Transcript IABP, VAD, ICD & Pacemaker Therapies

IABP, VAD, ICD &
Pacemaker Therapies
Diane E. White RN CCRN PhD
Intraortic Balloon Pump Therapy
Indications: less than 30% EF, MI, sepsis,
LV failure
 Contraindications
 Theory: decrease workload by decreasing
afterload, thus increasing oxygen supply
and decreasing demand
 40cc Helium Balloon
 Inserted into descending thoracic aorta

IABP
Timing is Essential: EKG “R” wave is used
to time deflation of balloon during onset
of systole. Diacrotic notch of arterial wave
form is used to time inflation of balloon
during diastole.
 .5-1.0 Liter increase in cardiac output
 Weaning the IABP
 Complications
 Nursing Role

Ventricular Assist Devices
Indications: PCWP > 25, MAP < 60, UO <
20 cc/hr, CI < 1.8, SVR > 2100
 History: 1935 developed IABP then in
1953 the assist device was developed.
First used in animals then in late 1950’s
and 1960’s used in humans

VAD
Types: roller pumps, centrifugal pumps,
and pneumatic devices
 Operation modes: fixed rate, synchronous,
fill-to-empty
 Implantation: need IABP, can be used in
one ventricle or both
 Weaning: trial every 4 hours x 2 based on
parameters

VAD
Complications: bleeding, disconnection,
coagubility problems, emboli
 Nursing Role: homodynamics, IABP,
prevent infection, labs, CT drainage,
anticoagulant tx, Ventilator mgt, EKG
monitoring, sedation/paralytics, &
psychosocial support

Pacemaker Therapy
Indications
 Types: Temporary (external and
tranvenous), Permanent
 Controls: On/off, rate control, electrical
output (ma), & sensitivity control
 Modes: demand & asynchronous
 Nursing Role

Pacemaker Therapy

Terminology:
 Capture
– depolarization
 Threshold – minimal energy required for
capture
 Sensitivity – generators ability to “sense”
patient's own heart beat
 Failure to capture – generate initiates pulse
but no response
 Failure to sense – spikes fall on/near patient’s
Implantable Cardioverter Defibrillator
Indications: Cardiac arrest secondary to VTach, or V- Fib, spontaneous VT, syncope
of undetermined origin
 Procedure: implanted pectoral area, 24
hour stay
 Transitional care: teaching, no lifting more
than 10 lbs. for 1 month, or over the head
activities, 1-2 week check-up post-op

ICD
Avoid certain activities alone such as
boating, swimming, etc.
 Security alarms, driving, machinery,
magnetic fields, cellular phone use
 Psychosocial Care: fear
 Call within 24 hour of shock, or repeated
shock
 Immediate EMS if multiple shocks and/or
symptomatic
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