INTRA AORTIC BALLOON PUMP Zahra Arab.M.Sc .student of critical care nursing - PowerPoint PPT Presentation

Loading...

PPT – INTRA AORTIC BALLOON PUMP Zahra Arab.M.Sc .student of critical care nursing PowerPoint presentation | free to download - id: 649ac7-NmIwN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

INTRA AORTIC BALLOON PUMP Zahra Arab.M.Sc .student of critical care nursing

Description:

20/2/89 z.Arab.M.Sc Conclusions The consistent application of intra-aortic balloon pump support of patients with coronary artery disease and its complications has ... – PowerPoint PPT presentation

Number of Views:467
Avg rating:3.0/5.0
Slides: 39
Provided by: goumsAcI3
Learn more at: http://www.goums.ac.ir
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: INTRA AORTIC BALLOON PUMP Zahra Arab.M.Sc .student of critical care nursing


1
(No Transcript)
2
INTRA AORTIC BALLOON PUMPZahra Arab.M.Sc
.student of critical care nursing
3
????? ???????
  • ??????? ?? ???? ??? ???? ????? ? ???? ??? ??
  • ?????? ????? ???????? ??? ??????? ? ????? ????
    ???
  • ???? ??????? ??????? ???????? ?? ??????? ????????
    ??
  • ????????? ??????? ?? ???? ???

4
  • ???? ??? ???? ????? ?? ????? ???? ??? ?? ????
    ????? ???? ??? ? ??? ??? ???? ??? ???? ?? ???.
  • ????? ??? ?? ??? 1967 ???? ???? ?? ???
    ?????????? ???? ????? ??.
  • ???? ?? ??? ?? ?? ????? ???? ??? ???? ? ??? ?????
    ?????? ??? ??? ????? ?? ????? ????? ?? ??? ???
    ???? ????? ?? ??????? ???? ?????? ?? ???? ???????
    ????.

5
The System 97e is a helium charged, mobile,
Intra-Aortic Balloon Pump (IABP).
6
Intra-aortic balloon catheter
7
(No Transcript)
8
Insertion Techniques
  • There are alternative routes for balloon
    insertion.
  • In patients with extremely severe peripheral
    vascular disease or in pediatric patients the
    ascending aorta or the aortic arch may be entered
    for balloon insertion.
  • Other routes of access include
    subclavian
    axillary
    iliac arteries

9
  • It is inserted into the descending aorta via the
    femoral artery either percutaneously or by
    surgical cut-down.
  • It should be positioned so that the tip is
    approximately 1 to 2 cm below the origin of the
    left subclavian artery and above the renal
    arteries.
  • On chest x-ray the tip should be visible in the
    2nd or 3rd intercostal space

10
IABP-correct placement
11
Timing
  • Two primary methods
  • Conventional timing
  • Real timing

12
Isovolumetric contractionSystole
Ejection
  • Isovolumic relaxation
  • Diastole
  • Ventricular filling

13
Arterial waveform
Arterial waveform With IABP
14
Inflation
  • It inflates immediately following aortic valve
    closure to augment diastolic coronary perfusion
    pressure.

15
  • ?Aortic diastolic pressure
  • ?Aortic root pressure
  • ?Coronary perfusion pressure
  • ?Oxygen supply
  • Inflation of IABP Causes

16
Deflation
  • The balloon rapidly deflates just before
    ventricular systole to reduce Left Ventricular
    work
  • Deflation creates a "potential space" in the
    aorta, reducing aortic volume and pressure

17
  • ?Aortic end-diastolic pressure
  • ? Impedance to ejection
  • ? Afterload
  • ? Oxygen demand
  • ? Cardiac output
  • Deflation of the IABP Causes

18
? ??? ????? ????? ?? ???? ??? ???? ??? (??? ??
???? ??? ????? ????? ) ????? ??????? ?????????
??? ?????? ?? ????.
19
? ??? ????? ????? ?? ???? ???? ??? ????? ?????
???? ???????? ????? ?? ?? ??? ???? ???? ??? ??? ?
???????? ?? ????? ???? ?? ????? ??? ???? ????
????? ?? ???.
20
? ??? ????? ????? ?? ???? ??? ????? ???( ???? ??
??? ??????? ????? ???) ????? ???? ???????? ?????
? ???????? ?? ????? ???? ?? ????? ???? ??? ?????
?? ???.
21
? ??? ????? ????? ?? ????? ????? ??? ??? ?????
??????? ???? ??? ?????? ?? ????.
22
???? ?? ???? ?????? ?? 1379?? ?????? ?? ?? ???
????? ????? ??? ???? ?????? ?? ??????? ?? ?????
????? ???? ?? ?? ????? ????? ??? ??? ???? ?????
???? ??? ?? ???? ???? ?????? ????? ???? ????? ??
???? ?????? ? ???? ????? ????? ?????? ???? ??????
???. ????? ?? ?? ???? ?? ?? ??????? ?? ????? ???
?? ???? ?? ?? ?? (????? ?????? ???? ?? ????? ???)
?????? ?? ???? ?? ?? ?? ?? ????. ?????? ????? ??
?? ?? ??????? ?????? ?????? ??????? ?? ????????
?? ??? ???? ???? ????? ???? ????? ????? ????
??????? ? ???? ?? ??????? ?? ????? ??? ???.
23
Indications
  • 1. Refractory ventricular failure
  • 2. Cardiogenic shock
  • 3. Unstable refractory angina
  • 4. Impending (To threaten to happen) infarction
  • 5. Mechanical complications due to acute
    myocardial infarction
  • 6. Ischemia related intractable (Difficult to
    manage) ventricular arrhythmias

