Technology in Practice Part II:
Intra-Aortic Balloon Pump
Background of Technology
Before tThe intra-aortic balloon pump (IABP) became a successful piece of technology, it was first introduced by Harken in 1958 in hopes of treating left heart failure (IABPumpers, 2006). Harken thought that by removing a certain amount of blood from both femoral arteries during systole, and rapidly replacing it during diastole, he could augment the cardiac output and increase coronary perfusion. However, this pumping system led to extreme hemolysis and turbulence with failure to increase coronary blood flow (IABPumpers, 2006).
Soon after, Moulopoulus from Cleveland Clinic developed the first successful IABP in the 1960’s. This newly developed IABP was timed to inflate and deflate according to the phases of the cardiac cycle, and was first used in a clinical practice in 1968 by the Kantrowiz’s group (IABPumpers, 2006). Initially the placement of the IABP was done through surgical grafting due to the large size of the catheter, but as this technology improved through the years, the catheters became small enough to be placed non-surgically at patient’s bedside (IABPumpers, 2006). Now, with more than 70,000 balloon catheters inserted each year in the U.S, IABP therapy is known to be the mostas a common treatment for cardiogenic shock (Vales, Kanei, Ephrem, & Misra, 2011).
Purpose of Technology
The most important purpose of the IABP therapy is to increase cardiac output (Vales, Kanei, Ephrem, & Misra, 2011). As stated previously, tThe IABP is timed to inflate and deflate according to phases of the individual’s cardiac cycle (IABPumpers, 2006). Inflation of the balloon occurs at diastole, which displaces the blood from the aorta to the coronary arteries and the vital organs. Deflation occurs just before systole and left ventricular ejection. This deflation along with the blood displacement during diastole leads to decreased afterload and pressure in the aorta, which ultimately results in decreased myocardial demand (Sole, Klein, & Moseley, 2009). Hemodynamically speaking, the overall goal is to reduce myocardial work and left ventricular afterload as well as improving coronary and systemic blood flow (Vales, Kanei, Ephrem, & Misra, 2011). Indications and Contraindications
The IABP is no different than other forms of medical technology, in which there are situations where it is an optimal option, as well as where the use is detrimental. For instance, the balloon pump can be considered an ideal treatment for left ventricular shock resulting from an acute myocardial infarction (MI). Other conditions in which the IABP is useful for include, unstable angina related to medical therapy, post MI irritability, failure to wean off of cardiopulmonary bypass, as well as those with low output syndrome and to stabilize high risk patients who are undergoing general anesthesia (Western Sydney Health Services, 2004).
Overall, the IABP should only be utilized in those patients with the possibility of recovery of the left ventricle, or those awaiting a heart transplant. On the contrary, there are situations in which the IABP would not be the optimal treatment. These would fall under the category of contraindications and are as follows: aortic dissection, patients with severe peripheral vascular disease and irreversible brain damage and severe aortic valvular insufficiency (Western Sydney Health Services, 2004). Steps Before, During and After Use
Nursing care of the IABP is absolutely critical to the success of treatment for the patient and includes care of the pump in addition to assessing the patient before, during and after use from a cardiovascular and haemodynamic perspective (O'Donovan, 2011). Prior to the insertion of IABP, the nurse is responsible for obtaining witnessing consent for the procedure, educating the patient about the procedure and specific limitations and risks, as well as performing a full hemodynamic and...
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