CLINICAL SUPPORT SERVICES

DEVELOPING AN IABP
TEACHING STRATEGY

DATASCOPE IS NOW MAQUET CARDIOVASCULAR

Caution: U.S. Federal Law restricts this device to sale by or on the order of a physician.
Refer to package insert for current indications, warnings, contraindications, precautions and instructions for use.
Datascope is now MAQUET Cardiovascular
In early 2009, the purchase agreement between Datascope and Getinge AB was completed.
As a result, Datascope’s innovative cardiovascular product portfolio will be integrated into MAQUET
Cardiovascular, a global leader representing the Medical Systems Business area of Getinge AB.
Cardiac professionals have always relied on gold-standard Cardiac Assist products from Datascope,
helping them to feel confident that they are delivering the highest quality of care to their patients.
Now, as a part of MAQUET Cardiovascular, Datascope is even better positioned to focus on the future
advancement of Cardiac Assist products and seeks to explore the full potential of this technology
through our continued dedication to innovation, service and clinical excellence.

Quality Products:
Expect the same great quality products you have relied on over the years with names you are familiar
with like: Fidelity, Linear and Sensation IAB’s, CS300 balloon pumps, SafeGuard and StatLock.

Quality Service:
Rest assured that you will receive the same amazing service and clinical support you have become
accustomed to from Datascope. We are still here for you 24/7 with technical support, loaner
equipment and clinical help.

Worldwide:
MAQUET ranks among the leading providers of medical products, therapies and services for Surgical
Workplaces, Critical Care and Cardiovascular applications. Since its foundation more than 170 years
ago, MAQUET has stood for innovation and the advancement of patient care technologies in the field
of medicine. The portfolio of MAQUET products is extensive, providing a comprehensive solution that
is designed for efficient workflows, safety and the improvement of patient lives and outcomes.

Welcome to MAQUET Cardiovascular:

With a fresh vision of the future, this new, combined organization is committed to providing the highest
quality patient care solutions for cardiologists, interventional radiologists, cardiothoracic and vascular
surgeons, critical care clinicians and their teams.

For further information please visit www.datascope.com

Developing an IABP Teaching Strategy

Course Description
The program will provide lectures on the importance of in-house resources and specifies the important points to
incorporate into programs to ensure effectiveness. Methods for teaching the technical components of the equipment will
be demonstrated with time provided for hands-on. Support materials available from Datascope, such as presentations,
teaching manuals, etc. will be reviewed. Methods of maintaining clinical proficiency will also be discussed.

Behavioral Objectives
1. Describe the importance of strategic pre-planning for an intra-aortic balloon pump course.
2. List the three modules that comprise a complete intra-aortic balloon pump course.
3. List two components of a technical presentation of the intra-aortic balloon pump.
4. Describe two strategies for maintaining expertise.

1
Program Outline: Train the Trainer

8:30 – 9:00 Registration

9:00 – 9:15 Introduction/Program Review

9:15 – 10:30 I. Developing an IABP Course

Pre--Program Planning
A. Pre

II. IABP Program Content: Three Modules

A. Theoretical

10:30 – 10:45 Break

10:45 – 12:30 B. Technical

12:30 – 1:30 Lunch

1:30 – 2:30 C. Clinical Considerations

2:30 – 3:30 III. Hands-

Hands-on Workshop

3:30 – 3:45 Break

3:45 – 4:15 IV. Review of Support Materials

4:15 – 4:30 V. Maintaining Expertise

4:30 Evaluation

2
I. Developing an IABP Course

A. Pre
Pre -program Planning

1. Participants

a. Background

b. Attitude awareness

2. Institution

a. Role of the staff with the IABP

b Policy/procedure

c. Usage

3
II. Program Content

A. Theoretical

1. Review CV anatomy/physiology

a. Structure/position

b. Movement of valves in response to pressure gradients

c. Conduction system

d. Mechanical cardiac cycle

4
e. Pressure Waves

f. Normal Arterial Waveform

5
g. Coronary artery origination and phasic perfusion

h. MVO2 supply/demand determinants

Supply Demand

1. Coronary artery anatomy 1. Heart Rate

2. Diastolic pressure 2. Afterload

MVO2
3. Diastolic time 3. Preload

4. 02 Extraction 4. Contractility
a. Hgb
b. Pa02

6
i. Measurement of Cardiac Performance
Cardiac Output = heart rate x stroke volume
(normal – 4-6 liters/minute)

j. LV Failure

7
2. Theory of Intra-aortic Balloon Counterpulsation
a. Balloon structure and position
b. IAB Inflation – Primary Effects
1). Augmentation of diastolic pressure
2). Increased coronary perfusion
c. IAB Deflation – Primary Effects
1). Afterload reduction
2). Decreased left ventricular workload
3). Increased cardiac output

