19. This is even more crucial now that they are encountered less commonly. Physiology of Balloon Pumping. Learn more about the procedure, benefits and risks, and recovery. Small holes visible when water is introduced under pressure. Includes: possible causes, signs and symptoms, standard treatment options and means of care and support. Dobutamine requirements increased to 10 μg/kg/min, and the decision was made to insert an IABP and Swan Ganz catheter for management of the persistent hypotension in the setting of a reduced ejection fraction. A 56-year-old woman presented with sudden onset central chest pain and shortness of breath on a background of PCI and stenting for worsening angina 3 weeks before. Removal of Intra-Aortic Balloon Catheter Preparation After Removal of Device • Removal should be performed by a competent and suitably trained person • If anticoagulated for IABP, stop 1-4 hours before removal IABP = intraaortic balloon pump; (6.2%) had rupture of the balloon pump necessitating urgent removal of the device. , Yoshioka M, Hirayama N, Kashiwagi T, Onitsuka T, Koga Y. Horowitz Successful use of a FemoStop device, however, requires an experienced, well-trained clinician who provides a compassionate, attentive approach, skillful preparation and proper follow-through. J.C. and P.M. were lead consultants/senior authors involved in the management of the case. Care guide for Intra-Aortic Balloon Counterpulsation Pump (Aftercare Instructions). The patient was brought to the operating theatre for cut down and removal under general anaesthesia. May be required to replace the balloon. 1999. Tip of intra-aortic balloon pump within distal right common iliac artery. If the balloon … The aorta is the very large artery leaving your heart. In this video, Dr Ray Raper outlines the background, physiology and indications for intra-aortic balloon pump. 2/2018 guidewire into the central aorta to the previously estimated correct position in the thoracic segment of the descending aorta. A Fogarty catheter was used to perform an iliac embolectomy, which resulted in the removal of a small clot. , Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Bohm M, Ebelt H, Schneider S, Werdan K, Schuler G. Ferguson The technique used here did not require the need for retro peritoneal aortic exposure, and the associated morbidity that comes with this, as suggested by Millham et al.15 Pre-operative imaging to delineate anatomy and identify the location of obstruction is vital in planning the most appropriate approach on a case-by-case basis, as it helps determine the most appropriate method for its removal. , Hückstädt T, Aksakal D, Klitscher D, Wowra T, Till H, Schier F, Kampmann C. Fukushima Due to the invasive nature of this device, usage is accompanied by consistent risk of complications. S The extension of IABP indication, as prophylactic tools, for high-risk patients undergoing coronary surgery  has contributed to enlarge the potential pool … 0 1991 by The Society of Thoracic Surgeons OOO3-4975/91/$3.50 326 HOW TO DO IT GORTON AND SOLTANZADEH • Monitor pedal and radial pulses on the affected side Q15minutes x 1hour, then hourly. The device used in this case involved a 40 cm3 polyurethane balloon, which can be easily inflated and deflated with helium. Thank you for submitting a comment on this article. Angiogram performed: stent thrombosis causing left anterior descending/first diagonal (LAD/D1) occlusion—thrombus aspirated and stenting performed—TIMI 3 flow, Hypotensive: dobutamine 5 μg/kg/min infusion commenced, Worsening hypotension—increasing dobutamine requirements. Increased to 10 μg/kg/min. Occlusion of right external iliac artery due to intra-aortic balloon pump entrapment. Helium should be the only thing within the helium tubing and blood can only enter if the balloon surface has been damaged. The existing arterial puncture site with catheter in situ was extended transversely, and the balloon was extracted without difficulty. Despite successful intervention, the patient remained persistently hypotensive and an echo revealed a reduced ejection fraction of 10–15% with anterior apicoseptal hypokinesis, a dilated left atrium and moderate functional mitral regurgitation. We report successful removal of a ruptured and entrapped intra-aortic balloon pump catheter after use of streptokinase solution to clear clots from the device. All health care professionals involved in IABP use and monitoring should familiarize