortic End Diastolic Pressure
US timing guide 5/5/05 3:31 PM Page 5
EARLY DEFLATION
Premature deflation of the IAB during the diastolic phase.
Waveform Characteristics:• Deflation of IAB is seen as a sharp
drop following diastolic augmentation.
• Sub-optimal diastolic augmentation.
• Assisted aortic end diastolic pressuremay be equal to or less than the unassisted aortic end diastolic pressure.
• Assisted systolic pressure may rise.
Physiologic Effects:• Sub-optimal coronary perfusion.
• Potential for retrograde coronary and carotid blood flow.
• Sub-optimal after load reduction.
• Increased MV02 demand.
Diastolic Augmentation
Assisted Aortic EndDiastolic Pressure Unassisted Aortic
End Diastolic Pressure
Assisted Systole
Incorrect IABP Timing
US timing guide 5/5/05 3:31 PM Page 6
LATE DEFLATION
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.
Physiologic Effects:
• Afterload reduction is essentiallyabsent
• Increased MV02 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
Unassisted Systole
Widened Appearance
Prolonged Rate of rise of Assisted Systole
Assisted Aortic End Diastolic Pressure
US timing guide 5/5/05 3:31 PM Page 7
Arterial Pressure Monitoringthrough the IAB Inner Lumen
FIDELITY IAB CATHETER
Transducer Setup
Inner Lumen Care
US timing guide 5/5/05 3:31 PM Page 8
Transducer Setup
5' Preferred
8' Maximum
A Minimize length of pressure tubing:
B Use only high stiffness pressure tubing. (as provided by Datascope or Abbott)
C Do not use a damping device.(e.g. R.O.S.E. resonance overshoot eliminator)
D Use gravity fill to minimize air bubbles.
E Elevate flush bag above transducer
US timing guide 5/5/05 3:31 PM Page 9
Inner Lumen Care
(3–5cc)
Profile8Fr. 25cc
25CC J1273456A Before pumping, after insertion,
gently aspirate & discard 3cc of blood & manually flush immediately with 3 – 5cc of flush solution.
B A 3cc/hour continuous flow throughthe inner lumen is recommended.
C If the central lumen becomes damped,• aspirate & discard 3cc of blood • fast flush to clear the pressure
tubing• continue flushing for
at least 15 seconds.
D Do not sample blood from the inner lumen
US timing guide 5/5/05 3:31 PM Page 10
25cc
34cc
40cc
50cc
Clinical ReferenceSizing Chart
Approx. Height – Less than 5' (152 cm)
Approx. Height – From 5'-5'4" (152 cm - 163 cm)
Approx. Height – From 5'4" - 6' (163 cm - 183 cm)
Approx. Height – Over 6' (183 cm)
6’
5’
4’
3’
2’
50cc
40cc
34 cc
25 cc
US timing guide 5/5/05 3:31 PM Page 11
innovation is the best medicineP/N 0002-08-0307 R2
Datascope Corp.
15 Law Drive
Fairfield, NJ 07004
800.777.4222 (tel.)
973.244.6100 (tel.)
800.258.8762 (fax)
973.244.6299 (fax)
www.datascope.com
US timing guide 5/5/05 3:31 PM Page 12