3. Trigger vs. Timing

a. Trigger

b. Timing

c. Predictive (Conventional) vs. R-wave deflation timing

8
d. Waveform Interpretation
1). Presence of “V”configuration between systolic and diastolic augmentation pressure
2). Diastolic augmentation ideally greater than systole
3). Reduction in aortic end diastolic pressure
4). Decreased assisted systolic pressure
5). Mean arterial pressure

e. Secondary effects
1). CO/CI
2). HR
3). PAD/PCWP
4). SVR
5). B/P:
Systolic
Diastolic
MAP
Diastolic augmentation

f. Systemic effects
1) Neuro
2) Renal
3) Vascular
4) Respiratory

9
 g. Indications

1) Refractory Unstable Angina

2) Impending Infarction
3) Acute MI
4) Refractory Ventricular Failure
5) Complications of Acute MI
6) Cardiogenic Shock
7) Support for diagnostic, percutaneous revascularization, and interventional procedures
8) Ischemia related intractable ventricular arrhythmias
9) Septic Shock
10) Intraoperative pulsatile flow generation
11) Weaning from bypass
12) Cardiac support for non-cardiac surgery
13) Prophylactic support in preparation for cardiac surgery
14) Post surgical myocardial dysfunction/low cardiac output syndrome
15) Myocardial contusion
16) Mechanical bridge to other assist devices
17) Cardiac support following correction of anatomical defects

h. Contraindications
1) Severe aortic insufficiency
2) Abdominal or aortic aneurysm
3) Severe calcific aorta-iliac disease or peripheral vascular disease
4) Sheathless insertion with severe obesity, scarring of the groin, or other contraindications to
percutaneous insertion

Please Refer to the Instructions for Use Prior to Insertion of the IAB

10
B. Technical: Intra-Aortic Balloon Catheter

Designed for sheathless or sheathed insertion

Fiberoptic IAB catheter

Conventional IAB Catheter

11
B. T echnical:
echnical: Intra-
Intra-Aortic Balloon Pump

1. Pneumatics

a. Safety Disk/Safety Chamber (Pediatrics)

b. Helium Supply

12
2. Electronics
a. Monitor Display

Alarm Messages Trigger

Advisories Heart Rate Display
ECG Pressure Display
Lead Systolic
Gain Diastolic
Pressure Source Mean
IAB Fill Mode Diastolic Augmentation
Slow Gas Alarm Status Augmentation Alarm
Operation Mode Helium Indicator
IAB Status Indicator Battery Indicator

13
b. CS100/CS300 IABP Key Pad Controls

Operation Mode Keys Zero Pressure Key START Key and Indicator
AUTO STANDBY Key and Indicator
Semi-Auto
Manual
Trigger Source Key IAB Frequency IAB Inflation Controls
ECG IAB Augmentation IAB Deflation Controls
Pressure
Pacer V/AV
Pacer A
Internal
Alarm Mute Key Menu Guide Inflation Interval Key
IAB Fill Key Ref Line Freeze Display Key
Help Key Indicator Aug. Alarm Print Strip Key
ECG/AP Sources
Pump Options
User Preferences

14
c. Recorder
1) ECG

2) Pressure

3) Balloon Pressure Waveform

15
The inflation marker shows the period of inflation. Vertical timing marks located below the arterial
waveform are also available to aid with initial timing. The timing markers indicate the point at which
the inflate and deflate commands are sent.

A unique automatic timing algorithm allows effective balloon pumping even during atrial fibrillation.
Press the Inflation Interval key to observe the period of inflation while pumping. Vertical markers
located below the arterial waveform and the highlighted portion indicate the period of balloon inflation.

16
3. Troubleshooting/CS100
a. Alarm Messages
1) Trigger Alarms
AUTO Operation Mode
a) No Trigger
b) Poor Signal Persists
Semi-
Semi-Auto or Manual Operation Modes
a) No Trigger
b) No Pressure Trigger
c) Check Pacer Timing
d) Trigger Interference
2) Catheter Alarms
a) Leak in IAB Circuit
b) Rapid Gas Loss
c) IAB Disconnected
d) Check IAB Catheter
e) Blood Detected
f) AutoFill Failure - No Helium
g) AutoFill Failure
h) AutoFill Required
3) Pneumatic Alarms
a) High Drive Pressure
b) Low Vacuum
4) System Surveillance Alarms
a) Electrical Test Fails Code # ________________
b) System Failure
c) Safety Disk Test Fails
b. Advisory Messages
1) Alert Messages
AUTO Operation Mode
a) Poor Signal Quality
b) No Pressure Source Available
c) Unable to Update Timing
Semi-
Semi-Auto or Manual Operation Modes
a) Irregular Pressure Trigger
b) Verify Proper Timing
c) ECG Detected
d) IAB not Filled
e) Manual Fill IAB
All Operation Modes
a) Prolonged time in Standby
b) Maintenance Required Code # _________________
c) No Patient Status Available
d) Low Helium
e) Low Battery
f) Low Battery [EXT]
g) Heart Rate Low

17
 2) Status Messages
AUTO Operation
Op eration Mode
a) Function Unavailable in the AUTO Operation Mode
Semi--Auto and Manual Operation Modes
Semi
a) Automatic Operation Mode is Disabled
b) Gas Loss and Catheter Alarms Disabled
c) Auto R-Wave Deflate
d) R-Wave Deflate
All Operation Modes
a) System Trainer
b) System Test OK
c) Autofilling
d) Leak Testing Safety Disk
e) Slow Gas Alarm is off
f) Battery in Use
g) Battery in Use [EXT]
3) Prompt Messages
a) Unplug Disk Outlet
b) Plug Disk Outlet
c) Manual Fill IAB
c. Patient Conditions
1) Atrial Fibrillation
2) Ectopics
3) Cardiac Arrest
4) Cardioversion/Defibrillation
d. Changing Helium Tank
e. Safety Disk Leak Test
f. Manual Fill
g. Manual Timing

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4. Troubleshooting/CS300

a. High Priority Alarms:

All Modes:
Augmentation Below Limit Set*
No Trigger
IAB Disconnected
Check IAB Catheter
Leak in IAB Circuit
Rapid Gas Loss
Blood Detected
Autofill Failure
Autofill Failure – No Helium
High Pressure Drive
Low Vacuum