themselves with their potential complications. Risk Stratification Using Neoadjuvant Rectal Score in the Era of Neoadjuvant Chemoradiotherapy: Validation With Long-term Outcome Data. Dharam Prakash Saran 1 2. Balloon Pump Consoles and Catheters. Consequently, at the catheter insertion site, there is a time-dependent potential for the creation of small vessel wall tears widening the arteriotomy and thereby increasing the possibility of hemorrhage. , Cohen M, Freedman JR, Stone GW, Miller M, Joseph DL, Ohman M. Nishida The restlessness and agitation which parallels long hours of positional discomfort and mechanical ventilation creates a scenario set up for bleeding. Your comment will be reviewed and published at the journal's discretion. Sign up to receive ATOTW weekly - email firstname.lastname@example.org ATOTW 220 – Intra-Aortic Balloon Pump Counterpulsation 25/04/2011 Page 4 of 8 Patient improving—reducing dobutamine requirements. Intra-Aortic Balloon Pump (IABP) The Intra-Aortic Balloon Pump, commonly called IABP, is a catheter-based procedure for patients with severe heart disease (e.g. It is removed when the heart can pump enough blood on its own or another heart assist device is needed. A femoral arteriotomy was performed after achieving proximal and distal control of the common femoral artery. The use of intraluminal thrombolytic administration can be used to aid removal; however, its use in cases where the balloon thrombus has been present for a period of >1 h, such as in this case, is debatable, given the solid consistency of the clot.12–15. If blood is noted within the external tubing supplying the balloon pump, it should prompt swift extraction of the balloon. Informed consent was obtained from this patient for publication of this case history and associated images in line with COPE recommendations. , Koyanagi H, Abe T, Arai H, Hirayama H, Hirayama T. Unverzagt The potential for benefit of 6. Characteristics of the balloon pressure waveform to be assessed include –the baseline pressure. A long IABP dwell can also blunt the important vasospastic reflex of initial hemostasis, increasing bleeding risk. lntraaortic balloon pump and vascular tourniquet have been removed in the intensive care unit and suture has been secured. Removal of the Balloon The balloon pump is used for short amounts of time. Krishna M, Zacharowski K. Principles of Intra-Aortic Balloon Pump Counterpulsation. , Smith J, Brown P, Zinetti C. Richter Introduction The intra-aortic balloon pump (IABP) was first introduced in the 1960s as a means to provide extra haemodynamic support to those in cardiogenic shock. Thiele Intra-aortic Balloon Pump: Assessing the Pressure Waveform ). 10. Published on behalf of the European Society of Cardiology, This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (. Four of the 5 patients had no serious hemodynamic … Kantrowitz also invented the intra-aortic balloon pump (IABP), a left ventricular assist device (L-VAD), and an early version of the implantable pacemaker. An intra-aortic balloon pump condensation prevention system comprising a water vapor extraction element, such as a Nafion tube (made by Dupont Inc.), or a condensation element, such as a cold trap or 2 More recent studies, however, have called into question the … Clopidogrel was switched to ticagrelor following the procedure. , Hudson HM, Woodson J, Menzoian JO. Kantrowitz 6. Entrapment is seen more commonly within the female vasculature, and this is felt to be due to the narrower calibre of the female femoral artery.11 The presence of atherosclerosis is also a known risk factor for entrapment.11. The problem may be within the balloon (Helium leak), connecting tubing or the IABP console. were involved in compilation of data and writing of this piece. Niall Hardy, Neasa Starr, John Cosgrave, Prakash Madhavan, Intra-aortic balloon pump entrapment and surgical removal: a case report, European Heart Journal - Case Reports, Volume 1, Issue 1, August 2017, ytx002, https://doi.org/10.1093/ehjcr/ytx002. Intra-aortic Balloon Pump Kanchi, Chandran 73 Journal of Cardiac Critical Care TSSVol. The arteriotomy site was closed uneventfully as was the skin. Insertion of IABP. With Serious intra-aortic balloon pump (IABP) complications are rare; however, they may have major consequences. Clinical Editor's Corner Live, International Symposium on Endovascular Therapy, Symposium on Clinical Interventional Oncology. This was done percutaneously via the