Intraaortic balloon pump insertion is traditionally performed through the femoral artery in the groin. The right or left common femoral artery often serve as access sites of choice; on rare occasions, the left brachial access can be considered (Figure 15.1A). Resistance usually indicates aorto-iliac disease, and in this case the balloon should be withdrawn and the aorto-iliac segment reassessed by angiography. On CXR it should be at the level of the AP window . However, this restricts the patient to bed rest, and prolonged implantation can be associated with infections in the groin crease. Intra-aortic balloon pump (partially inflated) in situ along with the usual post cardiac surgery lines (ETT, SGC, chest drain). Diagram showing correct placement of an intraaortic balloon pump. Dotted lines indicate the LSCA take-off (top) and the level of the inferior border of the transverse arch (bottom). Historically, IABPs are inserted through the femoral artery and patients are placed on bed rest. If the balloon functions well and timing is set correctly, the augmentation wave should be greater than the systolic pressure, and postdeflation aortic end-diastolic pressure should be 10–15 mm Hg lower than the same parameter of a nonaugmented beat (Figure 15.2C). Editor—An intra-aortic balloon pump (IABP) is frequently used to support patients with haemodynamic instability, such as that associated with cardiogenic shock, ischaemic heart disease, postsurgical myocardial dysfunction, or septic shock. The IABP inflates in diastole, increasing blood flow to the coronary arteries. After IABP insertion, peripheral pulses on both lower extremities must be checked regularly and frequently, and daily chest x-rays and general laboratory values (CBC, serum electrolytes, PTT) should be obtained. Note that the tip is 1 to 2 cm from the left subclavian artery (LSCA) take-off. The IABP balloon was selected according to the height of the patients and then connected to a CS300 TM (Getinge AB, Gothenburg, Sweden). Abstract Intra-aortic balloon pump (IABP) counterpulsation is a useful circulatory support adjunct in the setting of refractory cardiogenic shock in critically ill patients. Balloon deflation should be set to occur immediately prior to the aortic valve opening, which usually coincides with the “R” wave on the ECG tracing. The balloon size is based on patient’s height: Patients taller than 183 cm receive 50-mL balloons, patients less than 162 cm receive 30-mL balloons, and all other patients receive 40-mL balloons. Inflation of the balloon in this position should not cause occlusion of either the renal or subclavian arteries. This website and all content found herein is provided “as is” and any reliance on the content or this website is solely at your own risk. Pacing spikes should be used to trigger the balloon in patients who are 100% paced. Kvilekval, Kara HV, et al. As the tip of the needle is in the lumen of the common femoral artery, the 0.030-inch or 0.032-inch, J-tip guidewire is inserted and advanced through the needle into the descending aorta. The balloon is capable of being inflated or deflated. There are many indications for IABP and institutional practice patterns regarding the placement of IABPs is variable. Assistant: Remove Balloon Catheter from tray, leaving Blue Sheath on Balloon, and One-Way-Valve connected, need Picture of IABP with Blue Sheath removed. B. Detach syringe from One-way-valve, leave One-way-valve connected to IABP catheter. 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