AUTO Operation Mode:

Poor Signals Persist

Semi Auto or Manual Mode:

ECG Detected*
No Pressure Trigger
Trigger Interference
Check Pacer Timing
Autofill Required

Other:
Safety Disk Test Fails

* Pumping NOT suspended

b. Medium Priority Alarms:

All Modes:
IAB Optical Sensor Failure
Low Battery

AUTO Operation Mode:

Poor Signal Quality
No Pressure Source Available

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c. Low Priority Alarm:

AUTO Operation Mode:

Unable to Update Timing

d. Technical Alarms:

Electrical Test Fails Code #_____

System Failure
No Patient Status Available

e. Informational Messages:

All Modes:
A.P. Optical Sensing Module Failure
Unable to Calibrate IAB Optical Sensor
IAB Optical Sensor Calibration Expired
No Trigger
Prolonged Time In Standby
Autofilling
Auto Zeroing
Autofilling and Zeroing
Function Not Available
Low Helium
Battery in Use (EXT)
Battery In Use
System Test OK
System Trainer
Maintenance Required Code #_____
Slow Gas Loss Alarm is OFF
Leak In IAB Circuit – Overridden
Blood Detected – Overridden

AUTO Operation Mode:

Function Unavailable in Auto Operation Mode

AUTO or SemiAuto
SemiAuto Operation Mode:
Auto R-Wave Deflate
R-Wave Deflate

SemiAuto:
Irregular Pressure Trigger

20
 SemiAuto or Manual:
Verify Proper Timing
IAB Not Filled
Manual Fill IAB
Auto Operation Mode is Disabled
Gas Loss and Catheter Alarms Disabled

Manual Mode:
Manual Timing Selected – See Help

Other:
Install Safety Disk
Unplug Disk Outlet
Plug Disk Outlet
Leak Testing Safety Disk

f. Patient Conditions
1) Atrial Fibrillation
2) Ectopics
3) Cardiac Arrest
4) Cardioversion/Defibrillation

g. Changing Helium Tank

h. Safety Disk Leak Test

i. Manual Fill

j. Manual Timing

21
5. Factors Affecting Diastolic Augmentation
a. Patient Hemodynamics

1) Heart Rate

2) Stroke Volume

3) Arterial Pressure

4) System Vascular Resistance

b. Intra-Aortic Balloon

1) IAB in Sheath

2) IAB Not Unfolded

3) IAB Position

4) Kink in IAB Catheter

5) IAB Leak

6) Low Helium Concentration

c. IABP

1) Timing

2) Position of IAB Augmentation Control

22
6. Timing errors
Early Inflation
Inflation of the IAB prior to aortic
valve closure

Waveform Characteristics
• Inflation of IAB prior to dicrotic notch
• Diastolic augmentation encroaches onto
systole (may be unable to distinguish)

Physiologic Effects:
• Potential premature closure of aortic valve
• Potential increase in LVEDV and LVEDP or PCWP
• Increased left ventricular wall stress or afterload
• Aortic Regurgitation
• Increased MVO2 demand

Late Inflation
Inflation of the IAB markedly after closure
of the aortic valve

Waveform Characteristics:
Characteristics:
• Inflation of the IAB after the dicrotic notch
• Absence of sharp V
• Sub-optimal diastolic augmentation

Physiologic Effects:
• Sub-optimal coronary artery perfusion

23
Early Deflation
Premature deflation of the IAB during the diastolic phase

Waveform Characteristics
Chara cteristics
• Deflation of IAB is seen as a sharp drop
following diastolic augmentation
• Sub-optimal diastolic augmentation
• Assisted aortic end diastolic pressure may be equal
to or less than the unassisted aortic end diastolic pressure
• Assisted systolic pressure may rise

Physiologic Effects:
• Sub-optimal coronary perfusion
• Potential for retrograde coronary and carotid blood flow
• Angina may occur as a result of retrograde coronary blood flow
• Sub-optimal afterload reduction
• Increased MVO2 demand

Late Deflation
Deflation

Waveform Characteristics:
• Assisted aortic end-diastolic pressure may be equal to
the unassisted aortic end diastolic pressure
• Rate of rise of assisted systole is prolonged
• Diastolic augmentation may appear widened

Physiologic Effects:
• Afterload reduction is essentially absent
• Increased MVO2 consumption due to the left ventricle
ejecting against a greater resistance and a
prolonged isovolumetric contraction phase
• IAB may impede left ventricular ejection and
increase the afterload

24
7. Normal Balloon Pressure Waveform

25
 Variations in Balloon Pressure Waveforms

Heart Rate

Bradycardia Tachycardia
Increased duration of plateau Decreased duration of
due to longer diastolic phase. plateau due to shortened
diastolic phase.

Rhythm

Varying R-R intervals result in irregular plateau durations.

Blood Pressure

Hypertension Hypotension
Increased height or Decreased height or
amplitude of the waveform. amplitude of the waveform.

26
Gas Loss

Leak in the closed system causing the balloon pressure

waveform to fall below zero baseline. This may be due to a
loose connection, a leak in the IAB catheter, H2O
condensation in the external tubing, or a patient who is
tachycardic and febrile which causes increased gas diffusion
through the IAB membrane.

Catheter Kink

Rounded balloon pressure waveform, loss of plateau resulting

from a kink or obstruction of shuttle gas. This may be caused
by a kink in the catheter tubing, improper IAB catheter
position, sheath not being pulled back to allow inflation of the
IAB, the IAB is too large for the aorta, the IAB is not fully
unwrapped, or H2O condensation in the external tubing.

