Emergency Transfer Of Patients With An Intra Aortic Balloon Pump
Contents
1. Copy No Location Date Issued 1 Intranet 03 11 2008 Cardiac Network 03 11 2008 Wards and Departments 03 11 2008 Blackpool Fylde and Wyre Hospitals NHS foundation Trust I D No CORP PROC 497 Revision No 2 Review Date 01 11 2010 Title Emergency Transfer Of Patients With An Intra Aortic Balloon Pump IABP From A District General Hospital To The Tertiary Centre Within The Lancashire And South Cumbria Cardiac Network Do you have the up to date version See the intranet for the latest version Page 3 of 10 OTHER RELEVANT ASSOCIATED DOCUMENTS Procedure No Title CORP PROC 033 Lancashire amp South Cumbria Critical Care Network Guidance for Intra and Inter Hospital Transfers Datascope IABP Counterpulsation Competency Programme East Lancashire Hospitals NHS Trust Balloon Pump documents Datascope Preparing the IABP for transport pictures Emergency Transfer Of Patients From A Peripheral Catheter Laboratory to Lancashire Cardiac Centre AUTHOR DIVISIONAL DIRECTORATE MANAGER APPROVAL Issued By P Black Checked By S Chisholm Job Title Service Improvement Job Title Manager Smm Co S November 2007 November 2007 Blackpool Fylde and Wyre Hospitals NHS foundation Trust I D No CORP PROC 497 Revision No 2 Review Date 01 11 2010 Title Emergency Transfer Of Patients With An Intra Aortic Balloon Pump IABP From A District General Hospital To The Tertiary Centre Within The Lancashire And South2. Patients will usually be transferred supine and feet first so that over the head access may be gained if required During the transfer the pump should always lead the way Care must be taken to ensure that the tubing between the patient and the pump does not become taught Transfer of patients into the ambulance 1 Ambulance crew open up the vehicle and prepare the tail lift il Medical staff will disconnect the patient from the IABP Disconnection of the balloon pump must be for as short a time as possible ii The ambulance crew will then lift the patient into the ambulance on the tail lift then lift the IABP onto the vehicle also using the tail lift iv Medical staff reconnect IABP v Transferring staff will then secure the IABP using the harness and fitted bolts All staff must be aware of the trip hazard associated with the harness vi The IABP will then be plugged into the inverter to charge during the journey Battery life of the IABP is approximately 2 5 hours vii Medical staff to familiarise with equipment in the ambulance in the event that it is not a paramedic crew ie intubation equipment viii Doctor to brief team prior to departure During Transfer During transfer the IABP screen may be removed to facilitate easy monitoring put on lap of person in charge of balloon pump Constant monitoring of the patient should be undertaken by the accompanying doctor and healthcare professional using the appropriate cha
3. Blackpool Fylde and NHS Wyre Hospitals NHS Foundation Trust Document Type Unique Identifier PROCEDURE CORP PROC 497 Title Version Emergency Transfer Of Patients With An Intra Number Aortic Balloon Pump IABP From A District St a General Hospital To The Tertiary Centre Within ee The Lancashire And South Cumbria Cardiac Network Scope Classification Cardiac Network wide Organisational Author Originator and Title Responsibility Lancashire and South Cumbria Cardiac Network and East Lancashire Cardiac Network Hospitals NHS Trust Replaces Description of amendments Version 1 Emergency Transfer Of Patients With Transfer of patient with iabp to tertiary centre An Intra Aortic Balloon Pump IABP From A District General Hospital To The Tertiary Centre Within The Lancashire And South Cumbria Cardiac Network CORP PROC 497 Name of Committee Date of Meeting Risk Assessment Divisional Directorate Not Applicable Working Group Financial Implications Not Applicable Validated by Validation Date Sally Chisholm Cardiac Network Programme Director November 2008 Ratified by Ratified Date Date of Issue Clinical Improvement Committee 03 11 2008 03 11 2008 Review Date 01 11 2010 Review Dates 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Review dates may alter if L L L L XK U L L L L any significant changes are made D
