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CCT: INTRA-AORTIC BALLOON PUMP (IABP)
PURPOSE
A. To provide guidelines for transporting a patient requiring Intra-Aortic Balloon Pump
management.
SCOPE
A. All current Lifeline employees
DEFINITIONS
A. None
GUIDELINES
A. All critical care transport clinicians will be responsible for maintaining clinical
competency as defined in the annual clinical education policy.
B. IABP equipment will be checked daily utilizing current check sheets and checkoff
documented per current practice.
C. For rotor transports, the IABP must be secured to the aircraft by approved aircraft
mounting plate meeting current FAA regulations. Hardware must be installed into the
aircraft/ambulance by authorized personnel who have completed the appropriate training.
D. For ground transports, the IABP will be secured in the supplied mounts or by using
existing mounting options available.
E. The transport IABP module will remain in the transport asset. Lifeline crews will
transport the patient from the room to the transport asset utilizing the referring facility’s
IABP. Changeover will occur at the transport asset whenever feasible.
PROCEDURE
A. Receive report and prepare the patient for transfer. In addition to standard monitoring
procedures, IABP monitoring should also include documentation of referring facility IABP
waveforms (1:2 assist ratio), assisted/unassisted pressures, and augmentation pressures.
B. Assess insertion site for any signs of bleeding, infection, or swelling. Document the catheter
insertion length utilizing the markers on the balloon pump sheath, if possible. Circulation
distal to insertion site should also be assessed. If needed, consider restraining distal
extremity of IABP insertion site.
C. Assess helium line for any signs of balloon rupture (rust colored flakes in line).
D. Accurate I/O’s should be monitored during transport to ensure adequate renal blood flow.
E. At bedside, patient will have transport IABP ECG monitoring leads attached to facilitate
transfer to IABP at the asset. If necessary, change pressure line set-up to oval cable
transducer to maintain continuity with IU Health equipment standards.
F. After preparations for transport are completed, patient should be transferred to asset while
remaining on referring facility’s IABP.
G. Once at the transport asset, power up transport IABP. Connect transport IABP ECG lead to
module. Once internal checks are complete, transfer helium line to transport IABP, ensure
auto mode is selected, max augmentation is set, and initiate pumping. Once pumping is
resumed, transfer all other connections (pressure, fiber optic if equipped) to transport pump
and make final preparations for transport.
H. Set augmentation alarm 10 mmHg below current augmentation.
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I. Arterial pressure transducer should be re-zeroed once cruise altitude has been established. If
additional altitude changes are required during transport, arterial pressure transducer should
also be re-zeroed with every 1000’ of altitude change.
J. Contact receiving facility with at least 10-minute estimated time of arrival and request ICU
staff to await crew arrival at helipad/ambulance bay with receiving facility IABP.
K. Contact Medical Control as necessary.
ADDITIONAL CONSIDERATIONS:
A. Helium Tank (CS300): Verify onboard helium tank has at least 100 psi.
B. IABP failure: In the event of IABP failure, disconnect catheter from pump. Quickly inflate
and deflate balloon with 10 mL less than balloon size of room air every 5 minutes. Notify
receiving facility so preparation for IABP replacement can be initiated. Do not let IABP
catheter sit more than 15 minutes with no movement or shuttling of air.
C. Gas Loss in IAB Circuit/Autofill Failure-Blood Suspected: If blood is noted inside
balloon lumen/catheter tubing (may be the color and consistency of brown/copper/rust fleck
of dirt), immediately disconnect from IABP and clamp off. Notify receiving facility
immediately. D. Alarms: All alarms (with exception of above-mentioned alarms) should be referenced in the
imbedded help menu on the control panel of the IABP. If unable to troubleshoot alarm and
resume operation, follow IABP failure procedure and notify receiving facility.
E. Deviations from standards: Understanding that some situations regarding IABP transports
will arise that necessitate deviation from this protocol, crews should conduct operations with
optimal patient care and best practice in mind. Any deviations from protocol should be
documented in the transport record.
