Intra-aortic balloon pump therapy—a primer for perioperative nurses

AORN Journal,  July, 2006  by Roberta Schultz Tremper

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TROUBLESHOOTING IN THE OR

Challenges can occur when IABP therapy is used in the OR. The most frequent causes for IABP malfunction include the possibility that the

* balloon may not adequately augment CO,

* ECG trigger may not be functioning properly, or

* autofill function may fail. (15)

BALLOON MAY NOT AUGMENT CO ADEQUATELY.

The catheter may need to be repositioned if the pressure being generated by the balloon is inadequate to augment the patient's CO or is poorly augmenting CO. Profound hypovolemia or peripheral vasodilation also contribute to poor output augmentation and must be addressed by the anesthesia care provider.

THE ECG TRIGGER MAY NOT FUNCTION PROPERLY.

An ECG trigger that is not functioning properly can be caused by several factors. First, the perioperative nurse should ensure that electrodes are on the patient. The electrodes may have slipped off if the patient is sweating profusely or if prep solution has dampened the electrodes. Second, a patient undergoing cardiac surgery can experience a variety of cardiac rhythms. The perioperative nurse should make sure the patient has a rhythm that the IABP machine can identify. Machines in automatic mode should search for an appropriate lead; however, sometimes the voltage is so low that it does not recognize the R wave and, therefore, will not pump when the machine is placed on the ECG-trigger mode. Another trigger, such as pressure, may need to be used until the voltage increases. Electrosurgery also may cause artifact or disrupt the ECG trigger despite safeguards in the machine. The perioperative nurse should switch to the pressure-trigger mode temporarily until electrosurgery is complete, at which point he or she can switch the IABP machine back to the ECG-trigger mode.

AUTOFILL FUNCTION MAY FAIL. Autofill failure occurs when the gas outlet becomes plugged. A safety check must be performed after each use of the IABP machine. The previous operator may have forgotten to remove the sterile male Luer-lock cap. In this instance, the machine must be turned off, the cap removed, and then the machine restarted. If this does not fix the problem, another machine should be obtained and the failing machine sent for repair according to facility policy.

These are the most common types of problems encountered in the OR. It takes practice to identify these problems readily and develop the confidence to rectify them rapidly. The perioperative nurse should include in his or her report to the receiving nurse all information regarding the IAB insertion.

CONCLUSION

Perioperative nurses are responsible for many aspects of patient care. Although it may not be necessary for a nurse to be able to operate an IABP independently, it is extremely helpful for nurses to have a basic understanding of this therapy. Having a working knowledge of IABP therapy allows perioperative nurses to better anticipate the needs of the surgical team and help improve patient outcomes.

This program meets criteria for CNOR and CRFNA recertification, as well as other continuing education requirements.