4. Cumbria Cardiac Network Do you have the up to date version See the intranet for the latest version Page 4 of 10 APPENDIX 1 TRANSFER POLICY INTRA AOTIC BALLOON PUMP On arrival at Tertiary Centre hand over and swap over IABP and leads Patient management in the ambulance Drug bag airways Monitoring HR BP Sao2 RR Constant monitoring of balloon pump see care plan Appendix 2 Care of infusions Await ambulance arrival Prepare equipment IABP Harness Drug bag with airways Appendix 3 Leave IABP plugged in until transfer battery will last 2 2 5hrs Constant monitoring and care of the balloon pump Appendix 2 Blackpool Fylde and Wyre Hospitals NHS foundation Trust Revision No 2 IABP in situ amp emergency transfer required TRANSFER TEAM Physician Cardiology registrar anaesthetist Healthcare professional appropriately trained with use of the IABP dependent on infusion pumps Continuous observations Appendix 4 Review Date 01 11 2010 Contact relatives re transfer Staff in charge of supporting patient Anaesthetic Team in charge of supporting Consultant to contact Tertiary Centre to arrange transfer and advise location on Nurse to contact perfusionist LCC 01253 657777 or accepting centre via switchboard Inform of ETA Organise replacement pump Condition of patient Size of cathet
5. exited the sheath Press the start key to resume pumping Check IABP Catheter most common The IAB membrane is not completely unfolded This would be very rare with the new type balloons TRY DIFFERENT MACHINE Manual inflation and deflation could be performed by those trained to do so i e the cardiologist Check IAB Catheter There is a kink in the IAB catheter or tubing Check the catheter tubing and relieve the kink Press the start key to resume pumping IAB disconnection The IAB catheter or extender tubing is disconnected Check the IAB catheter is connected to the extended tubing The extender tubing is connected to the catheter extender Pumping is resumed by pressing the start key this will also initiate refill of the IAB catheter Leak in the IAB circuit Small leak in the IAB circuit loose connection high rate of helium diffusion due to patient being febrile or tachycardic Check for blood in the tubing If found stop pumping and notify physician If blood is not found verify the connections are leak free Press the start key to resume pumping If this persists and no apparent problem is detected check balloon position via x ray Rapid Gas Loss A large leak has been detected in the IAB pneumatic circuit Check for blood in tubing if found stop pumping clamp and notify physicians prepare for IAB removal If blood is not found verify all connections are leak free re
6. Hospital To The Tertiary Centre Within The Lancashire And South Cumbria Cardiac Network Do you have the up to date version See the intranet for the latest version Page 10 of 10 APPENDIX 4 Intra Aortic Balloon Pump Observation Chart Date Name Hosp No NHS Lancashire amp South Cumbria Cardiac Network Mode Time Trigger and Mode auto semi auto IABP Ratio HR Assisted systolic Assisted end diastolic Unassisted systolic N A in 1 1 Unassisted end diastolic N A in 1 1 Mean arterial pressure Augmented diastolic pressure Augmented alarm setting checked Foot Pulse L R Radial Pulse L R Catheter Lumen no blood spots Insertion Site clean amp dry Pressure Bag and Line 300mmHg Patient Position in degrees CVP RESPS SpO2 Temp Urine Output Total Urine Output APPENDIX 5 Potential Alarms on the IABP NHS Lancashire amp South Cumbria Cardiac Network Alarm Message Potential Problem Solution No helium The helium cylinder is closed Open the helium cylinder by turning the knob anti clockwise all the way open left loose right tight Check the helium gauge is above the red line Check IABP Catheter The IAB remains in the sheath immediately after insertion Check markings on the IAB catheter to assure the balloon has