F. Internal Helium Reservoir (Cardiosave Rescue): The IABP should be filled from the helium refilling station prior to every transport. The internal reservoir contains approxemently 36 fills that will be utilized according to the following:
a. 6 Fills: IABP balloon connected/reconnected and fill preformed for resume theropy
b. 6 Fills: IABP powered down\up and fill preformed for resume theropy
c. 1 Fill: Autofill every 2 hours
d. 1 Fill: Atmospheric pressure change 25mmHg decrease or altitude increase of 2000
feet
e. 1 Fill: Atmospheric pressure change 50mmHg increase or altitude decrease of 2000
feet
Required Documentation: A. Documentation of catheter size, IAB volume, insertion depth, and insertion site status should be
noted.
B. IABP trigger, frequency, and augmentation alarm settings will be documented at bedside and if
any changes are made during transport.
C. Augmented systolic/diastolic pressures, unaugmented systolic/diastolic pressures, and diastolic
augmentation should be noted every 15 minutes with waveform strips if possible. Waveform
strips from referring facility IABP and receiving facility IABP should also be attached to chart.
Citations/References: A. CARDIOSAVE Rescue Operating Instructions, Copyright 2015
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Intra-Aortic Balloon Pump (IABP) Checklist
Preflight: Date: Initials
IABP plugged in: Battery light on solid not flashing
Unplug IABP: Power on- check for low battery advisory
Check helium level: Indicator in red-change tank
Check IABP bag: comprehensive checklist is attached
Secure IABP in Aircraft-plug in cord.
After the pilot has the aircraft running ensure the inverter is turned on. If
“Battery in Use” message appears there is a problem with the inverter.
Switching to Transport IABP:
Record PTA IABP pre-switch readings on the hand off form
Briefly set IAB Freq1:2, “Print Strip” or quickly record unassisted pressures.
PTA IABP set to ECG trigger.
Connect Lifeline ECG cab les from Lifeline IABP to patient.
Connect Lifeline pressure cable from Lifeline IABP to transducer (switch
pressure transducer if connector not compatible with Lifeline cable).
Power on Lifeline IABP/helium on.
Confirm settings: ECG trigger, 1:1; Max Augmentation.
Zero transducer: off to patient, open vent to air, hold transducer at level of
heart and zero: after spike on screen, set transducer off to vent. Verify
accurate arterial waveform/readings. Reposition/Re-zero transducer if needed.
Place PTA IABP on standby. Switch IAB tubing to Lifeline IABP.
Press Start
Press Aug Alarm button, set alarm to 10mm/hg below augmentation pressure
OR press down arrow to turn alarm off.
Briefly set IAB Freq 1:2, then press “Print Strip” or quickly record unassisted
pressures.
Timing Rules:
Inflation:
Is the balloon inflating at the beginning of the dicrotic notch?
Is there a sharp V or gloved hand appearance?
Is there some rise in diastolic augmentation above native diastole?
Deflation:
Is the balloon deflating JUST prior to the next systole?
Is there a reduction in assisted End Diastolic Pressure compared to unassisted
EDP?
Is there a reduction in assisted systole compared to unassisted?
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IABP Pre transport Information Sheet
Call Request Date: Time:
Patient Transport Requested for: Date: Time:
Referring Facility Referring MD:
Name: Unit: Phone:
Receiving Hospital:
Receiving physician:
Phone number: Pager number:
Patient Name:
Patient Age: Patient Weight:
Diagnosis:
Neuro Additional History
Temp IABP settings
B/P Placement
Art line Augmented diastole CT loss
HR Assisted systolic/diastolic
Pacing Wires Unassisted systolic/diastolic NG
Monitor
Vent settings Alarm condition and how
Resolved
Bowel sounds
Breath sounds Fluid limit
Sao2 I/O
ABG Labs Pre-o wt
O2 K+ Post-o wt
pH Hct IV’s and sites
pO2 BS Additional notes
O2 sat Coag
BE
HCO3
Pedal pulses Drsgs
CVP CO
PA CI meds
PAW SvO2