protocol for transport of patients on an intra - MAQUET Cardiac Assist

TRANSPORT PROTOCOLSFOR PATIENTS ON ANINTRA-AORTIC BALLOON PUMPCourtesy <strong>of</strong> Datascope Corp.Clinical Support Services Department

TABLE OF CONTENTSObjectives <strong>of</strong> the Transport Team 2Interfacility Transfer Algorithm 3Protocol <strong>for</strong> referral/retrieval <strong>of</strong>a patient on IABP 4-7Suggested paper work 8Transport Equipment Checklist 9-11Pre-Transport In<strong>for</strong>mation Checklist 12Post-Transport Checklist 13Transport considerations <strong>for</strong> Datascope IABPConsoles 97 / 97e / 98 / 98XT 14-15These <strong>protocol</strong>s are designed to serve as guidelines and are notrecommendations from Datascope Corp.1

PROTOCOL FOR TRANSPORT OF PATIENTS ON AN INTRA-AORTICBALLOON PUMPObjectives <strong>of</strong> the Transport Team:Provide skilled personnel and the equipment necessary to deliver the specialized care neededto stabilize, maintain and <strong>transport</strong> a critically ill patient on the Intra-aortic Balloon Pump.It is imperative that all members <strong>of</strong> the team communicate, cooperate and collaborate withone another and all others involved in the <strong>transport</strong> procedure to insure optimal care <strong>of</strong> thepatient during all aspects <strong>of</strong> the <strong>transport</strong> process.All members <strong>of</strong> the <strong>transport</strong> team must:• Be familiar with the Guidelines <strong>for</strong> the Transfer <strong>of</strong> Critically Ill Patients* [Critical CareMedicine from the American College <strong>of</strong> Critical Care Medicine, Society <strong>of</strong> Critical Care Medicineand American Association <strong>of</strong> Critical Care Nurses].• Be skilled in the set-up, operation and troubleshooting <strong>of</strong> the intra-aortic balloon pump.• Possess a strong background in all aspects <strong>of</strong> acute coronary care.* Please contact Datascope <strong>for</strong> your copy <strong>of</strong> the Guidelines <strong>for</strong> the Transfer <strong>of</strong> Critically IllPatients.2

INTERFACILITY TRANSFER ALGORITHMAssess patient conditionDiagnosisPersonnel and technological resources to adequatelycare <strong>for</strong> patientBenefits <strong>of</strong> transfer- Further diagnostic testing- Specialized care requiredRisks <strong>of</strong> transfer- possible physiological effects orproblems encountered during transferShould the patient betransferred?YESNODetermine referral centerMatch patient’s medical, nursing, and technological needs toappropriate referral centerConsider bed availability, cost, and patient preference [asappropriate]Obtain acceptance from referral centerReceiving MD willing and qualified to accept patientReceiving staff aware <strong>of</strong> arrival time and unit bed availableIs it possible totransfer?YESNOContinue appropriate patient carePlace patient in most appropriate setting /department to maintain patient careCommunicate with receiving hospital- consider back-up plan- Request recommendationsAttempt to eliminate barriersRestabilize patient- Select different <strong>transport</strong>ation mode- Await weather changeReassess need <strong>for</strong> and barriers to transferInitiate Q/I screen to evaluate inability to transferSelect mode <strong>of</strong> <strong>transport</strong>ationPatient acuityGeographic and weather barriersSelect accompanying personnelPatient acuityCompetencies requiredInitiate transfer proceduresMobilize personnel and transfer equipmentUtilize developed transfer <strong>protocol</strong>s and proceduresIs it possible totransfer?YESNO[Possible change in patient condition,weather, or other previous decision].Prepare the patient and familyPhysically – Identify and provide appropriatetherapeutic interventions to minimize complicationsPsychologically – Removes patient temporarily fromfamily or significant other support. Ensure family aware <strong>of</strong> benefits<strong>of</strong> transfer, location <strong>of</strong> receiving hospital, and their plans andneedsAdministratively – Clear and completedocumentation <strong>of</strong> condition, interventions, and diagnostics.Sending and receiving nursing and medical management <strong>of</strong> thepatient and the consent process.TransferUtilize facility procedures and <strong>protocol</strong>Evaluate transfer episodesInitiate transfer outcome report/sReproduced with permission from the Society <strong>of</strong> Critical Care Medicine, Guidelines <strong>for</strong> the transfer <strong>of</strong> Critically Ill Patients.3

