Nurses Develop Protocols for Patients with PAxIABPs

Apr 02, 2019

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Article in Critical Care Nurse presents nursing protocols for patients with PAxIABP awaiting heart transplants, including mobility

ALISO VIEJO, Calif. – April 2, 2019 – The introduction of a new procedure or device often means adjustments to existing patient care protocols, but rarely is the intervention so new that new standards of practice need to be developed.

When transplant cardiologists at Debakey Heart and Vascular Center at Houston Methodist Hospital began using percutaneously placed axillary intra-aortic balloon pumps (PAxIABPs) in 2007 as a bridge to heart transplants, a literature search revealed no precedent or published nursing literature on the subject.

The nursing and medical team in the cardiac intensive care unit (CICU) encountered unique challenges in the care of patients with PAxIABP and collaborated to develop interventions and incorporate them into the standard of practice.

Nursing Care and Treatment of Ambulatory Patients With Percutaneously Placed Axillary Intra-Aortic Balloon Pump Before Heart Transplant” reviews the nursing challenges and unique problems of caring for patients with PAxIABP and the solutions developed by nurses in the CICU. The article is published in the April issue of Critical Care Nurse (CCN).

“During the early phase of implementation of the PAxIABP procedure, we used existing evidence-based practices to care for and treat patients with the device,” said co-author Frederick Macapagal, BSN, RN, CCRN. “We developed, implemented and revised clinical practice guidelines to reflect nursing care practice and patient treatment.”

The PAxIABP procedure allows patients to have mobility and physical therapy while waiting for a heart transplant, rather than remaining on bed rest as they would with the more common femoral artery IABP.

The CICU team had to develop its own mobilization and ambulation guidelines unique to these patients, but increased mobility of patients with PAxIABP presented its own unique challenges. Nurses encountered greater incidence of catheter malposition and migration, frequent IABP console alarms and clotted IABP arterial catheters, inaccurate arterial blood pressure readings, and the need for portable monitoring and IABP consoles. Whenever a challenge arose, the team devised solutions to address the situation.

Patients with a PAxIABP can wait for a heart transplant from four to 156 days, and the team recognized the potential psychological toll for patients with long wait times. Staff nurses help bolster morale by creating a welcoming environment for patients and their families, including celebrating holidays, birthdays and other special occasions. One patient was able to walk his daughter down the aisle during her wedding at the hospital chapel, with increased staffing and special accommodations.

Home-cooked meals are allowed as long as they comply with low-fat, low-sodium restrictions. Pets can visit after they have been screened for immunizations by volunteers from a local animal rescue and adoption organization. Patients are encouraged to decorate their rooms with photographs and mementos. Spouses and other family members are permitted to stay overnight and sleep in the patient’s room. Volunteers who are heart transplant recipients regularly conduct patient rounds in the unit and are available to talk to patients.

Over a 10-year period, the center cared for at least 120 patients with PAxIABP, and 84 percent of these patients received a heart or multi-organ transplant.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for high-acuity and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high-acuity, progressive and critical care settings. CCN enjoys a circulation of more than 120,000 and can be accessed at

About the American Association of Critical-Care Nurses: Founded in 1969 with 400 members, the American Association of Critical-Care Nurses (AACN) is now the world’s largest specialty nursing organization. In 2019, AACN celebrates 50 years of acute and critical care nursing excellence, serving more than 120,000 members and over 200 chapters in the United States. The organization remains committed to its vision of creating a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. During its 50th anniversary year, AACN continues to salute and celebrate all that nurses have accomplished over the last half century, while honoring their past, present and future impact on the evolution of high-acuity and critical care nursing.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109; 949-362-2000;;;