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Technical Seminar for Intra-aortic Balloon Pumping

System 98/98XT

Datascope Clinical Support Services


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TECHNICAL SEMINARTECHNICAL SEMINARTECHNICAL SEMINARTECHNICAL SEMINAR

C ourse DescriptionC ourse DescriptionC ourse DescriptionC ourse Description

This four hour presentation is designed for health care professionals with previous IABP

experience. The program begins with a brief review of the theory of intra-aortic balloon pumping

and a discussion of the percutaneous IAB. The technical aspects of the Datascope IABP will then

be discussed in detail highlighting troubleshooting in the clinical setting. A limited skills

workshop using the Abbreviated Operator s Guide and Performance Checklist will be provided.

Behavioral ObjectivesBehavioral ObjectivesBehavioral ObjectivesBehavioral Objectives

At the conclusion of this program, the participants will be able to:

1. Define the two physiological effects achieved by the mechanics of inflation and deflation of

the IAB as it relates to the cardiac cycle illustrated by an augmented arterial pressure waveform.

2. Identify four indications and three contraindications for IABP therapy.

3. Identif y the major complications associated with IABP therapy.

4. Discuss the operation and troubleshooting of the Datascope IABP uti lizing the Abbreviated

Operator s Guide and Performance Checklist.

D atascope C orp. 1998Datascope Corp. 1998Datascope Corp. 1998Datascope Corp. 1998


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Course ScheduleCourse ScheduleCourse ScheduleCourse Schedule

8:00-8:10 Introduction/Program Review

8:10-9:10 Theory of IABP

A. Effects

B. Indications

C. Contraindications

D. Side Effects/Complications

9:10-9:30 IAB Catheter Presentation

9:30-10:00 Break

10:00-11:00 Technical Components of the System

Set-up demonstration

Review Abbreviated O perator s Guide

11:00-11:50 Troubleshooting

Hands-on Skills Workshop

11:50-12:00 Evaluation


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I. Theory of IABPI. Theory of IABPI. Theory of IABPI. Theory of IABPA.A.A.A. CounterpulsationCounterpulsationCounterpulsationCounterpulsation

1. Balloon Structure and Position2. Increased Coronary Perfusion

a. Inflation

b. Augmentation of Diastolic Pressure3. Decreased Left Ventricular Workloada. Deflationb. Afterload Reduction

4. Physiological Pressure Wave Changesa. Dicrotic Notchb. Diastole: Augmentationc.

Decreased End-Diastolic Pressured. Systole: Decreased Assisted Systolic Pressure


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ARTERIAL WAVEFORM VARIATIO NS D URING IABP THERAPYARTERIAL WAVEFORM VARIATIO NS D URING IABP TH ERAPYARTERIAL WAVEFORM VARIATIO NS D URING IABP THERAPYARTERIAL WAVEFORM VARIATIO NS D URING IABP TH ERAPY

1:1 IABP Frequency1:1 IABP Frequency1:1 IABP Frequency1:1 IABP Frequency




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B.B.B.B. IndicationsIndicationsIndicationsIndications

1. Refractory ventricular failure

2. Cardiogenic shock

3. Unstable refractory angina

4. Impending infarction

5. Mechanical complications due to acute myocardial infarction, i.e., ventricularseptal defect, mitral regurgitation or papillary muscle rupture.

6. Ischemia related intractable ventricular arrhythmias

7. Cardiac support for high risk general surgical patients and coronaryangiography/angioplasty patients

8. Septic shock

9. Weaning from cardiopulmonary bypass

10. Intraoperative pulsatile flow generation

11. Support for failed angioplasty and valvuloplasty

D .D .D .D . Co nt raindicat ionsContraindicationsContraindicationsContraindications

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 othercontraindications to percutaneous insertion

PleasePleasePleasePlease Refer to the Instructions for Use Prior to Insertion of the IABRefer to the Instructions for Use Prior to Insertion of the IABRefer to the Instructions for Use Prior to Insertion of the IABRefer to the Instructions for Use Prior to Insertion of the IAB


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D . SID E EFFECTS AND COMPLIC ATIO NS OF IABP THD . SID E EFFECTS AND COMPLIC ATIO NS OF IABP THD . SID E EFFECTS AND COMPLIC ATIO NS OF IABP THD . SID E EFFECTS AND COMPLIC ATIO NS OF IABP TH

AssessmentAssessmentAssessmentAssessment PreventionPreventionPreventionPrevention TreatmTreatmTreatmTreatm

1. Limb Ischemia `

Check distal pulses, color, temp.and capillary filling Q30 min x

2 hrs, then Q2 hrs.

` Monitor differential toe

temperatures.

`

Use smallest sheath/cathetersizes indicated.

` Risk factors: female, di abetics,

peripheral vascular diseases.

` Select limb with best pulse.

`

Remove shbleeding.

` Subcutaneo

injection fo

` Change in

opposite li

` Bypass gra

2. Excessive bleeding from

insertion site

` Observation -anteriorly and

posteriorly for blood or

hematoma.

` Careful insertion technique.

` Monitor anticoagulation

therapy.` Prevent catheter movement at

insertion site.

` Apply pres

flow.