ACTIVATION OF THE INTRA-AORTIC BALLOON PUMP TRANSPORTTEAMRETRIEVAL FROM A REFERRAL HOSPITALPre-<strong>transport</strong> coordination and communication toinclude:• Obtain in<strong>for</strong>mation from the referral hospital:Patient name, referring physician’s nameand phone number, name <strong>of</strong> attending physician uponadmission at referral hospital.Referring hospital’s name and city, patientlocation within the hospital.Contact person at the referring facility andphone number.• Notify team members <strong>of</strong> impending <strong>transport</strong>• Secure a bed in the admitting unit and arrangestaffing <strong>for</strong> the new admission.• Obtain a status report on the patient, record the Pre-Transport In<strong>for</strong>mation Checklist and communicate thisin<strong>for</strong>mation to other team members involved in the<strong>transport</strong>.• If the referring physician is different from thephysician who will be attending the patient uponadmission, contact the receiving physician to confirmhe/she is aware <strong>of</strong> the impending admission and ifnecessary provide him/her with the name and phonenumber <strong>of</strong> the referring physician <strong>for</strong> consultation.• Notify the referring facility <strong>of</strong> the estimated time <strong>of</strong>arrival <strong>of</strong> the intra-aortic balloon pump team.• Identify the type [Manufacturer] <strong>of</strong> Intra-aorticballoon catheter [IAB] being used. May require anadapter to connect the IAB to the <strong>transport</strong> pump.REFERRAL TO A RECEIVING HOSPITALPre-<strong>transport</strong> coordination and communication toinclude:• Secure a bed in the admitting unit at the receivinghospital.• Notify team members <strong>of</strong> the impending <strong>transport</strong>.• Provide in<strong>for</strong>mation to the receiving hospital:Patient name, referring physician’s nameand phone number, name <strong>of</strong> the physician who will Beattending the patient upon admission to the receivinghospital.Referring hospital’s name and city, patientlocation within the hospital.Contact person at the referring facility andphone number.• Secure the availability <strong>of</strong> the <strong>transport</strong> vehicle anddetermine departure location from the hospital and theestimated time <strong>of</strong> departure.• If the referring physician is different from thephysician who will be attending the patient uponadmission, contact the receiving physician to confirmthat he/she is aware <strong>of</strong> the impending admission, and ifnecessary, provide him/her with the name and phonenumber <strong>of</strong> the referring physician <strong>for</strong> consultation.• Notify the receiving facility <strong>of</strong> the estimated time <strong>of</strong>arrival <strong>of</strong> the patient and the <strong>transport</strong> team.• Have copies made <strong>of</strong> the chart and all necessaryaspects <strong>of</strong> the medical records [ include cath recordsetc.].• If necessary, arrange to have staff at the receivingfacility meet the <strong>transport</strong> team upon arrival.4

RETRIEVAL FROM A REFERRAL HOSPITALUpon arrival at the referring facility, the TransportTeam will:• Identify themselves to the nurse caring <strong>for</strong> thepatient and assist in preparing the patient <strong>for</strong><strong>transport</strong>.• Confirm that consent <strong>for</strong>ms have been completed.• Explain the transfer procedure to the patient’s familyif they are available, provide the patient’s family within<strong>for</strong>mation regarding the receiving facility; how to getthere, what unit the patient will be admitted to, whothey can contact at the receiving facility, and thephone number <strong>for</strong> the admitting unit.• Confirm that the chart has been copied and that allnecessary aspects <strong>of</strong> the medical record are available.The Balloon Pump Operator will:• Set-up the <strong>transport</strong> pump, attach electrodes andarterial line transducer and prepare to switch thepatient to the <strong>transport</strong> pump.• Switch the patient to the <strong>transport</strong> balloon pump andassure optimal operation.• Check that there is enough battery time availablewith the balloon pump <strong>for</strong> the journey to the receivinghospital.• Manage the balloon pump operation <strong>for</strong> optimaltherapeutic effect.• Assist the nurse with the changing and arranging <strong>of</strong>intravenous lines, drips, invasive lines and assist in thetransfer <strong>of</strong> the patient from the bed to the stretcher.• Secure the availability <strong>of</strong> the <strong>transport</strong> vehicle <strong>for</strong>the return trip, provide them with an estimated time<strong>of</strong> departure and departure location. If necessary,arrange <strong>for</strong> additional personnel to help load thepatient and pump into the waiting <strong>transport</strong> vehicle.REFERRAL TO A RECEIVING HOSPITALIn preparation <strong>for</strong> the <strong>transport</strong>, the Transport Teamwill:• Confirm that consent <strong>for</strong>ms have been completed.• Explain the transfer procedure to the patient and thepatient’s family if they are available, provide thepatient’s family with in<strong>for</strong>mation regarding thereceiving facility; how to get there, what unit thepatient will be admitted to, who they can contact atthe receiving facility, and the phone number <strong>for</strong> theadmitting unit.• Confirm that the chart has been copied and that allnecessary aspects <strong>of</strong> the medical record are available.• Gather the necessary supplies and equipment <strong>for</strong> the<strong>transport</strong>.• In<strong>for</strong>m the receiving hospital <strong>of</strong> the Intra-aorticballoon catheter type, [manufacturer].The Balloon Pump Operator will:• Prepare the balloon pump <strong>for</strong> <strong>transport</strong>, confirm theECG lead cable and transducer are directly connectedto the pump and in working order.• Check that there is enough battery time availablewith the balloon pump <strong>for</strong> the journey to the receivinghospital.• Manage the balloon pump <strong>for</strong> optimal therapeuticeffect.• Assist the nurse with the changing and arranging <strong>of</strong>intravenous lines, drips, invasive lines and assist in thetransfer <strong>of</strong> the patient from the bed to the stretcher.• Secure the availability <strong>of</strong> the <strong>transport</strong> vehicle <strong>for</strong>the return trip, provide them with an estimated time<strong>of</strong> departure and departure location. If necessary,arrange <strong>for</strong> additional personnel to help load thepatient and pump into the waiting <strong>transport</strong> vehicle.5

