INTRA-AORTIC BALLOON PUMP 3.

After passing a #8 French vessel dilator over the guide wire into the
vessel, he removes the vessel dilator, leaving the guide wire in place.
4. Next, the doctor passes an introducer (dilator and sheath assembly)
over the guide wire into the vessel until about 1_ (2.5 cm) remains
above the insertion site. He then removes the inner dilator, leaving the
introducer sheath and guide wire in place.
5. After passing the balloon over the guide wire into the introducer
sheath, the doctor advances the catheter into position, 3⁄8” to 3⁄4” (1
to 2 cm) distal to the left subclavian artery under fluoroscopic
guidance.
6. The doctor attaches the balloon to the control system to initiate
counterpulsation. The balloon catheter then unfurls.

DEFINITION: Inserting the intra-aortic balloon surgically

The intra-aortic balloon pump (IABP) employs a balloon-tipped catheter 1. If the doctor chooses not to insert the catheter percutaneously, he
and a process called counterpulsation to temporarily support coronary and usually inserts it by femoral arteriotomy.
systemic perfusion in patients with severe cardiac disease (e.g., 2. After making an incision and isolating the femoral artery, the doctor
cardiogenic shock) or injury (e.g., myocardial infarction [MI]). attaches a Dacron graft to a small opening in the arterial wall.
3. He then passes the catheter through this graft. Using fluoroscopic
guidance as necessary, he advances the catheter up the descending
INDICATIONS: thoracic aorta and places the catheter tip between the left
subclavian artery and the renal arteries.
IABP is recommended for patients with a wide range of low cardiac-output 4. The doctor sews the Dacron graft around the catheter at the insertion
disorders or cardiac instability, including refractory anginas, ventricular point and connects the other end of the catheter to the pump
arrhythmias associated with ischemia, pump failure caused by cardiogenic console.
shock, intraoperative myocardial infarction (MI), or low cardiac output after
bypass surgery. IABP is also indicated for patients with low cardiac output
secondary to acute mechanical defects after MI (such as ventricular septal NURSING RESPONSIBILITIES:
defect, papillary muscle rupture, or left ventricular aneurysm).
Before:

STEPS: • Before insertion of IABP, informed consent is necessary, with a clear

explanation of the risks and benefits of IABP device insertion, with
Inserting the intra-aortic balloon percutaneously concise instructions about post-procedure care.
1. The doctor may insert the balloon percutaneously through the femoral • Aside from gathering the equipment specific to IABP insertion, nursing
artery into the descending thoracic aorta using a modified Seldinger care involves preparing the patients (attaching the patient to the
technique. First, he accesses the vessel with an 18G angiography pump’s electrocardiogram leads and labeling them, setting up the
needle and removes the inner stylet. transducer and leveling it with the patient’s phlebostatic axis, and
2. Then he passes the guide wire through the needle and removes the preparing the groin site).
needle.
 • Provide ongoing psychological support and education as required
• The patient is assessed for evaluation for any bleeding diathesis,
infection, and presence of severe peripheral arterial disease.
• The patient is assessed for their tolerance of lying flat and their needs for After:
sedation or anxiolytics as per hospital guidelines.
• Once the patient condition is stabilized, the IABP is considered for
• The patient is positioned supine, and adherence to the sterile technique
removal. This is preceded by a process of weaning the pump from 1:1–
should be practiced to insert the device.
2:2 and finally 1:3
During: • Observe the patient by critical care nurse for ischemic chest pain or
development of heart failure symptoms such as breathlessness,
• Assess cardiovascular hourly, or more frequently depending on clinical hypotension, and tachycardia
acuity, noting mean arterial pressure, augmented pressure heart rate, • The patient is kept on bed rest with the leg kept straight as per local
oxygen saturation and perfusion state (lower and upper limb perfusion guidelines.
assessment)
• Assess and observe for any alteration in neurological status
• Confirm timing, ratio and trigger of intra-aortic balloon pump hourly
• Strict intake and output record – aim for output 0.5ml/kg/hr – report any
sudden decrease in urinary output (signs of decreased renal perfusion
due to low cardiac output or migration of the catheter to the renal
arteries obstructing blood flow)
• Ensure the transducer is level with the phlebostatic axis, flushed hourly
and zeroed four hourly or on change of patient position. Always flush
with the pump on standby
• Check all connections, observe the balloon catheter for presence of
blood which may indicate balloon puncture/rupture hourly
• Monitor for signs of pulmonary oedema or ischaemia
• Monitor temperature two-to-four-hourly, observing for signs of infection
such as erythema/inflammation and pain at the insertion site and a
raised white cell count
• Observe for bleeding at cannulation sites, venepuncture sites, urinary
catheter, and insertion site as a complication of anticoagulation
therapy
• Educate the patient re importance of passive limb exercises, keeping
the affected leg straight
• Encourage deep breathing exercises to promote adequate ventilation
and lung expansion preventing the development of chest infections
• Provide skin care and pressure area care – may need a pressure
relieving mattress and if needed two-hourly turns
• Assist with nutrition and hydration as patient should be no higher than
30° which is challenging when eating or drinking
 KIDNEY TRANSPLANTATION 6. Prior to anastomoses, the patient is given a systemic dose of I.V.
heparin by the anesthesiologist.
7. The surgeon will implant the donor ureter into the bladder.
8. The bladder is grasped with two or more Allis clamps and then
incised.
9. A separate incision is made to accommodate the ureter.
10. The surgeon sutures the ureter through the first incision (3-0 or 4-0
chromic; Dexon).
11. A penrose drain is placed near the bladder wall, and the first incision
is closed in three layers.
12. The wound is closed in three layers as for an inguinal hernia repair.