`

Surgical re

3. Thrombocytopenia ` Daily platelet count. ` Avoid excessive heparin. ` Replace pla

4. Immobility of balloon catheter. ` D ATASC OPED ATASC OPED ATASC OPED ATASC OPE

REC OMM END S TH ATREC OMM END S TH ATREC OMM END S TH ATREC OMM END S TH AT

THE IABTHE IABTHE IABTH E IAB NO TNO TNO TNOT BE LEFTBE LEFTBE LEFTBE LEFT

IMM OBI LE IN TH EIMMO BI LE IN TH EIMM OBI LE IN TH EIMMO BI LE IN TH EPATIENT FOR MOREPATIENT FOR MOREPATIENT FOR MOREPATIENT FOR MORE

TH AN 30" .TH AN 30" .TH AN 30" .TH AN 30" .

` Observation of IAB status

indicator movement.

` Observation of augmentation.

` Maintain adequate trigger.

` Observe movement of IAB

Status indicator.

`

If unable to inflate the IABwith the IABP, inflate and

deflate the IAB by hand, using a

syringe and stopcock once every

3-5 min.

` Notify the

is immobil


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AssessmentAssessmentAssessmentAssessment PreventionPreventionPreventionPrevention TreatmenTreatmenTreatmenTreatmen

5. Balloon leak ` Observe tubing for blood

with or without the presence

of a blood detect, low

augmentation, and/or gas loss

or IAB catheter alarm.

` Do not remove the IAB from

its tray until it is ready to be

inserted.

` If blood is ob

pneumatic tu

the balloon f

and notify th

immediately.

6. Infection ` Observation of insertion site.

` Blood cultures for symptoms

of infection.

` Sterile technique during

insertion and dressing

changes as per infection

control policy.

` Antibiotics.

7. Aortic Dissection ` Assess for pain between

shoulder blades.

` Daily hematocrit.

` If suspected, aortogram may

be indicated.

` Insertion of IAB over guide

wire with fluoroscopic

control.

` Balloon remo

` Surgical repa

8. Compartment syndrome may

develop after IAB removed.

` Observation of limb for

swelling and/or hardness.

` Measure calf girth.

`

Monitor interstitial pressure.

` Use the smallest catheter/

sheath appropriate.

` Maintain adequate colloid

osmotic pressure.

` Fasciotomy if


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II. Int ra-aortic Balloon Cat heterII . Int ra-aortic Balloon Cat heterII. Int ra-aortic Balloon Cat heterII . Int ra-aortic Balloon Cat heterDesigned for sheathless or sheathed insertion.


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III. Technical Components of the System 98/98XT Intra-Aortic Balloon Pump


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This page intentionally left blank.


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A.A.A.A. Rear PanelRear PanelRear PanelRear Panel

1. Safety Disk/Condensate Removal

System

a. DC Input

b. IAB Fill Port

c. Drain Port

2. Helium Supply

a. Pressure Gauge

b. Manual Fill Port

3. Patient Connections

a. ECG

b. Pressure

c. Monitor Input

d. ECG/Pressure Output

4. Data C ommunications Outputs

a. RS-232

b. Phone Line

c. Diagnostic Output

5. Power Cord/Mains

a. Auxiliary DC Input

6. System Timer


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B. Monitor 98/98XT

1. Alarm Messages 5. IAB Status Indicator

2. Advisories 6. Trigger

3. ECG 7. Heart Rate Display

a. Lead 8. Pressure Display

b. Gain 9. Augmentation Alarm

4. Pressure 10. Helium Indicator

a. Source 11. Battery Indicator

b. Scale


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System 98 Key PadC. Control Panel

1. Auxiliary 3. Patient Waveforms

a. ECG Gain a. ECG Lead/Ext.

b. Pressure Threshold b. Pressure Source

c. Internal Rate c. Inflation Interval

2. Override d. Freeze Display

a.

Slow Gas

b. IAB Fill Mode

c. Timing

Auto/Manual System 98 Auto Mode System 98XTAuto R-Trac On

Manual R-Trac Off Manual


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System 98XT Keypad

C. Control Panel (Continued)

4. User Options

a. Ref Line

b. Aug Alarm

c. Alarm Volume

d. Help Screen

e. Preferences Menu

f. Printer Menu

g. Print Strip

h. Zero Pressure

i. Alarm Mute


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System 98 Keypad

System 98XT KeypadD. IABP Controls

1. Trigger Select 2. IAB Frequency

a. ECG 3. IAB Augmentation

b. Pressure 4. IAB Fill

c. Internal 5. Assist/Standby

d. Pacer V/AV 6. IAB Inflation

e. Pacer A 7. IAB Deflation


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E.E.E.E. RecorderRecorderRecorderRecorder

1. EC G

2. Pressure

3. Balloon Pressure Waveform


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4. Heart Rate Trend

5. Blood Pressure Trend

F.F.F.F. System BatterySystem BatterySystem BatterySystem Battery

1. Charge Status

2. Portable Operation

G.G .G .G . Doppler StorageDoppler StorageDoppler StorageDoppler Storage


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The inflation marker shows the period of inflation. Vertical timing marks located below thearterial waveform are also available to aid with initial timing.

