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CS58
An Alternate Care Environment for the Axillary IABP Patient
By Barbara Borman, Seton Medical Center, Austin,TX
For further information, please contact: bborman@seton.org
Purpose: Mechanical assist devices are an important bridge to transplant. Axillary IABP support is an alternative to VAD support and reduces the risks of immobilization associated with femoral insertion. Traditionally, the IABP patient is cared for in the ICU. Prolonged stays in the ICU increase the patient’s risks of complications which can significantly impact post transplant recovery. Utilizing the creative efforts of the cardiology team, our goal was to provide IABP care to the patient in a less stressful environment.
Description: Our transplant surgeons and cardiologists championed the effort to care for axillary IABP patients on the cardiac telemetry unit. An interdisciplinary team was formed to develop an implementation plan to ready telemetry staff for care of these patients. The team consisted of staff from ICU, transplant, telemetry, surgery, cardiac rehab, finance, administration, biomed, and the device manufacturer. Critical elements of the plan included: education/training to develop and maintain IABP competency, ‘just in time training’ to refresh skills, a discussion forum to promote expertise in critical thinking skills, refinement of physician communication, ICU support team, and alarm systems and checks for audibility. We developed a VAD team assignment approach to staffing. Administrative and financial services supported the concept and risks taken, and provided flexible staffing budgets.
Evaluation/Outcomes: Six IABP patients have received 227 days of care on the cardiac telemetry unit. Patients/families praise the nursing care and enjoy the freedom to move about and have family/ friends assist in care delivery. The staff has responded with prompt recognition and intervention to urgent patient changes, and no adverse patient events have occurred. The cardiac telemetry staff have enhanced their understanding of hemodynamics and express an unbelievable pride in their work with these patients.
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