ACAT1 Timing Triggering Troubleshooting Guide

Timing Trigger Troubleshooting Guide

50 Pages

Table of Contents 1 . T w o H o u r P r o g r a m S c h e d u l e : A C A T ®1 P L U S I A B P 1 2. Program Description 1 3. Program Objectives 1 4. Patient Connection ECG...3 ECG Cables ...3 Arterial Pressure ...4 AP Cables...4 Balloon...5 5. Start Up Power On ...7 Check...8 Remember! ...8 Initiate Pumping ...9 Heart Pump Setup ...1 0 6. Control and Function Keys ECG Select ...1 1 AP Select and AP Alarm ...1 2 Cursor ...1 3 Inflate ...1 4 Deflate ...1 4 Pump Status ...1 5 Trigger Modes ...1 5 Assist Ratio...1 6 Balloon Volume ...1 6 Recorder ...1 7 Alarm Control...1 8 Home...1 8 Weaning Setup/Start ...1 9 Flash Card ...2 0 7. Alarms Alarms ...2 3 Class 1 Alarms ...2 3 Class 2 Alarms ...2 6 Class 3 Alarms ...2 7 Timing Guidelines ...2 8 Recommended IABP Triggers ...3 0 Balloon Pressure Waveforms ...3 1 8. Skills Checklist 33 9. Evaluation tools 35 10. Self Evaluation tool (Self-test) 37 11. Reference List 39 © 2005 Arrow International, Inc. All rights reserved. CRB-05-0195 iii

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Education Materials

ACAT 1 PLUS ®

Intra-Aortic Balloon Pump Timing, Triggering, and Troubleshooting

Arrow International ACAT 1 PLUS Intra-Aortic Balloon Pump Timing, Triggering and Troubleshooting ®

The Arrow ACAT®1 PLUS Intra-Aortic Balloon Pump

Document Specification When making reference to or requesting additional copies of this document, please note the following Part Number: A2H-TG, Revision 1. Caution: U.S. Federal Law limits this device to sale by or on order of a physician. Contents of unopened, undamaged package are sterile. Disposable. Refer to package insert for current warnings, indications, contraindications, precautions, and instructions for use.

Table of Contents

1 . T w o H o u r P r o g r a m S c h e d u l e : A C A T ®1 P L U S I A B P

2. Program Description

3. Program Objectives

4. Patient Connection ECG...3 ECG Cables ...3 Arterial Pressure ...4 AP Cables...4 Balloon...5 5. Start Up Power On ...7 Check...8 Remember! ...8 Initiate Pumping ...9 Heart Pump Setup ...1 0 6. Control and Function Keys ECG Select ...1 1 AP Select and AP Alarm ...1 2 Cursor ...1 3 Inflate ...1 4 Deflate ...1 4 Pump Status ...1 5 Trigger Modes ...1 5 Assist Ratio...1 6 Balloon Volume ...1 6 Recorder ...1 7 Alarm Control...1 8 Home...1 8 Weaning Setup/Start ...1 9 Flash Card ...2 0 7. Alarms Alarms ...2 3 Class 1 Alarms ...2 3 Class 2 Alarms ...2 6 Class 3 Alarms ...2 7 Timing Guidelines ...2 8 Recommended IABP Triggers ...3 0 Balloon Pressure Waveforms ...3 1 8. Skills Checklist

9. Evaluation tools

10. Self Evaluation tool (Self-test)

11. Reference List

iii

1 . T w o H o u r P r o g r a m S c h e d u l e : A C A T ®1 P L U S I A B P

8:00 – 8:05

Registration and Welcome

9:20 – 9:35

Review of Common Alarm Situations

8:05 – 8:30

Trigger Acquisition and Criteria

9:35 – 9:50

Set-up and Operation

9:50 –10:00

Post test and Evaluation

8:30 – 9:00

Timing

9:00 – 9:20

Utilizing the Balloon Pressure Waveform in Troubleshooting

2. Program Description

The primary focus of this two hour session is the technical aspects, operation and troubleshooting of the ACAT®1 PLUS Intra-Aortic Balloon Pump (IABP). Participants should have previous IABP experience and a sound working knowledge of the anatomy, physiology and theory of IABP therapy.