A unique automatic timing algorithm allows effective balloon pumping even during atrialfibrillation. Press the Inflation Interval key to observe the period of inflation while pumping.Vertical markers located below the arterial waveform and the highlighted portion indicates theperiod of balloon inflation.


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IV.IV.IV.IV. Set-Up D emonstrat ionSet-Up Demonstrat ionSet-Up Demonstrat ionSet-Up Demonstrat ion

V.V.V.V. Review Abbreviated Operators GuideReview Abbreviated Operators GuideReview Abbreviated Operators GuideReview Abbreviated Operators Guide


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VI.VI.VI.VI. Troubleshoot ingTroubleshootingTroubleshootingTroubleshooting

A.A.A.A. Alarm MessagesAlarm MessagesAlarm MessagesAlarm Messages

1. Trigger Alarms

a. No Trigger

b. No Pressure Trigger

c. No Pressure Trigger -Zero Transducer

d. Trigger Interference

e. Check Pacer Timing

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


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B. Advisory

1. Alert Messages

a. Augmentation Below Limit Set

b. Irregular Trigger

c. Heart Rate Low

d. Low Helium

e. Low Battery

f. Low Battery (EXT)

g. ECG Detected

h. Prolonged Time in Standby

i. Maintenance Required Code # ______________

j. No Patient Status Available

2. Status Messages

a. System Trainer

b. System Test OK

c. Autofilling

c.

R-Wave D eflate

e. Auto R-Wave Deflate (System 98XT only)

f. Leak Testing Safety Disk

g. Slow Gas Loss Override On

h. Gas Loss and C atheter Alarms Disabled

i. Battery in Use

j. Battery in Use (EXT)


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3. Prompt Messages

a. IAB Not Filled

b. Unplug Disk Outlet

c. Plug Disk Outlet

d. Manual Fill IAB

C .C .C .C. Patient Condit ionsPatient ConditionsPatient C onditionsPatient Conditions

1. Atrial Fibrillation

2. Ectopics

3. Cardiac Arrest

4. Cardioversion/Defibrillation

D.D .D .D. C hanging Helium TankC hanging H elium TankChanging Helium TankC hanging H elium Tank

E.E.E.E. Safety D isk Leak TestSafety Disk Leak TestSafety Disk Leak TestSafety Disk Leak Test

F.F.F.F. Manual Fi llManual FillManual FillManual Fill

G .G .G .G. Manual TimingManual TimingManual TimingManual Timing


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H.H.H.H. Factors Affecting D iastolic AugmentationFactors Affecting Diastolic AugmentationFactors Affecting Diastolic AugmentationFactors Affecting Diastolic Augmentation

1. Patient Hemodynamics

a. Heart Rate

b. Stroke Volume

c. Mean Arterial Pressure

d. System Vascular Resistance

2. Intra-Aortic Balloon

a. IAB in Sheath

b. IAB Not Unfolded

c. IAB Position

d. Kink in IAB Catheter

e. IAB Leak

f. Low Helium Concentration

3. IABP

a. Timing

b. Position of IAB Augmentation C ontrol


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I .I .I .I . TIMINTIMINTIMINTIMING ERRORSG ERRORSG ERRORSG ERRORS1. Early Inflation

Inflation of the IAB prior to aortic valve closure

Waveform Characteristics:Waveform Characteristics:Waveform Characteristics:Waveform 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 MVO2demand

2. Late Inflation

Inflation of the IAB markedly after closure

of the aortic valve


` 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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3. Early Def lation

Premature deflation of the IAB

during the diastolic phase

Waveform C haracteristicsWaveform C haracteristicsWaveform C haracteristicsWaveform C haracteristics

` 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


` 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 MVO2demand

4. Late Deflation


` 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 theleft 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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J.J.J.J. Normal Balloon Pressure WaveformNormal Balloon Pressure WaveformNormal Balloon Pressure WaveformNormal Balloon Pressure Waveform


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

Variations in balloon pressure waveforms may be due to the following conditions:

1.1.1.1. Heart RateHeart RateHeart RateHeart Rate

BradycardiaBradycardiaBradycardiaBradycardiaIncreased duration ofplateau due to longerdiastolic phase

TachycardiaTachycardiaTachycardiaTachycardiaDecreased duration ofplateau due to shorteneddiastolic phase.

2.2.2.2. RhythmRhythmRhythmRhythm

Varying R-R intervalsresult in irregular plateaudurations.

3.3.3.3. Blood PressureBlood PressureBlood PressureBlood Pressure

HypertensionHypertensionHypertensionHypertensionIncreased height oramplitude of thewaveform.

HypotensionHypotensionHypotensionH ypotension Decreasedheight oramplitude of thewaveform.


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4.4.4.4. Gas LossGas LossGas LossGas Loss

Leak in the closed systemcausing the balloon pressurewaveform to fall belowzero baseline. This may bedue to a loose connection,a leak in the IAB catheter, H 2O condensationin the external tubing, or a patient who istachycardiac and febrile which causes increasedgas diffusion through the IAB membrane.

5.5.5.5. Catheter KinkC atheter KinkC atheter KinkC atheter Kink

Rounded balloon pressurewaveform, loss of plateauresulting from a kink orobstruction of shuttle gas.This may be caused by akink in the catheter tubing,improper IAB catheter position, sheath notbeing pulled back to allow inflation of the IAB,the IAB is too large for the aorta, the IAB is notfully unwrapped, or H 2O condensation in theexternal tubing.