Sustained Inflation

Theoretical possibility if the IAB remains inflated longer than

2 seconds. The Datascope intra-aortic balloon pumps will
activate the System Failure alarm and deflate the IAB.

27
 DATASCOPE IABP PERFORMANCE CHECKLIST – CS 100
Name: Date ____________________
Hospital policy and procedures review: Date __________ Initials ______
Basic Intra - aortic balloon pump course: Date __________ Initials ______
Technical Seminar / Advanced Troubleshooting: Date(s) ________/________ Initials ________
Challenge Exam (if applicable): Date __________ Score: __________ ( P / F )
Directions for Instructor: Place your initials next to the skills the participant is able to perform. Leave blank the skills
requiring repeat performance. Clarify learning needs if necessary in the comment section. The “Clinical Setting” column
is an optional checklist for use by a preceptor or resource person for reinforcement of skills acquired on system trainer.

Skills System Trainer Clinical Setting

INITIAL SET UP
• Establish Power: Main power switch & IABP On/Off switch ⇒ ON
• Open helium tank and verify helium pressure
• Establish ECG and Pressure connections
ZERO TRANSDUCER
• Open the transducer
• Press the zero pressure key for 2 seconds
• Close the transducer
CONFIRM OPERATION MODE – AUTO
INITIATE PUMPING
• Attach IAB catheter & appropriate extender to safety disk
• Press the Start key and observe the Auto Filling message
• Verify optimal diastolic augmentation
• If desired, IAB deflation can be fine tuned using the IAB deflation
control.
VERIFY AUG. ALARM
• Verify Aug. Alarm setting is approximately 10mmHg less than the
patient’s augmented diastolic pressure
• Adjust, if necessary by pressing Aug. Alarm key and using the up
and down arrow keys, in the navigation circle, to change value
displayed on the screen
ASSESS HEMODYNAMIC BENEFITS
• Ensure optimal augmentation
• Ensure optimal afterload reduction
RECORD PRESSURES: ASSISTED & UNASSISTED
• Press Print Strip key to record waveforms
• Use Printer Menu in User Preferences to change printer settings

28
 DATASCOPE IABP PERFORMANCE CHECKLIST – CS 100
Skills System Trainer Clinical Setting
AUTO OPERATION MODE
• Describe ECG and pressure source selection
• Describe Trigger source selection
• Describe automatic timing and CardioSync 2 with R-Trac
SEMI-AUTO OPERATION MODE
• Describe ECG and pressure source selection
• Describe Trigger source selection
• Describe automatic timing and CardioSync 2 with R-Trac
TROUBLESHOOTING System Trainer Clinical Setting
DEMONSTRATES ABILITY TO IDENTIFY VARIABLE TRIGGER SELECTION CRITERIA AND APPROPRIATE USE OF EACH TRIGGER
• Atrial Fibrillation
• Demand Ventricular Pacemaker, Rate 60
• AV sequential pacemaker, demand mode
• Unobtainable ECG signal, regular rhythm, BP 100/50
• Cardiac arrest with good chest compressions
• Sinus Tachycardia
• Sinus Rhythm with frequent PVC'S
• Fixed rate AV sequential pacemaker
• Atrial pacemaker - 100% paced
EVALUATES SITUATIONS THAT MAY CAUSE AN IAB CATHETER ALARM AND DESCRIBES APPROPRIATE INTERVENTION
• Kink in the catheter or tubing
• Patient sitting straight up in bed
• IAB has not exited the sheath
IDENTIFIES AND RECOMMENDS APPROPRIATE ACTION FOR POTENTIAL LOSS OF HELIUM (“GAS LOSS”)
• Blood in the IAB catheter shuttle gas tubing
• IAB catheter disconnected from the console
DISCUSSES THE FOLLOWING ALARM AND ADVISORY MESSAGES
• Poor Signal Quality
• Poor Signal Persists
• No Pressure Source Available
• Unable to Update Timing

29
 DATASCOPE IABP PERFORMANCE CHECKLIST – CS 100
Skills System Trainer Clinical Setting
DISCUSSES THE HEMODYNAMIC RELATIONSHIP BETWEEN THE PATIENT AND IABP THERAPY IN REGARDS TO DIASTOLIC
AUGMENTATION
• Increased heart rate
• Decrease in patient stroke volume
• Ectopy
• Increase in patient BP
• Decreased SVR
DEMONSTRATES APPROPRIATE INTERVENTION FOR THE FOLLOWING ERRORS IN TIMING AND VERBALIZES POTENTIAL
CLINICAL IMPLICATIONS
• Early inflation
• Late inflation
• Early deflation
• Late deflation
PORTABLE OPERATION
• Initiates and terminates portable operation
• Identifies location of battery charge light
INTERFACE (SLAVE) CABLES ( IF APPLICABLE):
• Identifies location and use of ECG and/or pressure cables
• Describes proper use of ECG slave cable in the presence of
pacemakers

30
 DATASCOPE IABP PERFORMANCE CHECKLIST – CS300

Name: ________________________________________ Date ____________________

Hospital policy and procedures review: Date __________ Initials ______
Basic Intra - aortic balloon pump course: Date __________ Initials ______
Technical Seminar / Advanced Troubleshooting: Date(s) ________/________ Initials ________
Challenge Exam (if applicable): Date __________ Score: __________ ( P / F )
Directions for Instructor: Place your initials next to the skills the participant is able to perform. Leave blank the skills requiring repeat
performance. Clarify learning needs if necessary in the comment section. The “Clinical Setting” column is an optional checklist for use
by a preceptor or resource person for reinforcement of skills acquired on system trainer.