3. Program Objectives

1. Identify improper timing and appropriate corrective action. 2. Identify the most appropriate trigger signal selection for a given patient situation. 3. Identify the alterations that would occur in the balloon pressure waveform for two alarm conditions. 4. Demonstrate the set-up and operation of the IABP, utilizing the skills checklist.

4. Patient Connections

Patient Connections 1. ECG

2. ECG Cables a. Skin Leads Cable 1. Must have SKIN selected on keypad

2. For 3-lead cable choose I, II or III 3. For 5-lead cable choose I, II, III, aVR, aVL, aVF or V 4. Lead selected is highlighted in white b. Phono to Phono Cable 1. Must have MONITOR selected on keypad 2. For monitor cables, actual lead choice is made at the monitor

4. Patient Connections

3. Arterial Pressure

4. AP Cables a. Transducer Cable • Must have XDUCER selected

b. Phono to Phono Cable • Must have MONITOR selected

Patient Connections 4

4. Patient Connections

5. Balloon a. Use a 30cc, 40cc or 50cc balloon b. Push balloon connector in firmly, right side up or upside down - it does not matter

c. Balloon volume is displayed above the helium bargraph display.

5. Start Up

1. Power On a. Applies power to the system

Power On

Plug in

5. Start-Up

2. Check:

White overlay on ECG

White overlay on Timing

IAB Volume

Helium Status

3. Remember a. The white overlay lines on the ECG and the Flashing Heart Symbol means the pump can see the Trigger that has been selected.

b. The console cannot pump without a Trigger. If no trigger, check to see if Trigger signal is present, check signal size, or change Trigger.

5. Start-Up

4. Initiate Pumping a. Press STANDBY to activate 4 beat purge. b. Then press ON to begin counterpulsation. Alternately: a. Press ON to purge once, fill, and initiate counterpulsation. BALLOON VOLUME

5. Start-Up

5. Heart Pump Setup An easy way to remember and complete the steps of setting up the ACAT®1 PLUS is to use the word HEART. Each letter stands for a step of set-up. Use of this method reduces the chance of incorrectly setting up the pump. LETTER

SET UP Plug in STEPS pump and Power ON Plug in pump and Power ON

Check HE Display BLUE: OK RED: OK but have an extra tank with the pump BLACK: Tank is OFF or empty. Turn tank ON or replace.

ECG Set-up Connect skin ECG cable or remote connection from bedside monitor Select or Verify ECG Source Select Lead

Arterial Pressure Set-up (Optional) Connect transducer or remote connection from bedside monitor Select or Verify AP Source Zero transducer

Reliable Trigger Check for WHITE overlay on ECG trace. This should appear on every other ECG if assist ratio is 1:2. Otherwise, the WHITE overlay should match the assist ratio. The WHITE overlay should be between the R waves.

Relative Timing Check the WHITE overlay on the AP. It will appear on every beat when the pump is OFF. Set inflation (beginning of WHITE overlay) at the dichrotic notch the deflation (end of the WHITE overlay) just prior to the next systolic upstroke.

Once these steps are complete, the pump is ready to start. Connect the IAB and verify the volume setting. Press PUMP ON to begin pumping. Follow recommendations for timing and triggering described in this manual.

6. Control and Function Keys

Information on the function of most keys can be obtained by pressing HELP, then pressing the key. For additional information, refer to the Operator’s Manual. 1. ECG Select a. ECG SELECT provides selection for LEAD, input source, gain mode and level. 1. To change input source, press ECG SELECT twice. 2. To change lead, press ECG SELECT once. Press key under desired LEAD label. To switch gain mode, press key under desired label. DECREASE/INCREASE GAIN keys can be used with AUTO or MANUAL GAIN. If AUTO is selected, the GAIN change is only valid until the lead is changed.