6.6.6.6. Sustained InflationSustained InflationSustained InflationSustained Inflation

Theoretical possibility if theIAB remains inflated longerthan 2 seconds. System 90Series intra-aortic balloonpump will activate theSystem Failure alarm and

deflate the IAB.


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VII.VII.VII.VII. Skills Workshop (optional)Skills Workshop (optional)Skills Workshop (optional)Skills Workshop (optional)

A.

Hands-on

Time

B.

Performance Checklist


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Datascope System 98/98XT IABP Performance Checklist

Name: Date:

Date and initial the following as completed:

Review of hospital policy and procedures:

Attends IABP Seminar:

Written exam taken: Score:

For the following: indicate 1 for Satisfactory, 2 for Repeat Performance Necessary.

Initial Set UpSystem Trainer Clinical Instructor

Initials

Establish Power, verify Mains power switch On &IABPOn/Off switch ON

Establish G as Pressure

Establish ECG and Pressure

Zero Transducer

Confirm Initial Control Settingsa. IABP controls

b. Auxiliary controls

c. Override controls

Init ial Timing

Identify and Adjust Inflate Point

Identify and Adjust Deflate Point

Preload Balloon

a. Attach IAB to appropriate connector

b. Attach connector to safety disk/condensateremoval module

c. Initiate autofill cycle

Fill the IAB Catheter and Initiate Pumping

a. Press Assist/Standby -observe for the Autofillingmessage

b. Verify optimal augmentation

c. Fine tune timing

d. Assess hemodynamic benefits

1. augmentation

2. afterload reduction

e. Record pressures1. assisted

2. unassisted


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TROUBLESHOOTINGTROUBLESHOOTINGTROUBLESHOOTINGTROUBLESHOOTING

For the following sections indicate 1111 for SATISFAC TO RYSATISFACTO RYSATISFACTO RYSATISFAC TO RY OR 2222 FOR REPEATREPEATREPEATREPEATPERFORMANCE NECESSARYPERFORMANCE NECESSARYPERFORMANCE NECESSARYPERFORMANCE NECESSARY:

SCORE:SCORE:SCORE:SCORE:

A.A.A.A. TRIG G ER - D EMO NSTRATES ABI LITY TO ID ENTIFY VARIABLETRIG G ER - D EMO NSTRATES ABI LITY TO ID ENTIFY VARIABLETRIG G ER - D EMO NSTRATES ABILITY TO ID ENTIFY VARIABLETRIG G ER - D EMO NSTRATES ABI LITY TO ID ENTIFY VARIABLETRIGGER SELECTION CRITERIA AND APPROPRIATE USE OF EACHTRIGGER SELECTION CRITERIA AND APPROPRIATE USE OF EACHTRIGGER SELECTION CRITERIA AND APPROPRIATE USE OF EACHTRIGGER SELECTION CRITERIA AND APPROPRIATE USE OF EACHTRIGGERTRIGGERTRIGGERTRIGGER

WHICH TRIGGER IS THE MOST APPROPRIATE FOR:

1. Atrial Fibrillation

2. Demand Ventricular Pacemaker, Rate 60

3. AV sequential pacemaker, demand mode

4. Unobtainable ECG signal, regular rhythm, BP 100/50

5. Cardiac arrest with good chest compressions

6. Sinus Tachycardia

7. Sinus Rhythm with frequent PVC'S

8. Fixed rate AV sequential pacemaker

9. Atrial pacemaker -100%paced

B.B.B.B. IAB C ATH ETER - D EMONSTRATES UND ERSTAND ING O FIAB C ATH ETER - D EMO NSTRATES UND ERSTAND ING O FIAB C ATH ETER - D EMO NSTRATES UND ERSTAND ING O FIAB C ATH ETER - D EMO NSTRATES UND ERSTAND ING O FSITUATIO NS TH AT MAY C AUSE AN IAB C ATH ETER ALARM ANDSITUATIO NS TH AT MAY C AUSE AN IAB CATH ETER ALARM ANDSITUATIO NS TH AT MAY C AUSE AN IAB C ATH ETER ALARM ANDSITUATIO NS TH AT MAY C AUSE AN IAB CATH ETER ALARM ANDDESCRIBES APPROPRIATE INTERVENTIONDESCRIBES APPROPRIATE INTERVENTIONDESCRIBES APPROPRIATE INTERVENTIONDESCRIBES APPROPRIATE INTERVENTION

DESCRIBE WHY THE FOLLOWING SITUATIO NS MAY CAUSE AN IAB

CATHETER ALARM

1. Pt. sitting straight up in bed

2. IAB has not exited the sheath

C .C .C .C . G AS LOSS - ID ENTIFIES ANG AS LOSS - ID ENTIFIES ANG AS LOSS - ID ENTIFIES ANGAS LOSS - IDENTIFIES AND RECOMMENDS APPROPRIATED RECOMMENDS APPROPRIATED RECOMMENDS APPROPRIATED RECOMMENDS APPROPRIATEACTION FOR POTENTIAL LOSS OF HELIUMACTION FOR POTENTIAL LOSS OF HELIUMACTION FOR POTENTIAL LOSS OF HELIUMACTION FOR POTENTIAL LOSS OF HELIUM

1. What does blood in the IAB catheter shuttle gas tubing indicate?

2. Describe the nursing considerations that would be involved

3. What status message would appear if the IAB catheter became disconnected from

the console?


