1. IABP, VAD, ICD & Pacemaker Therapies Diane E. White RN CCRN PhD

2. Intraortic Balloon Pump Therapy Indications: less than 30% EF, MI, sepsis, LV failure Indications: less than 30% EF, MI, sepsis, LV failure Contraindications Contraindications Theory: decrease workload by decreasing afterload, thus increasing oxygen supply and decreasing demand Theory: decrease workload by decreasing afterload, thus increasing oxygen supply and decreasing demand 40cc Helium Balloon 40cc Helium Balloon Inserted into descending thoracic aorta Inserted into descending thoracic aorta

3. 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. 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.5-1.0 Liter increase in cardiac output Weaning the IABP Weaning the IABP Complications Complications Nursing Role Nursing Role

4. Ventricular Assist Devices Indications: PCWP > 25, MAP 2100 Indications: PCWP > 25, MAP 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 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

5. VAD Types: roller pumps, centrifugal pumps, and pneumatic devices Types: roller pumps, centrifugal pumps, and pneumatic devices Operation modes: fixed rate, synchronous, fill-to-empty Operation modes: fixed rate, synchronous, fill-to-empty Implantation: need IABP, can be used in one ventricle or both Implantation: need IABP, can be used in one ventricle or both Weaning: trial every 4 hours x 2 based on parameters Weaning: trial every 4 hours x 2 based on parameters

6. VAD Complications: bleeding, disconnection, coagubility problems, emboli 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 Nursing Role: homodynamics, IABP, prevent infection, labs, CT drainage, anticoagulant tx, Ventilator mgt, EKG monitoring, sedation/paralytics, & psychosocial support

7. Pacemaker Therapy Indications Indications Types: Temporary (external and tranvenous), Permanent Types: Temporary (external and tranvenous), Permanent Controls: On/off, rate control, electrical output (ma), & sensitivity control Controls: On/off, rate control, electrical output (ma), & sensitivity control Modes: demand & asynchronous Modes: demand & asynchronous Nursing Role Nursing Role

8. Pacemaker Therapy Terminology: Terminology: Capture – depolarization Capture – depolarization Threshold – minimal energy required for capture Threshold – minimal energy required for capture Sensitivity – generators ability to “sense” patient's own heart beat Sensitivity – generators ability to “sense” patient's own heart beat Failure to capture – generate initiates pulse but no response Failure to capture – generate initiates pulse but no response Failure to sense – spikes fall on/near patient’s Failure to sense – spikes fall on/near patient’s

9. Implantable Cardioverter Defibrillator Indications: Cardiac arrest secondary to V- Tach, or V- Fib, spontaneous VT, syncope of undetermined origin Indications: Cardiac arrest secondary to V- Tach, or V- Fib, spontaneous VT, syncope of undetermined origin Procedure: implanted pectoral area, 24 hour stay 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 Transitional care: teaching, no lifting more than 10 lbs. for 1 month, or over the head activities, 1-2 week check-up post-op

10. ICD Avoid certain activities alone such as boating, swimming, etc. Avoid certain activities alone such as boating, swimming, etc. Security alarms, driving, machinery, magnetic fields, cellular phone use Security alarms, driving, machinery, magnetic fields, cellular phone use Psychosocial Care: fear Psychosocial Care: fear Call within 24 hour of shock, or repeated shock Call within 24 hour of shock, or repeated shock Immediate EMS if multiple shocks and/or symptomatic Immediate EMS if multiple shocks and/or symptomatic