TOP

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.

TOP

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

TOP

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?

TOP

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