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D .D .D .D . D EMONSTRATES UND ERSTAND ING O F TH E HEMO D YNAMICDEMONSTRATES UNDERSTANDING OF THE HEMODYNAMICDEMONSTRATES UNDERSTANDING OF THE HEMODYNAMICDEMONSTRATES UNDERSTANDING OF THE HEMODYNAMICRELATIONSH IP BETWEEN TH E PATIENT AND IABP TH ERAPYRELATIONSH IP BETWEEN TH E PATIENT AND IABP TH ERAPYRELATIONSH IP BETWEEN TH E PATIENT AND IABP TH ERAPYRELATIONSH IP BETWEEN TH E PATIENT AND IABP TH ERAPY

DESCRIBE WHY THE FOLLOWING FACTORS WOULD CAUSE THE

DIASTOLIC AUGMENTATION ALARM TO SOUND:

1. Increased heart rate 2. Decrease in patient stroke volume

3. Ectopy

4. Increase in patient BP

5. Decreased SVR

E.E.E.E. TIMING - RECO G NIZES, IND IC ATES PO TENTIAL C LINIC ALTIMING - RECOGNIZES, INDICATES POTENTIAL CLINICALTIMING - RECOGNIZES, INDICATES POTENTIAL CLINICALTIMING - RECOGNIZES, INDICATES POTENTIAL CLINICALIMPLICATIONS AND DEMONSTRATES APPROPRIATE INTERVENTIONIMPLICATIONS AND DEMONSTRATES APPROPRIATE INTERVENTIONIMPLICATIONS AND DEMONSTRATES APPROPRIATE INTERVENTIONIMPLICATIONS AND DEMONSTRATES APPROPRIATE INTERVENTIONFOR THE FOLLOWING:FOR THE FOLLOWING:FOR THE FOLLOWING:FOR THE FOLLOWING:

1. Early inflation 2. Late inflation

3. Early deflation

4. Late deflation

F.F.F.F. MISCELLANEOUSMISCELLANEOUSMISCELLANEOUSMISCELLANEOUS

a.a.a.a . PORTABLE OPERATION:PORTABLE OPERATION:PORTABLE OPERATION:PORTABLE OPERATION:

1. Initiates and terminates portable operation

2. Identifies location of battery charge light

b.b.b.b. SLAVE CABLES: (IF APPLICABLE)SLAVE CABLES: (IF APPLICABLE)SLAVE CABLES: (IF APPLICABLE)SLAVE CABLES: (IF APPLICABLE)

1. Identif ies location and use of ECG and/or pressure cables

2. Describes proper use of ECG slave cable in the presence of pacemakers

INSTRUCTOR SIGNATURE:INSTRUCTOR SIGNATURE:INSTRUCTOR SIGNATURE:INSTRUCTOR SIGNATURE:COMMENTS:COMMENTS:COMMENTS:COMMENTS:


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REFERENCE LISTREFERENCE LISTREFERENCE LISTREFERENCE LIST

Claflin, N.; guest editor, AACN Clinical Issues in Critical Care Nursing - Standards and QualityAssurance, Vol. 2, No. 1, J.B. Lippincott Company, Philadelphia, February 1991

Gould, K.A., Critical Care Nursing Clinics of North America, Mechanical Assist For The Failing Heart,

W.B. Saunders Company, Philadelphia, 1989

Guyton, A.C., Textbook of Medical Physiology, Seventh Edition; W.B. Saunders Company, Philadelphia,1986

Kinney, M.R.; Dear, C.B.; Packa, D.R.; Voorman, D.N., AACN's Clinical Reference For Critical CareNursing, Second Edition; McGraw Hill Book Company, 1988

Millar, S.; Sampson, L.K.; Soukup, M., AACN Procedure Manual for Critical Care, W.B. SaundersCompany, Philadelphia, 1985

Quaal, S.J., Comprehensive Intra-aortic Balloon Pumping, CV Mosby Company, St.Louis, 2nd Edition1993

Quaal, S.J.; guest editor, AACN Clinical Issues in Critical C are Nursing -Cardiac Assist D evices, Vol 2,No. 3, J.B. Lippincott Company, Philadelphia, August 1991

Underhill, S.l.; Wood, S.L.; Sivarajan, E.S.; Halpenny, C.J., Cardiac Nursing, Second Edition; J.B.Lippincott, Philadelphia, 1989

Vazquez, M.; Engman Lazear, S.; Larson, E.L., Critical Care Nursing, Second Edition, W.B. SaundersCompany, Philadelphia, 1992

Vender, J.S.; guest editor, Critical Care Clinics - Intensive Care Monitoring, W.B. Saunders Company,Philadelphia, 1989


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BIBLIOGRAPHYBIBLIOGRAPHYBIBLIOGRAPHYBIBLIOGRAPHY

THEORYTHEORYTHEORYTHEORY

Joseph, D.; Bates, S., Intra-aortic Balloon Pumping - How to Stay on Course, American Journal of Nursing1990 September; 90(9):42-47

