The apparatus for intra-aortic balloon counterpulsation is a mechanical device that, with a sharp decrease in the contractility of the left ventricle, instantly pumps blood into the lumen of the aorta. This device during the period of relaxation of the ventricles inflates the balloon at the ends of the catheter, which are connected to the artery, this function will provide oxygen to the internal organs and support the work of the heart.
Symptoms for applying counterpulsation
- Shock due to acute myocardial infarction.
- Rejection of the heart-lung machine.
- Injury to the septum between the stomachs.
- Situation before surgery.
Not often this operation has a positive effect on blood circulation:
- Ventricular pressure decreases.
- Needmyocardial oxygen is reduced.
- Blood flow increases.
Carrying out such a procedure requires maintaining a cardiac index, because of this, additional drugs are needed.
IABC b alton Intra-Aortic Balloon Pump Kit
Includes:
- Seldiger needle, guidewire 11 m 45 cm, sheath with hemostatic valve, scalpel.
- To measure pressure, a 91 cm catheter is attached through the VAB, with a three-way stopcock on one side and a luer cap on the other.
- You will need a 60 ml syringe to remove air.
- To connect the PSA to the security camera, you will need a catheter that is 150 centimeters long.
Catheter insertion technique
The catheter is inserted through the artery located in the thigh, then it is advanced until the left subclavian artery leaves. Distance measured in advance by ultrasound or x-ray:
- First you need to feel the femoral artery between the frontal tubercle and the ilium.
- Next, the area is treated and the patient is covered with gauze bandages.
- A syringe is attached to the balloon and negative pressure is created, the balloon is removed from the package.
- You will need a 10 ml needle, it is inserted continuously at a 45 degree angle until it enters the femoral artery, the blood from it will easily flow into the syringe.
- The syringe is disconnected, a conductor is passed through the needle, there should be no resistance.
- Using a scalpel, a small incision is made and a dilator is passed through the wire, which subsequently remains in the artery.
- Next, a balloon is taken and the insertion length is measured, the proximal end is passed through the balloon, and so that it exits through a special port.
- The dilator is removed and the area is pressed against bleeding.
- The conductor is removed.
- You need to very quickly select a line for measuring pressure and flush through a special valve that is attached to the cylinder, then connect it to the IBC console and observe the pressure curve on the monitor.
- If the process is slowed down, nothing will come of it, the balloon will have to be reinstalled.
- In some situations, the IBC turns on initially, the weight depends on the "curve" of pressure.
What are the indications for intra-aortic balloon pumping?
Indications for the use of IBD have become much larger since the device was first used. The purpose of the appointment is to equalize the need for special therapeutic measures associated with the inhalation of oxygen, the appointment of various drugs, solutions, but if this does not help and the case is completely critical, then the patient is shown IBD:
- Weak heart contractions caused by shock conditions.
- Increased necrosis zone.
- Developing angina.
- Impaired circulation caused by ventricular arrhythmia.
- Heart damage.
- Septal injury or papillary avulsionmuscles.
- Surgical intervention for diseases with coronary insufficiency.
- The need for a heart-lung machine.
- Reducing the load before the operation. Heart transplantation is one of the available operations in the West, for which patients first receive those medications that will help maintain the contractile function of the heart (for a long period of time, since there are very few donor hearts). Most often, vasoactive drugs are used, which increase the contractile function of the ventricle. Such treatment helps, but there are cases when the body does not react in any way to the procedures, so you have to try other methods to solve the problem. So, with the help of cardiological manipulations of intra-aortic balloon counterpulsation, it is possible to stabilize the patient's hemodynamics.
- Thrombolysis for myocardial infarction.
- Low output syndrome.
- Transportation of patients. There are patients who, having suffered a heart attack, are first treated in their medical institutions, and only after some time are redirected to other specialized hospitals. It is these patients who can be admitted to institutions with impaired hemodynamics, there are risks during their transportation, but the risk can be reduced by using IBD.
- Repeated contractile dysfunction, acute heart failure (drug-induced).
- If traditional methods don't help, then IBC will come in handy more than ever.
- If applied during surgery, it will improve coronary blood flow.
It is also possible to expand the indications for intra-aortic balloon manipulation at the discretion of the treating doctor.
Contraindications
The main factor to remember is to only perform IBD in people whose left ventricular function can recover.
VBC should not be used if:
- Arterial thrombosis.
- Vessels of the lower extremities are affected.
- Tumor processes.
- Renal or liver failure, last stage.
Deterioration during IBD
- Decrease in blood circulation in the vessels, lack of pulse, pain at the site of IBD, ischemia can occur in 13-45% of people who have the procedure. Patients should be under the constant supervision of doctors, the pulse and other characteristics should be checked several times. If there is a weakening of the pulse, then you need to remove the balloon.
- Infections. Such a complication is not so common, but nevertheless, redness or itching may appear at the site of the operation. If this happens, then sterility measures should be observed and a small treatment should be carried out if the problem begins to worsen. In the event that the patient's temperature rises, the place begins to fester, it is necessary to sow the secretions in order to find out which of the microorganisms caused the inflammatory reaction. This situation should lead to rethinking treatment.
- Sepsis may occur, possibly resulting in death.
- Cylinder rupture. If in the place wheregas is supplied, blood appears, then most likely the balloon exploded. The risk of gas leakage is high, so you need to remove the balloon very quickly, while placing the person so that the gas does not enter the brain.
Advantages and disadvantages
After the procedure was carried out, the work of the heart completely changes in a positive direction. The patient can observe the following positive dynamics:
- The load on the heart is reduced.
- Cardiac output increases.
- Blood is saturated with oxygen.
- Stagnation of blood in the lung tissue is gradually decreasing.
- The blood flow circulates faster.
- The exposure period is quite long.
- Preoperative preparation is fast.
Complications may occur, cardiac output increases, but not by much. The operation is performed when the heart has its own contractions.
Withdrawal deadlines
After the pressure and the main indicators return to normal, the counterpulsation rhythm must be reduced. All procedures must be carried out under the supervision of specialists. When already the cardiological manipulation of intra-aortic balloon counterpulsation is turned off, this means that the support from medications is reduced, at this time various measurements of heart beats are taken. If the results are good, then the ratio of drugs is reduced to 1:3, heparin administration is stopped, and if the platelets have reached the norm, then the balloon can be removed. A system that works at a ratio of 1 to3, do not leave in the aorta for too long, otherwise a blood clot may form, resulting in unfortunate consequences.
The balloon is installed with the help of the intervention of surgeons, it is removed in the same way. It is possible to remove it in a closed way, but you need to be sure that the balloon is deflated. On the screen, the standby button is pressed and the balloon is checked to see if it is inflating. You need to have several tampons with you, you need to carefully pull the balloon, but in a different direction, not the way it was inserted. You should press the place of withdrawal and hold for up to 30 minutes. Next, you need to monitor the condition of the person and the place where the balloon was removed from.
After the catheter is removed, the arteries may become blocked and the patient's condition will worsen. Factors that can make you feel bad are:
- Diabetes mellitus.
- Light weight.
- Diseases of internal organs.
- Retirement age (after 70).
Intra-aortic balloon pumping (IABP) is one effective method that helps keep the heart pumping.
Conclusion
The IBD machine is a tool that provides temporary support for the pumping function of the heart, this method is popular in the West. Any technology does not stand still, including this one. There are various courses for doctors, the trend of using IBD is growing every day and now this method is an important part of the treatment process