RETRIEVAL FROM A REFERRAL HOSPITALThe Transport Nurse will:• Maintain an ongoing assessment <strong>of</strong> the patient’scondition and intervene as necessary.• Assist with the changing and arranging <strong>of</strong> allintravenous lines, drips, invasive lines and assist in thetransfer <strong>of</strong> the patient from the bed to the stretcher.• Call report to the receiving unit and provide themwith an estimated time <strong>of</strong> arrival, request the balloonpump to be used at the bedside be set-up and ready <strong>for</strong>the patient on arrival.• Contact the receiving physician <strong>for</strong> transfer orders.When the Patient is ready <strong>for</strong> <strong>transport</strong>, theTransport Team will:• Transport the patient to the waiting <strong>transport</strong> vehicleand load the patient into the <strong>transport</strong> vehicle. Plug inand secure.• Make sure no supplies and equipment have been leftbehind.• Assess the patient and balloon pump operation andintervene if necessary.During the <strong>transport</strong> from the receiving facility, theTransport team will:• Maintain an ongoing assessment <strong>of</strong> the patient’scondition and maintain optimal operation <strong>of</strong> theballoon pump.• The <strong>transport</strong> nurse will document the ongoingassessment and interventions during the <strong>transport</strong>.• The balloon pump operator will intervene asnecessary to maintain optimal balloon pump operation.REFERRAL TO A RECEIVING HOSPITALThe Transport Nurse will:• Maintain an ongoing assessment <strong>of</strong> the patient’scondition and intervene as necessary.• Contact the physician <strong>for</strong> any further orders.• Assist with the changing and arranging <strong>of</strong> allintravenous lines, drips, invasive lines and assist in thetransfer <strong>of</strong> the patient from the bed to the stretcher.• Call status report to the receiving unit, record on thePre-Transport in<strong>for</strong>mation checklist and provide themwith an estimated time <strong>of</strong> arrival. Request the balloonpump to be used at the bedside be set-up and ready <strong>for</strong>the patient on arrival.When the Patient is ready <strong>for</strong> <strong>transport</strong>, theTransport Team will:• Transport the patient to the waiting <strong>transport</strong> vehicleand load the patient into the <strong>transport</strong> vehicle. Plug inand secure.• Make sure all necessary supplies and equipment areavailable.• Assess the patient and balloon operation andintervene if necessary.During <strong>transport</strong> to the receiving facility, theTransport Team will:• Maintain an ongoing assessment <strong>of</strong> the patient’scondition and maintain optimal operation <strong>of</strong> theballoon pump.• The <strong>transport</strong> nurse will document the ongoingassessment and interventions during the <strong>transport</strong>.• The balloon pump operator will intervene asnecessary to maintain optimal balloon pump operation.6

