IABP, VAD, ICD & IABP, VAD, ICD & Pacemaker TherapiesPacemaker Therapies

Diane E. White RN CCRN PhDDiane E. White RN CCRN PhD

Intraortic Balloon Pump Intraortic Balloon Pump TherapyTherapy

Indications: less than 30% EF, MI, sepsis, Indications: less than 30% EF, MI, sepsis, LV failureLV failure

ContraindicationsContraindicationsTheory: decrease workload by Theory: decrease workload by

decreasing afterload, thus increasing decreasing afterload, thus increasing oxygen supply and decreasing demandoxygen supply and decreasing demand

40cc Helium Balloon40cc Helium Balloon Inserted into descending thoracic aortaInserted into descending thoracic aorta

IABPIABP

Timing is Essential: EKG “R” wave is Timing is Essential: EKG “R” wave is used to time deflation of balloon used to time deflation of balloon during onset of systole. Diacrotic notch during onset of systole. Diacrotic notch of arterial wave form is used to time of arterial wave form is used to time inflation of balloon during diastole.inflation of balloon during diastole.

.5-1.0 Liter increase in cardiac output.5-1.0 Liter increase in cardiac outputWeaning the IABPWeaning the IABPComplicationsComplicationsNursing RoleNursing Role

Ventricular Assist DevicesVentricular Assist Devices

Indications: PCWP > 25, MAP < 60, Indications: PCWP > 25, MAP < 60, UO < 20 cc/hr, CI < 1.8, SVR > 2100UO < 20 cc/hr, CI < 1.8, SVR > 2100

History: 1935 developed IABP then in History: 1935 developed IABP then in 1953 the assist device was 1953 the assist device was developed. First used in animals then developed. First used in animals then in late 1950’s and 1960’s used in in late 1950’s and 1960’s used in humanshumans

VADVAD

Types: roller pumps, centrifugal Types: roller pumps, centrifugal pumps, and pneumatic devicespumps, and pneumatic devices

Operation modes: fixed rate, Operation modes: fixed rate, synchronous, fill-to-emptysynchronous, fill-to-empty

Implantation: need IABP, can be used Implantation: need IABP, can be used in one ventricle or bothin one ventricle or both

Weaning: trial every 4 hours x 2 Weaning: trial every 4 hours x 2 based on parametersbased on parameters

VADVAD

Complications: bleeding, Complications: bleeding, disconnection, coagubility problems, disconnection, coagubility problems, emboliemboli

Nursing Role: homodynamics, IABP, Nursing Role: homodynamics, IABP, prevent infection, labs, CT drainage, prevent infection, labs, CT drainage, anticoagulant tx, Ventilator mgt, EKG anticoagulant tx, Ventilator mgt, EKG monitoring, sedation/paralytics, & monitoring, sedation/paralytics, & psychosocial supportpsychosocial support

Pacemaker TherapyPacemaker Therapy

IndicationsIndicationsTypes: Temporary (external and Types: Temporary (external and

tranvenous), Permanenttranvenous), PermanentControls: On/off, rate control, Controls: On/off, rate control,

electrical output (ma), & sensitivity electrical output (ma), & sensitivity controlcontrol

Modes: demand & asynchronousModes: demand & asynchronousNursing RoleNursing Role

Pacemaker TherapyPacemaker Therapy

Terminology:Terminology:Capture – depolarization Capture – depolarization Threshold – minimal energy required for Threshold – minimal energy required for

capturecaptureSensitivity – generators ability to “sense” Sensitivity – generators ability to “sense”

patient's own heart beatpatient's own heart beatFailure to capture – generate initiates Failure to capture – generate initiates

pulse but no responsepulse but no responseFailure to sense – spikes fall on/near Failure to sense – spikes fall on/near

patient’spatient’s

Implantable Cardioverter Implantable Cardioverter DefibrillatorDefibrillator

Indications: Cardiac arrest secondary Indications: Cardiac arrest secondary to V-Tach, or V- Fib, spontaneous VT, to V-Tach, or V- Fib, spontaneous VT, syncope of undetermined originsyncope of undetermined origin

Procedure: implanted pectoral area, Procedure: implanted pectoral area, 24 hour stay24 hour stay

Transitional care: teaching, no lifting Transitional care: teaching, no lifting more than 10 lbs. for 1 month, or more than 10 lbs. for 1 month, or over the head activities, 1-2 week over the head activities, 1-2 week check-up post-opcheck-up post-op

ICDICD

Avoid certain activities alone such as Avoid certain activities alone such as boating, swimming, etc. boating, swimming, etc.

Security alarms, driving, machinery, Security alarms, driving, machinery, magnetic fields, cellular phone usemagnetic fields, cellular phone use

Psychosocial Care: fearPsychosocial Care: fearCall within 24 hour of shock, or Call within 24 hour of shock, or

repeated shockrepeated shock Immediate EMS if multiple shocks Immediate EMS if multiple shocks

and/or symptomaticand/or symptomatic