Transplant cardiologists in our hospital have performed the percutaneously placed axillary-subclavian intra-aortic balloon pump procedure since 2007. This procedure allows patients to mobilize and walk while they wait for a heart transplant, rather than remaining on bed rest as they would with a traditional femoral intra-aortic balloon pump. This procedure has presented challenges to the nursing staff. A 2007 literature search revealed no precedent or published nursing articles on this subject. This article reviews heart failure, medical treatments, complications of bed rest associated with the femoral intra-aortic balloon pump, the nursing challenges and unique problems of caring for patients with percutaneously placed axillary-subclavian intra-aortic balloon pumps, and our solutions for those challenges.
The intraaortic balloon pump (IABP) is a treatment for end-stage heart failure patients not responsive to pharmacological therapy pre heart transplantation. An alternative approach-the percutaneously placed axillary-subclavian intraaortic balloon pump (PAxIABP) developed by cardiologists in our hospital enable patients to be mobilized while awaiting transplant versus the traditional bedrest in the femoral approach. Our objective is to determine if PAxIABP therapy enable pre-heart-transplant patients to safely mobilize. A retrospective study of pre-heart-transplant PAxIABP patients in the Coronary Intensive Care Unit (CICU) from 2007 to 2013 (n = 45; 35 men, 10 women) was conducted to determine mobility. Data are presented as mean (standard deviation) for continuous variables and number (percentage) for categorical variables. Patients were mobilized at 1.39 (± 1.41) days after PAxIABP insertion. The number of times mobilized per day was 1.79 (± 2). Transplant waiting time was 24.98 (± 25.03) days. Thirty-seven patients (82%) were transplanted. Two patients had a left ventricular assist device (LVAD) inserted and later transplanted. Six patients died before receiving a heart transplant, patients were 100% mobile. Complication rates: 4% bleeding; 7% ischemic complications; 2% IABP-related infection. Pre-heart-transplant patients receiving PAxIABP therapy can be safely mobilized. Nursing care protocols were developed to safely take care of this patient population. PAxIABP can be utilized for other procedures requiring long IABP therapy.
Background Patients who have an intra-aortic balloon pump or a pulmonary artery catheter with vasoactive infusion while awaiting heart transplant have reduced mobility due to heart failure and activity restrictions. Stroke volume, respiratory capacity, and muscle strength decrease, and sleep disturbances occur. Patients require motivation to enhance ambulation. Objective To explore patients’ experiences with a fitness tracker to promote ambulation before heart transplant. Methods In 2017, a fitness tracker was issued to 43 patients before heart transplant who met the study criteria, which included orders to ambulate. Semistructured interviews were conducted after 2 weeks of fitness tracker use with 8 random participants, who were followed up to enhance the credibility of and validate the findings. Responses were interpreted by using descriptive phenomenology and purposive sampling. An expert in phenomenology examined the transcript interpretations and attested that the findings were supported by the data and were internally coherent. The Colaizzi method was used to analyze data. Results A total of 361 significant statements were identified during the participants’ interviews and yielded 224 formulated meanings and 16 themes. Themes were categorized into 4 clusters: happy/delighted, motivator, beneficial, and future potential. Conclusions Participants were happy to get a fitness tracker and motivated to be active and increase activity/ambulation. Patients expressed benefits from walks: better sleep, more stamina, and feeling stronger. They believed that this intervention could have potential benefit for future patients.
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