DEFINITION: NURSING RESPONSIBILITIES:

A kidney transplant is a surgery to place a healthy kidney from a living or Before:
deceased donor into a person whose kidneys no longer function properly.
Kidney transplantation involves removing a kidney from a living or • Assess the patient in any recent infection or received any blood
deceased donor and implanting it into the patient. transfusions, what the current and past medical history is, including
renal disease, any allergies, what the normal urine output if present,
the measurement of vital signs and the patients’ social history and
INDICATIONS: support.
• Patient is assessing for medical investigations, including blood tests,
Renal failure with the common etiologies, diabetes and hypertension, other such as tissue typing cross-match, urea and electrolyte, liver function
causes of CKD/ESRD that are grouped into prerenal (chronic or acute tests, viral screen and cross-match for a number of units of blood for
ischemia), intrinsic renal (glomerulonephritis, focal-segmental the impending transplant surgery should be undertaken. Additionally,
glomerulosclerosis), or postrenal categories (reflux nephropathy, chest X-ray, electrocardiogram (ECG), urinalysis (including a mid-
obstruction). Patients who reach chronic kidney disease (CKD) stage 4. stream specimen of urine), skin, nose, throat, axilla and groin swabs,
along with swabs taken from either the peritoneal dialysis or
subclavian catheters exit sites for methicillin-resistant Staphylococcus
STEPS: aureus, viral and bacterial screening, should all be undertaking.
1. The kidney is brought to the recipient team by the donor’s surgeon or • Preparation of the patient include consent, name badge, bath or
designee. shower, use of an enema, theatre gown, the marking and dressing to
2. The recipient’s surgeon makes a long inguinal incision that is carried protect the arteriovenous fistula from inadvertent use of invasive
down to the iliac fossa by blunt and sharp dissection. monitoring, anti-thrombosis stockings along with the commencement
3. The kidney is usually placed in the patient’s iliac fossa to avoid of immunosuppressive therapy as per the applicable transplant units’
peritonitis. policy.
4. The surgeon identifies the external iliac vein and hypogastric artery. • Pre-medication administration and should the patient be diabetic a
5. Anastomoses are then performed between the renal artery and sliding scale of insulin would be required as prescribed
hypogastric artery and between the removal vein and external iliac
vein (4-0 or 5-0) non absorbable vascular suture.
During:

• Assist the patient to remove jewelry and other objects that may
interfere with the procedure.
• Assist the patient to change into a hospital gown.
• Insert an IV line to the patient in preparation for the procedure.
• Insert a Foley Catheter to the patient to drain urine.
• Monitor Vital Signs of the patient along with the anesthesiologist.
• Management of the kidney organ preservation.

After:

• Carrying out the systematization of nursing care

• Maintaining bed rest for the first 24 hours and guiding the patient not
to exert physical effort
• Clinical evaluation of the sign and symptoms of sudden anuria, for
the prevention of kidney artery thrombosis
• Monitoring the level of consciousness and cough reflex
• Monitoring of systemic signs and symptoms and sites of infection such
as the surgical wound
• Carrying out medication handling
• Control of hemodynamic status, blood pressure, respiratory function
and capillary blood glucose levels
• Monitoring the hydration situation, performing volume replacement,
controlling diuresis every hour, weighing in fasting, assessing waist
circumference and laboratory results regarding fluid retention
• Care with an indwelling urinary catheter for the prevention of urinary
tract infections
• Care with surgical drains
• Administration of a light diet after 8 to 12 hours of fasting if clinical
conditions exist
• Limiting the number of visits