Skills System Trainer Clinical Setting

INITIAL SET UP
• Establish Power: Main power switch & IABP On/Off switch ⇒ ON
• Open helium tank and verify helium pressure
• Establish ECG and Pressure connections
If using a sensor IAB:
• Ensure the IAB Sensor Cable is connected to the sensor module
and clipped to helium extender tubing
If using conventional IAB/Transducer:
• Open transducer to air
• Press zero pressure key for 2 seconds
• Close transducer
CONFIRM OPERATION MODE – AUTO
INITIATE PUMPING
• Attach IAB catheter & appropriate extender to safety disk
• Press the Start key
If using a sensor IAB:
• Observe for the “Autofilling & Zeroing” message
If using conventional IAB/ transducer:
• Observe for the “Autofilling” message
• Verify optimal diastolic augmentation
VERIFY AUG. ALARM
• Verify Aug. Alarm setting is approximately 10mmHg less than
the patient’s augmented diastolic pressure
• Adjust, if necessary by pressing Aug. Alarm key and using the up
and down arrow keys, in the navigation circle, to change value
displayed on the screen
ASSESS HEMODYNAMIC BENEFITS
• Ensure optimal augmentation
• Ensure optimal afterload reduction
• If desired, IAB deflation can be fine tuned using the IAB deflation
control.
RECORD PRESSURES: ASSISTED & UNASSISTED
• Press Print Strip key to record waveforms
• Use Printer Menu in User Preferences to change printer settings

31
 DATASCOPE IABP PERFORMANCE CHECKLIST – CS300
Skills System Trainer Clinical Setting
AUTO OPERATION MODE
• Describe ECG and pressure source selection
• Describe Trigger source selection
• Describe automatic timing and CardioSync 2 with R-Trac
SEMI-AUTO OPERATION MODE
• Describe ECG and pressure source selection
• Describe Trigger source selection
• Describe automatic timing and CardioSync 2 with R-Trac
PRESSURE SOURCE - Describes understanding of how pressure source is
originated and calibrated
• Fiberoptics
• Conventional IAB/Transducer
TROUBLESHOOTING System Trainer Clinical Setting
DEMONSTRATES ABILITY TO IDENTIFY VARIABLE TRIGGER SELECTION CRITERIA AND APPROPRIATE USE OF EACH TRIGGER
• Atrial Fibrillation
• Demand Ventricular Pacemaker, Rate 60
• AV sequential pacemaker, demand mode
• Unobtainable ECG signal, regular rhythm, BP 100/50
• Cardiac arrest with good chest compressions
• Sinus Tachycardia
• Sinus Rhythm with frequent PVC'S
• Fixed rate AV sequential pacemaker
• Atrial pacemaker - 100% paced
EVALUATES SITUATIONS THAT MAY CAUSE AN IAB CATHETER ALARM AND DESCRIBES APPROPRIATE INTERVENTION
• Kink in the catheter or tubing
• Patient sitting straight up in bed
• IAB has not exited the sheath
IDENTIFIES AND RECOMMENDS APPROPRIATE ACTION FOR POTENTIAL LOSS OF HELIUM (“GAS LOSS”)
• Blood in the IAB catheter shuttle gas tubing
• IAB catheter disconnected from the console
DISCUSSES THE FOLLOWING ALARM AND INFORMATIONAL MESSAGES
• Poor Signal Quality
• Poor Signals Persist
• No Pressure Source Available
• Unable to Update Timing
• IAB Optical Sensor Failure
• AP Optical Sensing Module Failure
• Unable to Calibrate IAB Optical Sensor
• IAB Optical Sensor Calibration Expired

32
 DATASCOPE IABP PERFORMANCE CHECKLIST – CS300

SKILLS System Trainer Clinical Setting

DISCUSSES THE HEMODYNAMIC RELATIONSHIP BETWEEN THE PATIENT AND IABP THERAPY IN REGARDS TO DIASTOLIC
AUGMENTATION
• Increased heart rate
• Decrease in patient stroke volume
• Ectopy
• Increase in patient BP
• Decreased SVR
DEMONSTRATES APPROPRIATE INTERVENTION FOR THE FOLLOWING ERRORS IN TIMING AND VERBALIZES POTENTIAL
CLINICAL IMPLICATIONS
• Early inflation
• Late inflation
• Early deflation
• Late deflation
PORTABLE OPERATION
• Initiates and terminates portable operation
• Identifies location of battery charge light
INTERFACE (SLAVE) CABLES (IF APPLICABLE):
• Identifies location and use of ECG and/or pressure slave cables
• Describes proper use of ECG slave cable in the presence of
pacemakers
LOW LEVEL OUTPUT CABLE (IF APPLICABLE):
• Identifies location and use of low level output cable

33
8. Frequently asked questions
a. What adjustments do I need to make with:
sinus tachycardia

ventricular tachycardia

atrial fibrillation

pacemakers

asystole

b. Can I alter weaning settings if a patient’s condition deteriorates?

c. What happens with a balloon leak?

d. Where are the helium tanks stored and who is responsible for changing them?

e. How can we bring in ECG and pressure signals from our monitor?

f. How does the modem work?

g. How do I change the recorder paper and where is extra paper stored?

h. When can I view the help screens?

i. Other questions?

