Intra-Aortic Balloon Counter Pulsation

Balloon Catheter

Control Console

Helium Gas Supply

Tubing and Connector

Patient preparation

Medical History: Assess for the patient’s history of cardiovascular, peripheral vascular and bleeding disorders.

Physical Exam: Undertake overall evaluation with special emphasis on the cardiovascular and peripheral vascular systems.

 Laboratory Tests: Check complete blood count, electrolytes, coagulation profile, renal function and other related tests.

Obtain Informed Consent: Make sure that the Patient has filled and signed a consent form on the risk and benefits of the examination.

Access Site Preparation: The femoral artery is the usual site. Ensure the site is clean and prepared with antiseptic solution. Shave the area if necessary.

Pre-Medication: Give any pre-procedure medicines if a patient needs any for relaxation or for pain such as sedation or analgesia.

Patient position

Head of Bed (HOB) Position: However, the head of the bed is only elevated to an angle of no more than 30 degrees. The semi-Fowler’s position thus helps in reducing the pressure over the femoral artery (if inserted via the femoral route) and prevents the migration of the balloon.

Leg Position: Depending on which leg was placed distal to the femoral insertion site the opposite leg should be positioned with the knee straight or fully extended.

Step 1-Preparation:

Gather Equipment: An IABP machine, a balloon catheter, sterile drapes, local anesthetics and, in case ultrasound guidance is required an ultrasound machine.

Explain the Procedure: Inform the patient about the procedure if they are conscious.

Prepare the Insertion Site: Normally the femoral artery is utilized; however, the axillary artery is sometimes employed as an alternate site. The skin area is cleaned and is prepared with sterile drapes.

Step 2-Insertion of the Sheath and Balloon Catheter:

Anesthetize the Site: Local anesthesia is administered to the access site.

Insert Sheath: Intravascular protection is provided by the form of a vascular sheath placed into the femoral artery to create an access portal for the balloon catheter.

Insert Balloon Catheter: Inflate larger balloon catheter is inserted moving it over the sheath to the descending aorta and place it below the left subclavian artery but above the renal arteries.

Fluoroscopy or ultrasound guidance may be used to place the needle accurately.

Step 3-Connect to IABP Console and Set Timing:

Connect Balloon Catheter to the IABP Console: The catheter is then attached to the IABP device by which the inflation and deflation are determined.

Set Counter pulsation Timing: The timing of inflation and deflation is synchronized with the cardiac cycle.

Inflation happens just after the second heart sound, at the beginning of diastole and deflation happens just before the first heart sound, to support the cardiac output.

Step 4-Start IABP Therapy:

Inflate and Deflate the Balloon: During diastole, the balloon inflates, creating a counter pulsation effect that pushes blood toward the coronary arteries, improving myocardial perfusion.

During systole, the balloon deflates rapidly, reducing afterload and assisting with ventricular ejection.

Monitor Hemodynamic Response: It is possible to track arterial pressure, frequency and other constants during therapy continuously, and, thus, evaluate the necessity of changes in the therapy processes.

Step 5-Ongoing Monitoring and Adjustments:

Check Balloon Position Regularly: Regularly assess the balloon position through imaging if available, as displacement can compromise the effectiveness of therapy.

Monitor for Complications: Bleeding, ischemia, thrombosis of the balloon or artery/vein rupture, distal limb ischemia should be alerted for to limit long term complication.

Step 6-Weaning and Removal: Weaning from IABP, after stabilizing of the patients’ condition finally wean the IABP off, decreasing the frequency of inflations.

Balloon Removal: After attaining this stage, the balloon catheter is retrieved to free the patient from support that they may no longer need.

The femoral artery sheath is also removed, and the puncture site is managed to prevent bleeding or hematoma formation.

Step 7-Post-Procedure Care:

Monitor for Hemodynamic Stability: Supervise the patient for signs of worsening of the clinical state after removal of IABP.

Watch for Complications: Vascular complications, infection or any problems like bleeding may occur after removing an appendix and therefore, continue checking the patient.

Complications

Vascular Complications

Arterial Injury or Dissection: The insertion of the catheter may harm arterial wall and cause dissection or other vessel complication. Thrombosis and Embolism: Blood clot formation around the catheter tip can lead to emboli, potentially causing limb ischemia or other systemic embolic events.

Bleeding and formation of hematoma

Access-Site Bleeding: Consequently, insertion usually takes place in the femoral artery through which bleeding at the puncture site can occur if the patient is on anticoagulant agents.

Thrombosis and Embolism: Blood clotting can occur around the catheter tip, possibly creating emboli leading to limb ischemia or systemic embolic events.
Bleeding and Hematoma Formation
Access-Site Bleeding: The common site of insertion is the femoral artery, making this patient at increased risk for bleeding at the puncture site, especially if the patient is anticoagulated.
Retroperitoneal hemorrhage: In rare cases, bleeding can track up into the retroperitoneal space, leading to an unrecognized and potentially fatal bleed.

Infection: The foreign body’s presence increases the odds of infection at the point of insertion and may ascend to deeper tissue and even sepsis if promptly not addressed.
Balloon Rupture and Gas Embolism:
Balloon rupture can lead to helium release into the bloodstream with potential induction of an embolism, though is very reduced by modern designs.
Rupture of the balloon also tends to leave fragments in the bloodstream, which urgently need removal.