24
  • 7. Cardiac support for high-risk general surgical
    and coronary angiography/ angioplasty patients
  • 8. Septic shock
  • 9. Weaning from cardiopulmonary bypass
  • 10. Support for failed angioplasty and
    valvuloplasty

25
Contraindications
  • 1.Severe aortic valve insufficiency
  • 2. Abdominal or aortic aneurysm
  • 3. Severe calcific aorta-iliac disease or
    peripheral vascular disease
  • 4. Scarring of the groin

26
Potential Side Effects and Complications
  • Bleeding at the insertion site
  • Thrombocytopenia
  • Immobility of the balloon catheter
  • Balloon leak
  • Infection
  • Aortic dissection during insertion

27
  • Peripheral emboli
  • Balloon rupture with gas embolus
  • Renal failure (balloon occlusion of renal artery)
  • Vascular insufficiency of catheterized limb

28
???? ?? ????
  • ??? ???? ???????? ?? ??? 1384 ???????? ?? ?????
    ?????? ?? ??? ???? ???? ??? ?? ???????? ?? ??
    ????? ??? ??? ????? ??????? ???? ???? ? ????????
    ?? ????? ??? ????? ??? ?? ??? ?? ???? ??30 ????
    ????? ??? ??? ???? ????? ?? ???? ????? . ??
    ???????? ?? ?? ????? ??? ??? ???? ?? ?????
    ??????? ????? ??????? ???? ? ????? ???? ?????
    ????? ??? ???? ?? ?? ???? ???.

29
????????? ??????? ?? ????? ????? ????? ???
  • ?????? ??? ??? ????? ??????? ?????? ????? ??? ???
    ??? ?? ????? ????? ????? ??? ??? ???? ? ???? ??
    ????.
  • ????????? ????? ???? ???????? ? ????? ????????
    ??????? ??? ?????.
  • ?????? ??? ??? ????? ?????? ???? ???????? ???????
    ?? ???
  • ???? ? ??? ? ???? ???.
  • ????? ???? ???? ?? ???? ????? ?? 1??2 ???? ???
    ??????? ?? ????? ?????.
  • ?.??????? ?? ?? ???? ???? ?? ????? ???? ??? ???.

30
  • ?.????? ????? ?? ??? ???? ????? ????? ????????.
  • ?.????? ???? ????? ?????? ? ??? ?? ????? ?? ????
  • 60??70 ???? ??? ???? ? ????? ???? ?? ??????.
  • ?.?? ??? ???? ???? ???? ??????? ???????? ????.
  • ?.??????? ?? ???????? ( ????? ????? ???????
    ?????) ?????? ?????? ??? ??????.

31
  • ?.??????? ?? ??? ????.
  • ?.????? ??????? ????? ?????? ?? ??? ??? ??????.
  • ?.????? ????? ????? ?? ??? ???? ??? ????
    ???????????
  • ???? ????? ??? ???? ??? ???.
  • ?.????? ???? ?? ???????? ????? ???? ??
    ??????????? ??????????????? ????? ????
  •  

32
Indications for weaning
  • Hemodynamic stability
  • Cardiac indexgt2L/min/m²
  • Pulmonary artery wedge pressurelt20mmHg
  • Systolic blood pressuregt100mmHg
  • Minimal requirements for vasopressor support
  • Evidence of adequate cardiac function
  • Good peripheral pulses
  • Adequate urine output
  • Evidence of good coronary perfusion

33
???? ???????
  • 1.??????? ????? ?????.???? ???? ??????? ?????? ??
    ????? ?? ??????? ???? ?????11? ??? 12???? 13
    ??? ????? 14 ????? ?????
  • 2.???? ?????? ??? ?????? ?????
  • 3.?????? ?? ?? ??? ????

34
Conclusions
  • The consistent application of intra-aortic
    balloon pump support of patients with coronary
    artery disease and its complications has provided
    a therapeutic platform for direct surgical
    intervention on otherwise unstable patients with
    cardiac ischemia, heart failure, and shock.
  • This integrated approach to the treatment of
    patients with coronary artery disease has
    profoundly affected how this disease process is
    managed throughout the world.

35
  • Arterial insufficiency is the most common
    complication of IABP therapy.
  • Patient requiring IABP are managed much like any
    other critically ill patient.

36
?????
  • 1.???? ??????-????.??????? ????????? ???? ?? ??
    ??? ?? ?? ??? ??????.??? ?????.1387?150-157
  • 2. ??? ???? ?????. ?? ????? ?????. ????? ???
    ????. ????? ?????? ????? ??? ???? ????? ??
    ??????? ????? ??? . ???? ??????? ???? ?????
    ?????. ???? ??????? ????? 48. ??? ?????? ???
    1384?55-60
  • 3.?????? ????? ???. ????? ????? ??? ???? ??????
    ?? ??????? ?? ????? ????? ???? ?? ?? ????? ?????
    ??? ???. ??????? ???? ????? ???????? . ?????
    ??????? 1379 4(1 (????? 6))1-7.
  • 4.Morton.P, Fontaine.D. Critical Care NursingA
    holistic Approch.9th editionWolters
    Kluwer,lippincott Wilkins2008. pp365-374
  • 5.Black.J, Hawks.J. Medical Sergical Nursing.7th
    editionElsevier 2005.pp
  • 6.Weigand DL, editor AACN procedure manual for
    critical care, ed 6, Philadelphia, 2010,
    Saunders.

37
Thank you
38
Cycle leading to cardiogenic shock
About PowerShow.com