right groin. It consists of two parts: a balloon inserted into the aorta, one of the large arteries through which blood passes from the heart to the rest of the body; and a machine outside the body. The principal objective of balloon counterpulsation is to enhance the balance between myocardial oxygen consumption and supply. The patient was then transferred for primary PCI. The patient encountered no post-operative complications from the surgery and was discharged home. Intra-aortic balloon pump is used frequently to support a failing myocardium in cardiac patients. The patient was on aspirin and clopidogrel 75mg along with atorvastatin 40 mg at night. Close monitoring of the balloon pump at ward level to allow for swift extraction in the event of complication and therefore obviating the need for surgical intervention is crucial. Methods of Insertion and Removal of Intra . 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. Groin cut down to allow proximal and distal artery control followed by arteriotomy is a relatively non-invasive and safe method of device removal. The challenge of achieving and maintaining femoral arterial hemostasis following Intra-aortic Balloon Pump (IABP) counterpulsation therapy can be daunting. 9. JW Tel: +353 87 9009907, Email: Search for other works by this author on: Department of Cardiology. Moreover, as their intensive nursing care needs are met, these patients are more physically manipulated and re-positioned than usual to mobilize secretions and so on. Prompt recognition of blood within the balloon pump’s helium tubing is crucial as it indicates balloon rupture. On inspection following removal, a significantly sized solid thrombus was visible within the lumen of the balloon (Figure 4). Other factors, like an obese or distended abdomen, pre-existent hematoma or compromised distal pulses, can add further adversity to line withdrawal. 2. Background medical history was significant for hyper-cholesterolaemia and a spontaneous intracranial bleed 4 years previously. Due to this marked improvement in haemodynamic parameters, the decision to remove the device was made. These findings are a direct contrast to previously described literature, which traditionally have advocated gradual weaning of balloon pump prior to removal. Surgical removal of the balloon may be required to ensure complete removal. Ensure that the standby advisory tone is on. If pump operation can't be restored within 15 minutes, the balloon becomes dormant. H The balloon itself looks 3. You must manually inflate and deflate the balloon optimally every 5 minutes; at a minimum, at least several times per hour. Vascular complications abound in critical care patients for many reasons. heart attack, heart failure, etc.) On examination, the patient was dyspnoeic with a heart rate of 100 beats/min and blood pressure of 110/70 mmHg. 2009;9(1):24-28. , Otero M, de Marchena EJ, Neibart RM, Novak S, Bolooki H. Millham Swan Ganz catheter located in right femoral vein. General Criteria, Contraindications and Guidelines for Balloon Pumping. A number of different approaches have been referenced in the literature with varying degrees of success. At the time of removal, however, it was noticed that there was blood within the helium tubing suggesting device perforation. Balloon Pump Equipment. Over the next 48 h, the patient’s condition improved with a reduction in ionotropic requirements and stable renal function. The intra-aortic balloon pump (IABP) was first introduced in the 1960s as a means to provide extra haemodynamic support to those in cardiogenic shock.1 Over the next 40 years, the insertion of an IABP became a common occurrence in cases of cardiogenic shock not reversed with the use of pharmacological agents.2 More recent studies, however, have called into question the mortality benefit of IABP use in myocardial infarction, and this has seen a sharp decline in their use in recent years.3 Their use is still widespread, however, and the balloon pump remains a viable tool in the management of cardiogenic shock. 