Guidelines for assessing and stabilizing axillary intra-aortic balloon pumps : promoting mobilization
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Nature and scope of the project: Cardiogenic shock can result in impaired peripheral tissue and end-organ dysfunction. Axillary intra-aortic balloon pumps (AxIABP) may improve circulation and ventricular function. This device requires cardiac intensive care unit (CCU) stays and patients are at risk for device complications (e.g., cannula kinks), muscle wasting, and decreased mobility. The objectives were to decrease adverse events by 10% decrease, a 10% increase in mobilization, and 85% increase in confidence related to mobilizing AxIABP. Synthesis and analysis of supporting literature: A thorough literature review supported ambulation protocols, interventions, and ways to overcome barriers when mobilizing AxIABP. Project implementation: A dual focus on standard protocol development for insertion, securement, and dressing application. Also, knowledge gain regarding assessing, stabilizing, and mobilizing AxIABP. Comparison of adverse events at T1 and T4 are pending. Evaluation criteria: An evaluation of changes in adverse events (T1 vs T4), mobilization occurrences (T1 vs T4), and knowledge gain at T2 and T3. Outcomes: There were 73 nursing participants, 55% (n=37) primarily worked days and 58% (n=42) had 5+ years of experience. Eighty-five percent (n=62) reported some or a lot of knowledge gain. When asked about confidence related to safety, there was a large statistically significant increase in the mean score from T2 (M = 3.55, SD = .99) to T3 (M = 4.52, SD = .36), Cohen’s d=.98 (p < .001). When asked about confidence related to securement, there was a moderately statistically significant increase in the mean score from T2 (M = 3.66, SD = 1.02) to T3 (M = 4.40, SD = .66), Cohen’s d=.78 (p < .001). When asked about confidence related to mobilization, there was a large statistically significant increase in the mean score from T2 (M = 3.36, SD = 1.18) to T3 (M = 4.40, SD = .70), Cohen’s d=.97 (p < .001). Recommendations: Establish guidelines for device integrity and to decrease adverse events pre-post mobilization. Key stakeholders support utilizing standardized guidelines and protocols to decrease procedural interventions and to increase safety at the bedside. Guidelines should be reviewed on an annual basis to ensure best practices are implemented.
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License.