Maccioli, G.A., Ed., Intra-aortic Balloon Pump Therapy, Baltimore Williams &Wilkins, 1997

Maccioli, G .A.; Lucas, W.J.; Norf leet, E.A., The Intra-aortic Balloon Pump: A Review, Journal ofCardiothoracic Anesthesia 1988; 2:365-373

Shinn, A.E.; Joseph, D., Concepts of Intraaortic Balloon Counterpulsation, Journal of CardiovascularNursing 1994; 8(2):45-60

Whitman, Gayle, Intra-aortic Balloon Pumping and C ardiac Mechanics: A Programmed Lesson, H eartand Lung 1978; 7(6):1034-1050

Wolvek, Sidney, The Evolution of the Intra-aortic Balloon: The Datascope Contribution, Journal ofBiomaterials Applications 1989 April; 3:527-542

INDICATIONSINDICATIONSINDICATIONSINDICATIONS

Anwar, A.; Mooney, M.R.; Stertzer, S.H., Intra-Aortic Balloon Counterpulsation Support for ElectiveCoronary Angioplasty in the Setting of Poor Left Ventricular Function: A Two Center Experience, TheJournal of Invasive Cardiology 1990 July/August; 1(4):175-180

Bolooki, Hooshang, 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

Califf, R.M.; Ohman, E.M., Reocclusion After Thrombolytic Therapy and Percutaneous TransluminalCoronary Angioplasty, Cardiac Assists 1990 March; 5(2)

Dietl, C.A.; Berkheimer, M.D.; Woods, E.L.; Gilbert, C.L.; Pharr, W.F.; Benoit, C.H., Efficacy and Cost-Effectiveness of Preoperative IABP in Patients with Ejection Fraction of 0.25 or Less, Annals of ThoracicSurgery 1996;62:401-409

Emmerman, C.L.; Pinchak, A.C.; Hagen, J.F., Hemodynamic Effects of the Intra-aortic Balloon PumpDuring Experimental Cardiac Arrest, American Journal of Emergency Medicine 1989 July; 7:373-383

Emery, R.W.; Eales, F.; Joyce, L.D., Mechanical Circulatory Assistance After Heart Transplantation, Annalsof Thoracic Surgery 1991; 51:43-7

Freedman, Jr., R.J., MD, Myoconservation in Cardiogenic Shock - The Use of Intra-Aortic BalloonPumping and Other Treatment Modalities, Cardiac Assists, 1992 January; 6(2)

Freedman, Jr., R.J., MD, The Intra-Aortic Balloon Pump System: Current Roles and Future Directions,Journal of Applied Cardiology, 1991, Vol. 6, pp. 313-318


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George, Barry S., Thrombolysis and Intra-Aortic Balloon Pumping Following Acute Myocardial Infarction-Experience in Four TAMI Studies, Cardiac Assists, 1988 October; 4(3)

Georgen, R.F.; Dietrick, J.A.; Pifarre, R., Placement of Intra-Aortic Balloon Pump Allows Definitive BiliarySurgery In Patients with Severe Cardiac D isease, 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 ofCardiology 1989; 64:937-938

Grotz, R.L.; Yeston, N.S., Intra-Aortic Balloon Counterpulsation in High-Risk Cardiac PatientsUndergoing Non-Cardiac Surgery, Surgery 1989 July; 106(1):1-5

Gunnar, R.M.; Bourdillon, P.D.V.; Dixon, D.W., Guidelines for the Early Management of Patients WithAcute Myocardial Infarction, American College of Cardiology 1990 August; 249-292

Gurbel, P.A.; Anderson, R.D; MacCord, C.S.; et al, Arterial Diastolic Pressure Augmentation byIntra-aortic Balloon Counterpulsation Enhances the Onset of Coronary Artery Reperfusion by

Thrombolytic Therapy, Circulation 1994; 89(1):361-365

Ishihara, M., MD; et al, Intra-Aortic Balloon Pumping as the Postangioplasty Strategy in Acute MyocardialInfarction, American Heart Journal, August 1991, 122(2), pp. 385-389.

Kahn, J.K., MD, Intra-Aortic Balloon Pumping: Theory And Clinical Applications A Monograph For TheClinician, Communications Media for Education, Inc., Princeton, NJ 1991 March

Kahn, J.K.; Rutherford, B.D.; McConahay, D.R., Supported "High Risk" Coronary Angioplasty UsingIntraaortic Balloon Pump Counterpulsation, Journal of American College of Cardiology 1990 April;15:1151-5

Kern, M.J.; Aguirre, F.; Bach, R.; et al, Augmentation of Coronary Blood Flow by Intra-aortic BalloonPumping in Patients After Coronary Angioplasty, Circulation 1993 February; 87(2):500-511

Kern, M.J.; Aguirre, F.V.; Tatineni, S.; et al, Enhanced Coronary Blood Flow Velocity During IntraaorticBalloon Counterpulsation in Critically Ill Patients, Journal of the American College of Cardiology 1993February; 21(2):359-368

Kern, M.J., MD, Intra-Aortic Balloon Pumping Post-Angioplasty -Documentation of Increased CoronaryBlood Flow, Cardiac Assists, 1992 June, Vol. 6, pp. 1-5

Kern, M.J., MD, Intra-Aortic Balloon Counterpulsation, Coronary Artery Disease, August 1991, 2(6), pp.