Protocol <strong>for</strong> Insertion <strong>of</strong> the Intra-Aortic Balloon by the Retrieval TeamThe Transport Team will:• Explain the insertion procedure to the patient and the patient’s family if they are available.• Set up insertion supplies, prep and drape the patient.• Set up the balloon pump.• Assist the physician with the insertion <strong>of</strong> the intra-aortic balloon catheter. [Please refer to Instructions <strong>for</strong> Use]The Balloon Pump Operator will:• Set up the balloon pump. [Please refer to the Manufacturer’s operators manual]• Following catheter placement, attach the balloon catheter to the balloon pump, initiate counterpulsation andmanage the balloon pump <strong>for</strong> optimal therapeutic effects.AT THE RECEIVING FACILITYThe Transport Team will:• Transport the patient from the <strong>transport</strong> vehicle to the bedside and the patient will be changed from the<strong>transport</strong> balloon pump to the waiting balloon pump, unless the <strong>transport</strong> balloon pump is to be utilized at thebedside.• Assist with the transfer <strong>of</strong> intravenous lines, drips, invasive lines, and assist with transfer <strong>of</strong> the patient from thestretcher to the bed.The Transport Nurse will:• Complete all documentation <strong>of</strong> the <strong>transport</strong> and place on the patient’s chart.Following the completion <strong>of</strong> the <strong>transport</strong>, the Transport Team will:• Complete the Post Transport Check List.• Check, charge, and replace all used supplies.• Store all supplies in there designated location and confirm that the balloon pump is plugged in and batterycharging and the Helium tank is closed.7

SUGGESTED PAPER WORK:ConsentsFor TransportPre-Transport In<strong>for</strong>mation Check ListTransport RecordThe hospital patient care record will be used to document all aspects <strong>of</strong> patientcare delivered during the <strong>transport</strong> and all events <strong>of</strong> the <strong>transport</strong>.Post-Transport Check ListEquipment Check ListsIntra-Aortic Balloon pumpAirway and VentilationCardiacVascular AccessMedications8

TRANSPORT EQUIPMENT CHECK LISTIntra-Aortic Balloon Pumping EquipmentIntra-Aortic Balloon Pump with Transport Support ModuleLead CableSkin ElectrodesTransducerArterial Pressure Set-upBalloon Catheters8 Fr. With insertion kit9.5 Fr. With insertion kitExtender TubingAdapters – to adapt other brands <strong>of</strong> balloon catheters to aDatascope Balloon pumpSpare Helium CylinderOperators manualStopcocks60cc SyringeAirway and Ventilation EquipmentPortable Oxygen EquipmentLaryngoscope HandlesPortable Suction Apparatus LaryngoscopeOxygen Administration Equipment Straight BladeET Tubes [various sizes] Curved BladeET Tube Stylet Pocket MaskSpare Batteries and Lightbulbs Bag-Valve SystemOral Airways Oxygen MasksMagil Forceps [various sizes] 10cc SyringesLubricating Jelly [water soluble] Pulse Oximetry9

Cardiac EquipmentPortable, Battery-operated Monitor/Defibrillator [to include:]Paper / RecorderDefibrillator Pads / gelQuick-look Paddles or Hands-free PatchesECG LeadsChest Attachment ElectrodesPaddles with capability to provide electrical discharge below 25watts/secondTranscutaneous Cardiac PacemakerVascular Access EquipmentIntravenous Administration EquipmentIntravenous Administration SetsMicrodrip and Macrodrip3-way stopcocks with extensionsY-Blood tubing drip setsCrystalloid Solutions1,000 ml Normal Saline 500 ml Normal Saline1,000 ml Ringers Lactate 500 ml Dextrose 5%[in water]Intravenous Catheters 14G – 24GTourniquetNeedles 19G – 25GAntiseptic Solution [alcohol wipes, povidine-iodine wipes]Tape / Band-aidsIV PoleSyringes <strong>of</strong> various sizes10

Medications:Medications should be compatible with current standards as indicated by the American HeartAssociation’s Emergency Care Committee.In general medications should include:Cardiovascular Medications:1:10,000 EpinephrineAtropineLidocaineBretylium TosylateAdenosineDiltiazemHydrochloridePropranololNitroglycerin tablets / intravenousAspirinDopamineCardiopulmonary/respiratory medications:AlbuterolFurosemide1:1,000 EpinephrineAminophyllineOther Medications:MorphineCalcium Chloride50% Dextrose solutionDiazepamMidazolamMagnesiumPotassium ChlorideNaloxoneSterile water <strong>for</strong> Injection11