34
C. Clinical Considerations
Goal: Stress the similarities between the IABP patient and the critical cardiovascular patient while highlighting
differences.
the differences
1. Potential side effects/complications

a. Limb ischemia

b. Excessive bleeding from insertion site

c. Thrombocytopenia

d. Immobility of balloon catheter

e. Balloon leak

f. Infection

g. Aortic dissection

h. Compartment syndrome (may develop after IAB removed)

2. Review of care plan for the IABP patient

3. Care of the inner lumen

4. Weaning and removal

5. Transport

35
III. Hands-On Workshop

Set-
Set -up and use of the Datascope Intra-
Intra-Aortic Balloon Pump Trainer

• Trainer plugs into the direct ECG and Pressure input connectors on back of pump.
• The short phono plug cable connected to the trainer plugs into the Trainer Input jack on back of pump.
• Pump must be turned on in order for trainer to function.
• The SYSTEM TRAINER message will appear in the upper left corner of the monitor screen.
• Not all alarms and trainer simulations are listed.
• Trainer iiss NOT to be used while pump is being used for patient therapy.

Functions To Simulate

Press the “Pressure” key on trainer until “Vent” is highlighted, then press the “Zero”
Zeroing - Conventional IAB button on IABP keypad for 2 seconds. Once zeroed, press the “Pressure” key on
trainer until “Normal” is highlighted.

If a Sensation catheter is connected to the fiber-optic sensor module, calibration is

automatic on start-up and every 2 hours thereafter. To initiate a calibration anytime
Zeroing - Fiberoptic IAB after start-up, WHILE PUMPING simply press the “Zero” button on the IABP keypad
for 2 seconds. The message “Auto Zeroing” will be displayed in the advisory section
of the monitor.

Press the “Pressure” key until “Vent” is highlighted to simulate the loss of the
pressure waveform (doesn’t require user to zero again). Can also press the “BP
Loss of arterial pressure
Disconnect” key once. Press again and pressure waveform will reappear (user will
waveform
have to zero again). In Auto Operation Mode, the message “No Pressure Source
Available” will be displayed.
While in Auto Operation Mode, press the “Noisy ECG” key. Pump will cycle through all
available leads, then switch to pressure trigger. Press the “Noisy ECG” key again and
artifact will disappear. Pump will switch back to ECG trigger in 2 min. if rhythm is
ECG artifact regular, 1 min. if rhythm is A-fib. While in Semi-Auto Operation Mode, the pump will
NOT automatically make changes. To return to ECG Trigger more quickly, press the
“Pressure” key on the trainer until “Vent” is highlighted and pump will return to ECG
Trigger.

While in Auto Operation Mode, press the “ECG Lead Fault” key once and a flat line
ECG will appear and pump will switch to Pressure Trigger. Press “ECG Lead Fault” key
ECG lead disconnect
again and rhythm will reappear and pump will switch back to ECG Trigger. While in
Semi-Auto Operation Mode and in ECG Trigger, this will cause a “No Trigger” alarm.

Sinus Rhythm Normal Sinus Rhythm with a heart rate of 80 is the default “Mode”.

When “Sinus Rhythm” mode is selected, press the “Rate” key to simulate various
Heart rate changes
heart rates: the choices are 60, 80, 100, and 130 when highlighted.

Press the “Mode” key until “Atrial Fib” is highlighted. Press the “Mode” key twice to
Atrial fibrillation
return to Sinus Rhythm.

36
Functions To Simulate

100% V paced rhythm Press the “Mode” key until “Pacer Fixed 80bpm” is highlighted.

First, press the “Mode” key until “Pacer Fixed 80bpm” is highlighted. Next, press the
“Pacer” key, which will allow you to cycle through the following choices: V paced, A-V
Various pacer settings
paced, A paced, and A-V demand pacing. To stop simulating any of the paced
rhythms, press the “Mode” key once to return to Sinus Rhythm.

First, make sure you are in Sinus Rhythm (any rate is fine). Next, press the “Ventric.
Rhythms” key, which will allow you to cycle through the following choices: PVC (1 PVC
Ventricular arrhythmias every 6 to 10 beats), Couplets (1 couplet every 10 to 12 beats), Bigeminy (short run of
bigeminy every 10 to 12 beats), and V-Tach (15 beat run of v-tach every 15 to 20
beats). To stop simulating any of the arrhythmias, press the “Mode” key once.

Press the “Pressure” key until “No Aug.” is highlighted. The IABP monitor screen will
No augmentation
display an arterial pressure waveform with no augmentation.

While in Auto Operation Mode, press the “ECG Lead Fault” key, then press the
“Pressure” key until “Vent” is highlighted. The pump will stop pumping and alarm
“No Trigger”. Press the “Pressure” key until “Normal” is highlighted, which will bring
Cardiac arrest back the arterial pressure waveform (this demonstrates that the CS100/300 will start
pumping automatically when an adequate arterial pressure waveform appears, which
is similar to what would happen if adequate chest compressions are being done in a
code).

Alarm: “Augmentation Set the Aug. Alarm to a level higher than current augmentation pressure or decrease
Below Limit Set” the IAB Augmentation control setting.
Alarm:
Disconnect the catheter extender tubing from the safety disk while pumping.
“IAB Disconnected”
Alarm: While pumping, slowly loosen the extender tubing where it connects to the catheter
“Rapid Gas Loss” (may be difficult to simulate).

