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 aortic lumen. This apparatus 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 on the background of acute myocardial infarction.
- Refusal of the cardiopulmonary bypass.
- Damage to the septum between the stomachs.
- The situation before the operation.
Not so often, this operation has a positive effect on blood circulation:
- Ventricular pressure decreases.
- Myocardial oxygen demand is reduced.
- The blood flow rises.
Carrying out such a procedure requires maintaining a cardiac index, because of this, additional drugs are needed.
Iabc balton intra-aortic balloon counterpulsation set
The kit includes:
- Seldiger needle, conductor 11 m long 45 cm, introducer sheath with hemostatic valve, scalpel.
- To measure the pressure, a catheter 91 cm long is connected through the PSA, on one side there is a three-way valve, and on the other a Luer cap.
- To remove air, you need a syringe of 60 ml.
- To connect the PSA to the security camera, you will need a catheter, the length of which is 150 centimeters.
Catheter placement procedure
A catheter is inserted through an artery located in the thigh, then it is advanced until the left subclavian artery leaves. The distance is measured in advance by ultrasound or X-ray:
- First you need to probe the femoral artery between the frontal tubercle and the ilium.
- Next, the site is processed, and the patient is covered with gauze dressings.
- A syringe is attached to the cylinder and negative pressure is created, the cylinder is removed from the package.
- A 10 ml needle is required, it is introduced continuously at an angle of 45 degrees until it enters the femoral artery, blood from it will easily enter the syringe.
- The syringe is disconnected, a conductor is drawn along the needle, there should be no resistance.
- Using a scalpel, a small incision is made and a dilator is passed through the conductor, which subsequently remains in the artery.
- Next, a balloon is taken and the insertion length is measured, the proximal end is drawn through the balloon, so that it exits through a special port.
- The dilator is removed and the place is pressed so that there is no bleeding.
- The conductor is removed.
- It is necessary to quickly select a line for measuring pressure and rinse through a special valve that is connected to the cylinder, then connect it to the VBC console and observe the pressure curve on the monitor.
- If the process is slowed down, then nothing will come of it; the cylinder will have to be reinstalled.
- In some situations, IBD is turned on initially, the weight depends on the "curve" of pressure.
What are the indications for intraaortic balloon counterpulsation?
Indications for the use of IBD has become much greater since the moment the device was first used. The purpose of the appointment is to make equal the need for special therapeutic measures related to the inhalation of oxygen, the appointment of various drugs, solutions, if this does not help and the case is absolutely critical, then the patient is shown IBD:
- Weak heart contractions caused by shock conditions.
- An increase in the zone of necrosis.
- Developing angina pectoris.
- Disruption of blood circulation, which is provoked by ventricular arrhythmias.
- Heart damage.
- Damage to the septum or detachment of the papillary muscles.
- Surgical intervention for diseases with coronary insufficiency.
- The need to connect a cardiopulmonary bypass.
- Reduced load before surgery. Heart transplantation is one of the available operations in the West, for its implementation, patients first receive those medications that will help support the contractile function of the heart (over a long period of time, since there are very few donor hearts). Most often, vasoactive drugs are used that increase the contractile function of the ventricle. Such treatment helps, but there are cases when the body does not respond to the procedure, so you have to try other methods to solve the problem. So, with the help of cardiological manipulations of intra-aortic balloon counterpulsation, the hemodynamics of the patient can be stabilized.
- Thrombolysis with a heart attack.
- Low ejection syndrome.
- Patient transportation. There are those patients who, having suffered a heart attack, are first treated in their medical facilities, and only after some time are redirected to other specialized hospitals. It is such 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 violations of contractile function, acute heart failure (caused by drugs).
- If traditional methods do not help, then IBD will come in handy as never before.
- If you apply the procedure during surgery, it will improve coronary blood flow.
It is also possible to expand indications for intra-aortic balloon manipulation at the discretion of the attending doctor.
Contraindications
The main factor to remember is the conduct of IBD only in those people whose left ventricular function can recover.
PBC should not be used if:
- Arterial thrombosis.
- The vessels of the lower extremities are affected.
- Tumor processes.
- Renal or liver failure, last stage.
Deterioration during IBD
- Decreased blood circulation in the vessels, lack of pulse, pain at the site of IBD, ischemia can occur in 13-45% of people who use the procedure. Patients should be constantly monitored by doctors, 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 This complication is not so often seen, but nevertheless, redness or itching may appear at the site of the operation. If this happened, then sterility measures should be followed and a little 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, you need to do a seeding of secretions to find out which of the microorganisms caused an inflammatory reaction. This situation should make you think about reviewing treatment.
- Sepsis can occur, which can lead to death.
- Balloon rupture. If blood appears in the place where the gas is supplied, then most likely the balloon exploded. The risk of gas leakage is great, so you need to remove the balloon very quickly, while placing the person so that gas does not enter the brain.
Advantages and disadvantages
After the procedure has been carried out, the work of the heart completely changes in a positive direction. The patient can observe such a positive trend:
- The load on the heart is reduced.
- Cardiac output increases.
- Blood is saturated with oxygen.
- Blood stasis in lung tissue is gradually reduced.
- The bloodstream circulates faster.
- The exposure period is quite long.
- Preoperative preparation is fast.
Complications may occur, cardiac output increases, but not by much. An operation is performed when the heart has its own contractions.
Terms of withdrawal
After the pressure and the main indicators return to normal, the rhythm of counterpulsation must be reduced. All procedures must be carried out under the supervision of specialists. When the cardiological manipulation of intra-aortic balloon counterpulsation is already turned off, this means that the support from the drugs is reduced, at this time various measurements of heart contractions are performed. If the results are good, then the ratio of medicines is reduced to 1: 3, heparin is stopped, and if the platelets reach the norm, then the balloon can be removed. A system that works in a 1 to 3 ratio does not need to be left in the aorta for too long, otherwise a blood clot may form, which will lead to sad consequences.
A balloon is installed with the help of surgeons, 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. The standby button is pressed on the screen and it is checked whether the balloon is inflated. You need to have several tampons with you, you need to carefully pull the bottle, but in a different direction, not the way it was inserted. Squeeze the place of withdrawal and keep up to 30 minutes. Next, you need to monitor the condition of the person and the place from which the balloon was taken.
After the catheter is removed, the arteries may become clogged and the patient's condition worsens. Factors that can make you feel unwell are:
- Diabetes.
- Little weight.
- Diseases of the internal organs.
- Retirement age (after 70).
Intra-aortic balloon counterpulsation (IABA) is one of the effective methods that helps maintain heart function.
Conclusion
The device for IBD 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 with the use of IBD is growing every day, and now this method is an important part of the treatment process.