649-660

Lane, A.S.; Woodward, A.C.; Goldman, M.R., Massive Propranolol Overdose Poorly Responsive toPharmacologic Therapy: Use of the Intra-aortic Balloon Pump, Annals of Emergency Medicine 1987December; 16(12):1381-1383

Lazar, Harold L,.MD; et al, Role of Percutaneous Bypass in Reducing Infarct Size After Revascularizationfor Acute Coronary Insufficiency, Circulation 1991; 84 [suppl III]: III-416-III-421


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Mangano, D.T.; Browner, W.S.; Hollenberg, M., Association of Perioperative Myocardial Ischemia WithCardiac Morbidity and Mortality in Men Undergoing Noncardiac Surgery, The New England Journal ofMedicine 1990 December 27; 323(26):1781-8

Mercer, D.; Doris, P.; Salerno, T.A., Intra-aortic Balloon Counterpulsation in Septic Shock, The CanadianJournal of Surgery 1981 November; 24(6):643-645

Ohman, E.M.; George, B.S.; White, C.J.; et al, Use of Aortic Counterpulsation to Improve SustainedCoronary Artery Patency During Acute Myocardial Inf arction. Results of a Randomized Trial,Circulation 1994 August; 90(2):792-799

Ohman, E.M.; Calif f, R.M.; George, B.S., et al, The Use of Intra-Aortic Balloon Pumping as an Adjunctto Reperfusion Therapy in Acute Myocardial Infarction, American Heart Journal 1991 March; 121(3)

Schreiber, T.L. MD; et al, Management of myocardial infarction shock: Current status, American HeartJournal 1989 February, 117(2):435-443

Siu, S.C.; et al, Intra-Aortic Counterpulsation Support in the High-risk Cardiac Patient Undergoing Urgent

Noncardiac Surgery, Chest, June 1991, 99(6), pp. 1342-1345

Stomel, R.J.; Rasak, M.; Bates E.R., Treatment Strategies for Acute Myocardial Infarction Complicated byCardiogenic Shock in a C ommunity Hospital, Chest 1994; 105(4):997-1002

COMPLICATIONSCOMPLICATIONSCOMPLICATIONSCOMPLICATIONS

Barnett, M.G.; Swartz, M.T.; Peterson, G.J.; et al, Vascular Complications from Intraaortic Balloons: RiskAnalysis, Journal of Vascular Surgery 1994 January; 19(1):81-89

Brodell, G.K.; Tuzcu, E.M.; Weiss, S.J., Intra-aortic Balloon Pump Rupture and Entrapment, ClevelandClinic Journal of Medicine 1989 October; 56(7):740-742

Eltchaninoff, H.; Dimas, A.P.; Whitlow, P.L., Complications Associated with Percutaneous Placement andUse of Intraaortic Balloon Counterpulsation, American Journal of Cardiology 1993 February; 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, S.F., Vascular Complications of the Patient Undergoing Intra-Aortic Balloon Pumping, CriticalCare Nursing Clinics of North America, September 1989, 1(3): 459-467

Gottlieb, S.O.; Brinker, J.A.; Borken, A.M., et al, Identification of Patients at High Risk for Complicationsof Intra-aortic Balloon C ounterpulsation: A Multivariate Risk Factor Analysis, American Journal ofCardiology 1984; 53:1135-1139

Kantrowitz, A.; Wasfie, T.; et al, Intra-aortic Balloon Pumping 1967 through 1982: Analysis ofComplications in 733 Patients, American Journal of Cardiology 1986; 57:976-983

Kvilekval, Kara H.V., MD; et al, Complications of Percutaneous Intra-aortic Balloon Pump Use in PatientsWith Peripheral Vascular D isease, Archives of Surgery, May 1991, Vol. 126, 621-623.


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Lazar, H.L., MD; et al, Outcome and Complications of Prolonged Intraaortic Balloon Counterpulsationin Cardiac Patients, American Journal of Cardiology April 1992, Vol 69 955-958

Schecter, D.; Murali, S.; Uretsky, B.F., Vascular Entrapment of Intra-aortic Balloon After Short TermBalloon Counterpulsation, Catheterization and Cardiovascular Diagnosis 1991; 22:174-176

Stahl, K.D.; et al, Intra-aortic Balloon Rupture, Trans AM Soc Artif Intern Organs, 1988, Vol. XXXIV,

496-499

INSERTIONINSERTIONINSERTIONINSERTION

Gorton, M.E.; Soltanzadeh, H., Easy Removal of Surgically Placed Intra-aortic Balloon Pump Catheter,Annals of Thoracic Surgery 1991; 51:325-6

Heebler, Robert F., Simplified Technique for Open Placement and Removal of Intra-aortic Balloon,Annals of Thoracic Surgery 1989; 48:134-6

Nash, I.S., MD; et al, A New Technique for Sheathless Percutaneous Intra-aortic Balloon CatheterInsertion, Archives of Surgery, May 1991, Vol. 126, 57-60