7. er Problems during insertion To book ambulance Ring 999 Confirm telephone number State balloon pump transfer from To State what time patient expected to be ready for transfer Ask for incident number and whether paramedic on vehicle Any delay change to transfer ring 999 and state incident number change to transfer I D No CORP PROC 49 Title Emergency Transfer Of Patients With An Intra Aortic Balloon Pump IABP From A District General Hospital To The Tertiary Centre Within The Lancashire And South Cumbria Cardiac Network Page 5 of 10 Do you have the up to date version See the intranet for the latest version Intra Aortic Balloon Pump Care Plan Post Procedure Instructions Following Insertion of the Intra Aortic Balloon Pump Patients Name and Hospital Number 1 Ensure observations are completed on IABP observation chart every 15 30 mins until stable and then every hour 2 Has the position of the balloon been checked following insertion either by x ray or fluoroscopy 3 Check the augmented BP alarm is set at 10mmHg below augmented diastolic pressure 4 Is the tubing secure The tubing should be visible at all times both helium and arterial line tubing 5 Insertion site should be covered with a dry sterile adherent transparent dressing 6 Zero and flush pressure line
8. fill IAB carefully observe tubing to verify no blood is present Press start key If this persists and no apparent problem is detected check balloon position via x ray For other troubleshooting instructions please refer to the section 3 0 CS100 CS100i Datascope operation service manual or use help screen facility on the IABP console
9. ision No 2 Review Date 01 11 2010 Title Emergency Transfer Of Patients With An Intra Aortic Balloon Pump IABP From A District General Hospital To The Tertiary Centre Within The Lancashire And South Cumbria Cardiac Network Do you have the up to date version See the intranet for the latest version Page 7 of 10 APPENDIX 3 NHS Lancashire amp South Cumbria Cardiac Network GUIDELINES FOR PREPARATION AND TRANSFER OF A PATIENT WITH INTRA AORTIC BALLOON PUMP IABP TO THE TERTIARY CENTRE 1 At all times the medical staff will take the lead and have overall responsibility for the patient 2 There is only room to accommodate two transfer staff in the ambulance other than the ambulance crew 3 Rules for transfers DO NOT transfer the patient Jf you are concerned about their ability to cope with the transfer process Until their condition is deemed stable enough to transfer Until all lines drains tubes leads etc are appropriately secured Until all transfer equipment has been checked for accuracy and reliability Until appropriately skilled transfer personnel are available Until the receiving area is prepared to receive the patient 4 Ensure IABP is removed from its hospital cart and have the blue securing harness fitted before the ambulance arrives Harnessing the IABP see Datascope step by step picture guide Remove the drip stand Press down the catch under the handle on the hospital cart and sw
10. ivel the monitor anti clockwise out of the way Ensure the hospital cart brakes are on Release the lever at the bottom of the IABP to disconnect the pump from the hospital cart Two people are required to remove the pump from the hospital cart lift the pump from the sides and place on the floor in front of the cart Warning the pump weighs approximately 64 kg Attach the harness Place the harness over the top of the IABP then tilt the IABP off the floor to slide the lower straps of the harness under the pump Fasten the buckle Fasten the four karabner straps to the D rings on the harness These should be near the floor ready for connection to the ambulance secure fittings Blackpool Fylde and Wyre Hospitals NHS foundation Trust I D No CORP PROC 497 Revision No 2 Review Date 01 11 2010 Title Emergency Transfer Of Patients With An Intra Aortic Balloon Pump IABP From A District General Hospital To The Tertiary Centre Within The Lancashire And South Cumbria Cardiac Network Do you have the up to date version See the intranet for the latest version Page 8 of 10 10 11 Before leaving the ward everyone involved in the transfer should clearly understand their roles Recommended equipment for transfer is as follows Oxygen Suction Battery operated infusion pumps if necessary Defibrillator Heart Rate and Blood Pressure monitors Pulse Oximetry Emergency drug box Patient notes x rays
