IABP insertion

The common femoral artery is the most frequent and easiest route of insertion. A meticulously sterile technique is used and the percutaneous method is attempted first. The artery is cannulated with a needle and a Seldinger technique is used. The IABP is passed along a guidewire either through a sheath or, more recently, without a sheath, particularly in small-caliber femoral arteries. If the percutaneous approach is unsuccessful, the common femoral artery is exposed and the IABP catheter is inserted either using a modified Seldinger technique or by direct cannulation through a purse string. The length of the IABP catheter to be inserted is measured from the entry point of the femoral artery to the angle between the sternum and the manubrium. Fluoroscopy makes the insertion safer and can also check the final position of the catheter, which should be just distal to the left subclavian artery. If fluoroscopy is not available, the position can be verified with a chest radiograph.

If the femoral approach is unsuccessful, the catheter can be inserted through the ascending aorta secured by either a purse string or a long Dacron graft. This approach is possible only following cardiac surgery, and in other situations the axillary or subclavian arteries can be used. These approaches should not be used without careful assessment of benefit versus risk, because the greatest source of morbidity and mortality is related to the arterial access for the insertion of the IABP catheter.

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