Phillips, Steven J., MD; et al, Sheathless Insertion of the Percutaneous Intra-aortic Balloon Pump: AnAlternate Method, Annals of Thoracic Surgery 1992; 53:162

Shahian, D.M.; Jewell, E.R., Intra-aortic Balloon Pump Placement through Dacron Aortofemoral Grafts,Journal of Vascular Surgery 1988 June; 7:795-7

PEDIATRICSPEDIATRICSPEDIATRICSPEDIATRICS

Anella, J.; McCloskey, A.; Vieweg, C., Nursing Dynamics of Pediatric Intra-aortic Balloon Pumping,Critical Care Nurse 1990 April; 10(4):24-28

del Nido, P.J.; et al, Successful Use of Intra-aortic Balloon Pumping in a 2-kilogram Infant, Annals ofThoracic Surgery 1988 November; 46:574-576

Dunn, Jeffrey M., The Use of Intra-Aortic Balloon Pumping in Pediatric Patients, Cardiac Assists 1989June; 5(1)

Nawa, Sugato MD; et al, Eff icacy of Intra-aortic Balloon Pumping for Failing Fontan Circulation Chest1988 March; 93/3: 599-603

Veasy, L.G.; Blalock, R.C.; Orth, J., Intra-aortic Balloon Pumping in Infants and Children, C irculation1983; 68(5):1095-1100Webster, H.; Veasy, L.G., Intra-aortic Balloon Pumping in Children, Heart and Lung 1985; 14(6)

TRANSPORTTRANSPORTTRANSPORTTRANSPORT

Bellinger, R.L.; Califf, R.M.; Mark, D.B., Helicopter Transport of Patients During Acute MyocardialInfarction, American Journal of Cardiology 1988 April; 61:718-722


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Gottlieb, S.O.; Chew, P.H.; Chandra, N., Portable Intra-aortic Balloon Counterpulsation: ClinicalExperience and Guidelines for Use, Catheterization and Cardiovascular Diagnosis 1986; 12:18-22

Kramer, R.P., Jr., Helicopter-Transported Intra-Aortic Balloon Pumping: Advanced Technology MadeAirborne, Cardiac Assists 1988 June; 4(2)

Mertlich, G.; Quaal, S.J., Air Transport of the Patient Requiring Intra-Aortic Balloon Pumping, Critical

Care Nursing Clinics of North America, September 1989, 1(3); 443-458

NURSING CARENURSING CARENURSING CARENURSING CARE

Bavin, T.K.; Self, M.A., Weaning From Intra-Aortic Balloon Pump Support, American Journal of Nursing,October 1991, 54-59

Patacky, M.G.; Garvin, B.J.; Schwirian, P.M., Intra-aortic Balloon Pumping and Stress in the CoronaryCare Unit, Heart and Lung 1985 March; 14(2)

Quaal, S.J., Guest Ed., Critical Care Clinics of North America, Philadelphia, W.B. Saunders December1996; 8(4)

Shoulders, Odom, Managing the Challenge of IABP Therapy, Critical Care Nurse 1991 February;11(2):60-76

Weinberg, L.A.; Buying Time with an Intra-Aortic Balloon Pump, Nursing 1988 September; 44-49


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41

Clinical Support ServicesSeminar for IABP

Subjective Evaluation

1

Poor

2

Fair

3

Good

4

VeryGood

5

Excellent

1. Please rate the overall quality of the program

2. Please rate how well this program met yourpersonal objectives

3. How well did this program meet thefollowing objectives?

a. Define the two (2) physiological effectsachieved by the mechanics of inflation anddeflation of the IAB as it relates to the cardiaccycle illustrated by an augmented arterialpressure waveform

b. Identify four (4) indications and three (3)contraindications for IABP therapy.

c. Delineate the major clinical complicationsassociated with IABP therapy.

d. Discuss the operation and troubleshooting ofthe Datascope IABP utilizing the AbbreviatedOperators Guide and Performance Checklist.

4. Please Rate the Following

Content

a. Theory of IABP

b. Technical recommendations for Datascope IABP

c. Clinical considerations for an IABP patient

Speakers Presentation

a. Theory of IABP

b. Technical aspects of Datascope IABP

c. Clinical considerations for an IABP patient

d. Teaching strategies and presentation style

5. Please rate how well the program willchange and/or validate your practice

6. Please rate the educational tools usedduring the program

a. Teaching manual

b. Abbreviated Operators Guide

c. Audiovisual Materials

7. Please rate the program facilities


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DatascopeDatascopeDatascopeDatascope Corp.Corp.Corp.Corp.Cardiac Assist DivisionCardiac Assist DivisionCardiac Assist DivisionCardiac Assist Division

15 Law Drive15 Law Drive15 Law Drive15 Law DriveFairfield, NJ 07004Fairfield, NJ 07004Fairfield, NJ 07004Fairfield, NJ 07004Tel. 1-973-244-6100Tel. 1-973-244-6100Tel. 1-973-244-6100Tel. 1-973-244-6100

P/N 0002-08-0295P/N 0002-08-0295P/N 0002-08-0295P/N 0002-08-0295 D atascope C orp. 1998 D atascope C orp. 1998 D atascope C orp. 1998 D atascope C orp. 1998

datascope_s98xt_tech_seminar[1] copy.pdf

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