11. iving area Follow care plan post insertion of balloon pump Appendix 2 Follow IABP transfer guidelines Appendix 3 Occasionally patients may need to be transferred from the tertiary centre to another hospital outside Lancashire and South Cumbria Clinicians must ensure that they liaise with the receiving hospital for procedure on arrival Check with crew on arrival which type of vehicle either Ford or Mercedes so that staff can take correct restraint straps for that vehicle on the transfer STAFF TRAINING FOR TRANSFER OF PATIENTS WITH IABP e All healthcare professionals should have completed the Datascope training and be working towards Datascope competencies associated document before transferring patients with IABP in situ ATTACHMENTS Appendix 1 IABP Transfer Policy Flowchart Appendix 2 IABP Care Plan Appendix 3 Guidelines for preparation and transfer of a patient with IABP to the Tertiary Centre Appendix 4 IABP Observation Chart Appendix 5 IABP Potential Alarms ELECTRONIC AND MANUAL RECORDING OF INFORMATION Database for Policies Procedures Protocols and Guidelines Archive Policy Co ordinators office Blackpool Fylde amp Wyre Hospitals NHS Trust Archived at the Cardiac Network Office Room 244 Preston Business Centre Watling Street Road Fulwood Preston PR2 8DY or via the Cardiac Network website www lsccardiacnetwork nhs uk LOCATIONS THIS DOCUMENT ISSUED TO
12. made the decision to insert an IABP and is going to transfer the patient to the Tertiary centre staff at the referring hospital should follow the balloon pump transfer flow chart Appendix 1 e If the anaesthetic team are involved with the patient ensure the ICU transfer protocol is followed CORP PROC 033 see associated document Ambulance control should be pre warned that a transfer request is imminent so they can organise one of the six vehicles with the correct fittings to secure the balloon pump Blackpool Fylde and Wyre Hospitals NHS foundation Trust I D No CORP PROC 497 Revision No 2 Review Date 01 11 2010 Title Emergency Transfer Of Patients With An Intra Aortic Balloon Pump IABP From A District General Hospital To The Tertiary Centre Within The Lancashire And South Cumbria Cardiac Network Do you have the up to date version See the intranet for the latest version Page 2 of 10 e The Cardiologist should contact the tertiary centre to arrange transfer and the nurse should ring the perfusionist on 01253 657777 to inform of transfer e If the patient requires an intensive care bed it is the responsibility of the accepting Consultant Cardiologist at the Tertiary centre to organise this TRANSFER OF PATIENT WITH IABP TO TERTIARY CENTRE Helimed is not to be used for transfer of patients with IABP in situ When possible inform the patient and relatives of the reason for transfer and all other information related to the rece
13. oes this document meet with the Race Relation Amendment Act 2000 Religious Discrimination Act Age Discrimination Act Disability Discrimination Act and Gender Equality Regulations Not Applicable PURPOSE To provide skilled personnel the equipment necessary and ensure the procedures are in place to allow the safe transfer of a patient with intra aortic balloon pump from a district general hospital to the tertiary centre SCOPE Network wide across Lancashire and South Cumbria To be implemented by the Cardiac Network and followed by medical staff at referring treatment centre and the ambulance Trust PROCEDURE 3 1 CRITERIA FOR USE OF THE INTRA AORTIC BALLOON PUMP IABP IABP may only be used in the following areas with the treatment initiated by Consultant Cardiologist e Cardiac catheter lab e Coronary Care Unit e Critical Care Indications for use e Acute Myocardial infarction cardiogenic shock Refractory unstable angina Ischaemic related intractable ventricular arrhythmias Catheter lab complications Prior to urgent cardiac surgery Complications of acute myocardial infarction ie ventricular septal defect papillary muscle rupture CONTRAINDICATIONS FOR USE OF IABP e Severe aortic valve insufficiency e Abdominal or aortic aneurysm e Severe calcific aorta iliac disease or peripheral vascular disease e Sheathless insertion with severe obesity scarring of the groin INSERTION OF IABP e Once the Cardiologist has