6. Control and Function Keys

2. AP Select and AP Alarm (1.28 or higher software only) a. AP SELECT provides selection for source SCALE, ZERO, and CAL. 1. To change input source, press AP SELECT twice. 2. To adjust SCALE, ZERO or CAL, press AP SELECT once, then: • To change AP scale, press AP SCALING. • To zero, open transducer to air and press ZERO.

b. Setting AP ALARM (1.28 or higher) 1. Press AP SELECT 2. Press AP ALARM OFF. This will turn the alarm ON. 3. Select AP parameter for alarm. MAP or PDP. 4. Set alarm limit. Alarm limit can be adjusted in 5 mmHg increments. 4.1. MAP pre-set alarm limit: 70 mmHg 4.2. PDP pre-set alarm limit: 100 mmHg

Control and Function Keys 12

6. Control and Function Keys

3. Cursor a. Moves horizontal cursor on AP and BPW. Move cursor to desired assessment point. Value is displayed above cursor on the right hand side.

6. Control and Function Keys

4. Inflate – Adjusts inflation point. a. Inflation occurs earlier when the left arrow is depressed and later when the right arrow is depressed. Allows the operator to optimize timing by monitoring the hemodynamic changes produced on the AP waveform. 1. Move the inflation point to the right until you can clearly see the dicrotic notch on the arterial pressure waveform.

Makes < inflation occur earlier

> Makes inflation occur later

2. Slowly move the inflation point to the left until the dicrotic notch (40ms in front of AVC/DN) is no longer visible. 3. Check PDP/DA. Generally PDP/DA should be > APSP. If not, additional assessment of the patient or IABP may be required. 5. Deflate – Adjusts deflation point. a. Deflation occurs earlier when the left arrow is depressed and later when the right arrow is depressed. Allows the operator to optimize timing by monitoring the hemodynamic changes produced on the AP waveform. 1. Move the deflation point to the left to see its effect on the AP waveform. Note the rise in the APSP and the plateau of the BAEDP/AEDP.

Makes < deflation occur earlier

> Makes deflation occur later

2. Move the deflation point to the right to lower the APSP while simultaneously keeping the BAEDP/AEDP lower than the PAEDP/UEDP. 3. Return the ASSIST RATIO to 1:1.

Control and Function Keys 14

6. Control and Function Keys

6. Pump Status a. ON Starts pumping. If pressed before STNDBY, pumping starts after one purge cycle and the pneumatic system fills with helium to 2.5mmHg. b. STNDBY If pump is on, immediately stops pumping but does not vent the pneumatic system. If pump is off, completes a four beat purge cycle and pressurizes the pneumatic system with helium to 2.5mmHg. If pump left in STNDBY > 3 minutes an alarm will be issued. c. OFF Immediately stops pumping, deflates the balloon and vents the pneumatic system to atmosphere. Six alarms automatically stop the pump. 7. Trigger Modes a. Preset trigger. For normal QRS complex.Uses height, width and slope of positive or negative QRS complexes. Width must be between 25 and 135 msec. Rejects pacer spikes. b. For any type of QRS complex and changing QRS shapes. Uses height and slope only of positive or negative QRS complexes. May be preferred for HR > 140. Rejects pacer spikes. c. For irregular cardiac rhythms. Uses height and slope only of positive or negative QRS complexes with REAL TIME (R-Wave) deflation. Rejects pacer spikes. d. Uses V-pacer spikes to trigger. MUST BE 100% PACED. For V and AV sequential pacers. e. Uses A-pacer spikes to trigger. MUST BE 100% PACED. For Atrial pacers only. f. Uses AP waveform to trigger. Recommended when ECG is not available or too noisy. NOT RECOMMENDED FOR IRREGULAR RHYTHMS. g. Uses IABP internal signal for triggering. Used when no ECG or AP signal is available. ASYNCHRONOUS TO PATIENT CARDIAC ACTIVITY. Press INT twice to confirm.

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Intra-Aortic Ballon Pumps

ACAT1 Timing Triggering Troubleshooting Guide