Pre-Transport In<strong>for</strong>mation ChecklistName Age Date TimeReferring Hospital Unit Phone #Contact Person Phone #Referring Physician Phone #Consulting Physician Phone #DiagnosisVital Signs: BP HR Rhythm Temp RespRateSpont/Mech Vent PA Wedge RACurrent Medications:Drips Dose Other MedicationsInvasive Lines – Site and Insertion Date:Intra-Aortic Balloon CatheterBalloon Pump Model Catheter Size IAB VolumeArterial LineSwan GanzCentral LinePacing LeadIV’sETTVent SettingsFoley CatheterNasogastric TubeTeam Members:Team LeaderBalloon Pump OperatorOthersNurseEquipment:Intra-Aortic Balloon Pump Extra Helium CylinderIAB Supplies Emergency MedicationsInfusion SuppliesTime Departed to Referral HospitalTime Arrived at Referral HospitalTime Departed from Referral HospitalTime Arrived at Retrieval HospitalAdditional In<strong>for</strong>mation:12

TRANSPORT CONSIDERATIONS FOR DATASCOPE INTRA—AORTICBALLOON PUMP SYSTEMS 97/97e/98/98XTIf it is necessary to disconnect patient connections or to detach the battery from the console t<strong>of</strong>acilitate movement into a <strong>transport</strong> vehicle or aircraft, the IABP consoles will hold the settingsin memory <strong>for</strong> 15 minutes. Once, the patient and pump are reattached, turn the power ON,verify timing settings, press ASSIST/STANDBY to Auto Fill the IAB and resume pumping.Portable Operation:• To switch from AC power to battery operation, unplug the power cord from the AC outlet.The IABP Console switches automatically to battery operation.• The message “Battery in use” will be displayed in the ADVISORIES section <strong>of</strong> the monitor.For the IABP Console 98/98XT the BATTERY INDICATOR will be displayed on the monitorscreen.• The batteries recharge whenever the Console is plugged into an AC outlet with the MAINSswitch ON. T o maintain batteries at full charge and maximize battery life, it is recommendedthat the Console be plugged in at all times even when not in use.• When approximately 30 minutes <strong>of</strong> battery operation time remains, the following occurs: Themessage, “Low Battery”, is continuously displayed in the ADVISORIES section and a doublebeep alarm is activated <strong>for</strong> 30 seconds.• To return to AC power, plug the AC power cord into an AC outlet. The Console automaticallyswitches to AC operation and the internal batteries will recharge. Verify BATTERY CHARGINGLED indicator on the front <strong>of</strong> the pump is either continuously illuminated or is flashing whenthe Console is plugged in.• If the unit is stored <strong>for</strong> an extended period and AC power is unavailable, disconnect theConsole battery pack from the console. Refer to the Operating Instructions <strong>for</strong> additionaldetail.14

Portable Operation from a Vehicle Inverter:• The AC power <strong>for</strong> the Console can be supplied from an emergency vehicle inverter.• The inverter should be checked <strong>for</strong> proper operation.• Refer to the Operating Instructions <strong>for</strong> vehicle inverter specifications.• The message “Battery in use” will not be displayed during proper AC inverter operation.• Interruption <strong>of</strong> the vehicle inverter AC power will result in internal battery operation.Portable Operation from External DC Source:• The Console can be powered from an External DC power source such as may be availablefrom an ambulance, helicopter, or external battery pack.• Connect a voltage compatible external 24-volt DC power source to the External DC InputConnector. [Refer to the Operating Instructions <strong>for</strong> additional detail].• The message, “Battery in use (EXT)” will be displayed in the ADVISORIES section <strong>of</strong> themonitor when the Console is operated from the External DC power source.• Interruption <strong>of</strong> the External DC power source will result in internal battery operation.Altitude changes during Air Transport:• For proper operation during air <strong>transport</strong>, the IABP Console balloon pressure must adapt tolocal atmospheric pressure.• In the Auto Fill mode, the Console will automatically purge and fill the IAB when localatmospheric pressure decreases or increases by 25 or 50 mmHg respectively. These pressurechanges occur approximately every 1,000 feet <strong>of</strong> rise in altitude or 2,000 feet <strong>of</strong> drop inaltitude.• The Auto Fill mode should be used during air <strong>transport</strong>. If the Auto Fill mode cannot be usedand the Manual Fill mode is required, a Manual Fill must be per<strong>for</strong>med at the same intervalsthat an Auto Fill would occur. When in the manual fill mode, direct communication with thepilot <strong>for</strong> altitude changes is mandatory.15

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