Alarm: While pumping, slowly loosen the extender tubing where it connects to the catheter.
“Leak in IAB circuit” (may be difficult to simulate).
Alarm:
While pumping, kink the extender tubing.
“Check IAB Catheter”
Alarm: While in Auto Operation Mode, the ECG and Pressure signal are lost by pressing the
“No Trigger” “ECG Lead Fault” key and “Pressure” key until “Vent” is highlighted.
Alarm:
While in Auto Operation Mode with an adequate ECG signal, press the “BP
“No Pressure Source
Disconnect” key.
Available”
If a Sensation catheter is connected to the fiber-optic sensor module, remove the
sensor connector from the fiber-optic sensor module while pressing the “BP
Alarm: CS300
Disconnect” key. To resume pressure waveform, reconnect sensor connector to
“No Pressure Source
sensor module and press “BP Disconnect” key once. CS300 will auto-calibrate after 1
Available”
min. or WHILE PUMPING simply press the “Zero” button on the IABP keypad for 2
seconds.

37
Functions To Simulate

While in Auto Operation Mode, press the “Pressure” key until “Vent” is highlighted,
Alarm:
then press the “Noisy ECG” key. This will alarm once a minute for 3 minutes while the
“Poor Signal Quality”
CS100/CS300 continues to pump.

While in Auto Operation Mode, after the “Poor Signal Quality” alarm has been
Alarm:
displayed for 3 minutes, the “Poor Signals Persist” alarm will sound and the
“Poor Signals Persist”
CS100/CS300 will stop pumping.

While in Auto Operation Mode while pumping, press the “Semi-Auto” Operation Mode
Alarm: key on the IABP keypad, then press “ECG Lead Fault” and “No Aug.” on the trainer.
“Unable to Update Timing” Next, switch to Auto Operation Mode on the IABP keypad, then press the “Start” key.
The alarm will sound in approximately 30 seconds.

Alarm: While in Semi-Auto Operation Mode in Pressure Trigger, press the “Mode” key until
“Irregular Pressure Trigger” “Atrial Fib” is highlighted.

Alarm: While in Semi-Auto Operation Mode, establish an adequate ECG signal while in
“ECG Detected” Internal Trigger.

If already pumping, put the pump on standby, disconnect the extender tubing from
Alarm:
the safety disk, then push the “Start” key. The CS100/CS300 will automatically
“Autofill Failure”
attempt to perform an autofill and will fail since the catheter is not connected.
Alarm:
Close the helium tank and then attempt to perform an autofill. This may take 3 or 4
“Autofill Failure – No
autofills to simulate because there will be residual helium in the line.
Helium”
If a non-functional sensor connector is connected to the fiber-optic sensor module
Alarm:
while pumping, completely disconnect the trainer from the back of the pump. The
“Sensor IAB Failure”
alarm will go away when the trainer is re-connected.

38
IV. Review of Support Materials

Pre-inservice Self-Study Guide*

Course Outlines*

Theory CD

Website / E-learning modules*

Abbreviated Operator’s Guides*

Timing Pocket Reference Guide*

Case Studies

Performance Checklist

Inservice Videos

IAB catheter insertion

IABP operation

PowerPoint presentations

Journal article reprints

Policies and Procedures*

Transport Protocols*

* Denotes files available on the Datascope website: http://www.datascope.com/ca/ed_resources.html

39
V. Maintaining Expertise

A. Suggested Resources

B. Inservice Videos

C. Theory CD-ROM

D. E-Learning Modules

E. Hands on with performance checklist

F. Case studies

G. Website

H. Written Test

I. Combination of all of the above

40
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INDICATIONS

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the setting of poor left ventricular function: A two center experience. The Journal of Invasive Cardiology 1990
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Emmerman CL, Pinchak AC, Hagen JF. Hemodynamic effects of the intra-aortic balloon pump during experimental
cardiac arrest. American Journal of Emergency Medicine 1989 July;7:373-383.

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46
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COMPLICATIONS

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Angiology 2003;54:577–85.

Barnett MG, Swartz MT, Peterson GJ, et al. Vascular complications from intraaortic balloons: Risk analysis. Journal of
Vascular Surgery 1994 Jan;19(1):81-89.

Brodell GK, Tuzcu EM, Weiss SJ. Intra-aortic balloon pump rupture and entrapment. Cleveland Clinic Journal of
Medicine 1989 Oct;56(7):740-742.

Cohen M, Ferguson JJ, Freedman RJ Jr, et al. Comparison of outcomes after 8 vs. 9.5 French size intra-aortic
balloon counterpulsation catheters based on 9,332 patients in the prospective Benchmark Registry. Catheterization
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Eltchaninoff H, Dimas AP, Whitlow PL. Complications associated with percutaneous placement and use of intraaortic
balloon counterpulsation. American Journal of Cardiology 1993 Feb;71:328-332.

Funk M, Gleason J, Foell D. Lower limb ischemia related to use of the intra-aortic balloon pump. Heart and Lung
1989;18:542-552.

Goran SF. Vascular complications of the patient undergoing intra-aortic balloon pumping. Critical Care Nursing
Clinics of North America 1989 Sep;1(3):459-467.

Gottlieb SO, Brinker JA, Borken AM, et al. Identification of patients at high risk for complications of intra-aortic
balloon counterpulsation: A multivariate risk factor analysis. American Journal of Cardiology 1984; 53:1135-1139.

Kantrowitz A, Wasfie T, Freed PS, et al. Intra-aortic balloon pumping 1967 through 1982: Analysis of complications
in 733 patients. American Journal of Cardiology 1986;57(11):976-983.