3) Pump related problems Balloon pressure baseline depression - Place pump on stand by. The length of time elapsed from balloon rupture to recognition of entrapment along with balloon location are important factors that will dictate management options. Wide ranges of complication rates with the use of the IABP have been reported. This skill set, combined with a patient first mindset, will ensure patient safety and comfort for all persons involved, regardless of one’s hemostasis methodology. There have been a number of extrication methods described when dealing with balloon pump entrapment. MD The Intra-Aortic Balloon Pump (IABP) is frequently used to mechanically support the heart. Intra aortic balloon pump (IABP) is the mechanical assist device most frequently used in cardiac surgery . In the case reported herein, it was possible to gain both proximal and distal control of the involved vessels to ensure any bleeding could be controlled quickly and adequately should the need arise. The patient had a 10 pack-year smoking history; however, they had not smoked for the past 10 years. In this report, we share our experience of a case of balloon entrapment within the right common iliac artery and successful removal of the device via groin cut down under general anaesthesia. Use of FemoStop® Plus for Intra-Aortic Balloon Pump Removal, Robotic-Assisted Intervention at the University of Virginia Cath Labs, Treatment of Totally Occluded Popliteal Artery With the Auryon Laser Via Pedal Access in a Patient With Chronic Limb-Threatening Ischemia, Same-Day Discharge After Complex Percutaneous Coronary Intervention Using Radial Artery Approach, A Safe Working Environment: Avoiding Radiation, Edwards SAPIEN 3 TAVI Receives Expanded Approval In Canada, HMP Global, Publisher of Cath Lab Digest, to Introduce Journal of Critical Limb Ischemia in Spring of 2021, MagicTouch SCB Granted 'Breakthrough Device Designation' for the Treatment of Small Coronary Artery Lesions, FDA Authorizes Ellume COVID-19 Home Test as First Over-the-Counter Fully At-Home Diagnostic Test, Your Patient Took Sildenafil Last Night. Careful monitoring of these devices should be stressed at all times while insitu. Know the fundamentals of IABP technology. This should then prompt immediate removal to reduce the risk for entrapment. Patient presents acutely with chest pain 3 weeks post-percutaneous coronary intervention (PCI) and stenting to left anterior descending artery (LAD). In many cases, this procedure is done through a small cut on the inside of your upper leg. The pump was removed without difficulty to 10 cm, at which point significant resistance was encountered suggesting balloon entrapment. This is because pressure inside the balloon is not sufficient enough to overcome the surface tension at the balloon—blood interface and as a result blood moves into the cavity.10 As blood is drawn into the balloon on deflation, it results in the formation of clot within the balloon, which is particularly hard and can prevent withdrawal of the catheter through the vasculature, as was the case in this report. Arterial helium embolism is a documented complication of larger perforations in the balloon membrane allowing a sudden introduction of a large volume of helium into the systemic circulation and resulting in significant neurological deficit and even death.7,8 The use of carbon dioxide in place of helium significantly lowers the risk of embolus, given its increased solubility in blood; however, its higher density means a slower diffusion coefficient and it is therefore not commonly used.9, Smaller micro-perforations such as in this case tend to result in the entry of blood into the lumen of the catheter. Is removed when the heart Turnover Flap and Full-thickness skin Graft balloon pump removal of balloon pump frequently to support failing!, there have been a number of extrication methods described when dealing with balloon pump catheter into an Old.! Under pressure was made related problems balloon balloon pump removal baseline depression - Place pump on by! 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Purchase an annual subscription catheter after use of streptokinase solution to clear from... Reduce the risk for entrapment TIMI 3 flow entrapment along with balloon pump ( )... And P.M. were lead consultants/senior authors involved in IABP use and monitoring should familiarize themselves with potential... A failing myocardium in cardiac patients degrees of success 30 minutes the past 10 years to promptly and..., although it occurs rarely, may lead to entrapment if diagnosis.... Frequently used to mechanically support the heart the external tubing supplying the balloon pump lodged within right common iliac.., 22-25 traditionally, 2 forms of weaning have been a number of different approaches have been..
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