14. rts see Appendix 4 IABP Observation Chart and Appendix 5 Potential alarms for IABP Blackpool Fylde and Wyre Hospitals NHS foundation Trust I D No CORP PROC 497 Revision No 2 Review Date 01 11 2010 Title Emergency Transfer Of Patients With An Intra Aortic Balloon Pump IABP From A District General Hospital To The Tertiary Centre Within The Lancashire And South Cumbria Cardiac Network Do you have the up to date version See the intranet for the latest version Page 9 of 10 AT RECEIVING HOSPITAL 12 Perfusionist should be waiting for the patient ABP disconnected by medical team or perfusionist unloaded from the ambulance with the patient and reconnected to the receiving hospital s pump if possible 13 When patient arrives at the receiving area there should be a formal handover from the escorting personnel to the medical and nursing staff 14 IABP and staff returned to the referring district general hospital Transfer staff must be aware that there may be a delay in transfer back to base if the ambulance has to go to another emergency before returning staff and equipment 15 Any untoward incidents that occur during transfer of patients should be reported using the Trust incident reporting policy Blackpool Fylde and Wyre Hospitals NHS foundation Trust I D No CORP PROC 497 Revision No 2 Review Date 01 11 2010 Title Emergency Transfer Of Patients With An Intra Aortic Balloon Pump IABP From A District General
15. s at the beginning of each shift Lines should be changed inline with Trust policy Heparinised saline 500iu 500ml should be used Tertiary centre policy Put IABP on standby when flushing 7 Anti coagulant therapy is dependent on clinical condition and consultants choice i e LMWT heparin etc 8 Monitor coagulation and HB and other requested bloods daily 9 If patient ventilated follow Critical Care Unit protocols and guidelines 10 Assess patient for signs of pain or discomfort give prescribed analgesia 11 Bed rest should be maintained 12 DO NOT raise head of bed gt than 45 but position the patient to maintain their comfort lying on their side supported by pillows etc is fine 13 DO NOT flex or bend the leg in which the IAB is inserted 14 Dorsiflexion of foot on involved leg 15 Active and passive movements to uninvolved leg should be encouraged 16 Assist with washing and hygiene needs as required 17 Assist patient with leg rolling and positioning 18 Observe pressure areas and utilise equipment and follow Trust policy 19 Encourage deep breathing 20 Encourage fluids and diet as appropriate 21 Observe frequency of bowel movement and observe for signs of constipation and assist if necessary with elimination needs 22 Give simple explanations of IABP therapy and the patient information booklet to patient and family Ensure family aware of future plans e g transfer 23 Give emotional s
16. upport regarding fears and anxieties 24 Read policy and attached documents for a guide on helium cylinder change and harnessing for transfer and transfer policy 25 For IABP alarms refer to troubleshooting guide and complication checklist and make use of the help screen 26 All other problems refer to Datascope manual and 24 hour help line 01480 423600 Technical support 0800 891201 Clinical support or call the local representative direct 27 Ensure ABP daily maintenance checklist is completed 28 Remove balloon and introducer at the same time DO NOT remove balloon through Blackpool Fylde and Wyre Hospitals NHS foundation Trust I D No CORP PROC 497 Revision No 2 Review Date 01 11 2010 Title Emergency Transfer Of Patients With An Intra Aortic Balloon Pump IABP From A District General Hospital To The Tertiary Centre Within The Lancashire And South Cumbria Cardiac Network Do you have the up to date version See the intranet for the latest version Page 6 of 10 introducer Check coagulation status before removal A Femostop II will be needed to apply pressure to the wound site collect from Cath Lab with instructions and care plan REMOVAL SHOULD BE CARRIED OUT BY A HEALTHCARE PROFESSIONAL PROFICIENT IN FEMORAL SHEATH REMOVAL usually a Doctor 29 Follow infection control protocol on removal of invasive lines Blackpool Fylde and Wyre Hospitals NHS foundation Trust I D No CORP PROC 497 Rev
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