Kvilekval KH, Mason RA, Newton GB, et al. Complications of percutaneous intra-aortic balloon pump Use in patients
with peripheral vascular disease. Archives of Surgery 1991 May;126:621-623.

47
Lazar JM, Ziady GM, Dummer SJ, et al. Outcome and complications of prolonged intraaortic balloon counterpulsation
in cardiac patients. American Journal of Cardiology 1992,Apr;69:955-958.

Robicsek F, Holleman JH, Roush TS, et al. Peri-operative intra-aortic balloon assist, decreasing complications to the
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Schecter D, Murali S, Uretsky BF. Vascular entrapment of intra-aortic balloon after short term balloon
counterpulsation. Catheterization and Cardiovascular Diagnosis 1991;22:174-176.

Stahl KD, Tortolani AJ, Nelson RL, et al, Intra-aortic balloon rupture. ASAIO Journal 1988;XXXIV:496-499.

Velez CA, Kahn JK. Compartment syndrome from balloon pump. Catheterization and Cardiovascular Interventions
2000;51:217–219.

INSERTION

Gorton ME, Soltanzadeh H. Easy removal of surgically placed intra-aortic balloon pump catheter. Annals of Thoracic
Surgery 1991;51:325-6.

Heebler RF. Simplified technique for open placement and removal of intra-aortic balloon. Annals of Thoracic Surgery
1989;48:134-6.

Nash IS, Lorell BH, Fishman RF, et al. A new technique for sheathless percutaneous intra-aortic balloon catheter
insertion. Catheterization and Cardiovascular Interventions 1991 May;23(1):57-60.

Phillips SJ, Tannenbaum M, Zeff RH, et al. Sheathless insertion of the percutaneous intra-aortic balloon pump: An
alternate method. Annals of Thoracic Surgery 1992; 53:162.

Shahian DM, Jewell ER. Intra-aortic balloon pump placement through dacron aortofemoral grafts. Journal of Vascular
Surgery 1988 Jun;7:795-7.

PEDIATRICS

Anella J, McCloskey A, Vieweg C. Nursing dynamics of pediatric intra-aortic balloon pumping. Critical Care Nurse
1990 Apr;10(4):24-28.

del Nido PJ, Benson LN, Bohn D, et al. Successful use of intra-aortic balloon pumping in a 2-kilogram infant. Annals
of Thoracic Surgery 1988 Nov;46:574-576.

Dunn JM. The use of intra-aortic balloon pumping in pediatric patients. Cardiac Assists 1989 June; 5(1).

Nawa S, Sugawara E, Murakami T, et al. Efficacy of intra-aortic balloon pumping for failing fontan circulation. Chest
1988 Mar;93(3):599-603.

Pinkney KA, Minich LL, Tani LY, et al. Current results with intra-aortic balloon pumping in infants and children.
Annals of Thoracic Surgery 2002;73:887–91.

Veasy LG, Blalock RC, Orth J. Intra-aortic balloon pumping in infants and children. Circulation
1983;68(5):1095-1100.

Webster H, Veasy LG. Intra-aortic balloon pumping in children. Heart and Lung 1985;14(6):548-555.

48
TRANSPORT

Bellinger RL, Califf RM, Mark DB. Helicopter transport of patients during acute myocardial infarction. American
Journal of Cardiology 1988 Apr;61:718-722.

Gottlieb SO, Chew PH, Chandra N. Portable intra-aortic balloon counterpulsation: Clinical experience and guidelines
for use. Catheterization and Cardiovascular Diagnosis 1986;12:18-22.

Kramer RP Jr. Helicopter-transported intra-aortic balloon pumping: advanced technology made airborne. Cardiac
Assists 1988 Jun;4(2).

Mertlich G, Quaal SJ. Air transport of the patient requiring intra-aortic balloon pumping. Critical Care Nursing Clinics
of North America 1989 Sep;1(3):443-458.

NURSING CARE

Bavin TK, Self MA. Weaning from intra-aortic balloon pump support. American Journal of Nursing 1991 Oct;91(10):
54-59.

Patacky MG, Garvin BJ, Schwirian PM. Intra-aortic balloon pumping and stress in the coronary care unit. Heart and
Lung 1985 Mar;14(2):142-8.

Quaal SJ, guest ed. Critical Care Clinics of North America. Philadelphia WB Saunders 1996 Dec;8(4).

Shoulders O. Managing the challenge of IABP therapy. Critical Care Nurse 1991 Feb;11(2):60-76.

Weinberg LA. Buying time with an intra-aortic balloon pump. Nursing 1988 Sep;18(9):44-49.

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PROGRAM AND SPEAKER EVALUATION

Developing an IABP Teaching Strategy Date:

Program Code 07

Please rate the program and speaker items by placing a mark in the appropriate
column.

Program Evaluation 1 2 3 4 5
Poor Fair Good Very Excellent
Good
1. Program met the stated objectives
2. Content covered topic adequately
3. Overall quality of this program
4. Overall quality of speaker(s)
5. Quality of the program facilities
6. Program met my personal objectives
7. I can incorporate program content
into my practice

Speaker Name:

Speaker Evaluation 1 2 3 4 5
Poor Fair Good Very Excellent
Good
1. Objectives – Stated learning
objectives met
2. Audiovisual – Contributed to
presentation
3. Content – Relevance of content to
objectives
4. Presentation – Speaker qualified and
held interest
5. Effectiveness – Speaker was
organized and effective
6. Practice – Validated and/or changed
practice

Comments:

Participant Name:

51
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