Start-up and Getting Started checklist

Procedure AC3 · startup-checklist

Overview

The manual's six basic steps for bringing an AC3 Series intra-aortic balloon pump (IABP) into service: power up, complete the Getting Started Checklist (helium, trigger, intra-aortic balloon connection, and on the AC3 Optimus™ the optional FiberOptix™ sensor (FOS) zero), start the pump, assess triggering and timing, and verify alarms are on. The pump starts in AutoPilot™ mode and will not offer Start Pump until every checklist item shows a green check.

When to perform

Every initiation of therapy, from a cold console to the first assisted beat.

Equipment

• AC power (or confirmed adequate battery time)
• helium tank above 100 psi
• recorder paper
• 5-lead ECG cable or a bedside-monitor ECG slave cable
• arterial pressure source (FOS, transducer or monitor)
• IAB with its volume connector
• an operational checkout performed within about one week

Steps

1. Before powering up, confirm power is available along with helium, recorder paper and other supplies, and that an operational checkout was performed recently, generally within one week.¹

   The weekly checkout is what proves the pump, recorder, alarms and helium pathway worked before a patient depends on them.

2. Engage the wheel brakes to secure the system.²

   A rolling console stresses the catheter and connector once the patient is attached.

3. Connect AC power.¹

   Running on battery from the start spends the minimum 90 minutes of reserve meant for transport and outages.

4. Press the power switch at the lower right of the interface panel and verify the display is on and the LEDs are illuminated; check the power status and helium supply shown in the upper right corner of the display.²

   If the power icon shows battery, the console is not receiving AC and the outlet needs checking; a fully charged battery lasts a minimum of 90 minutes.

5. Double-check the helium and recorder paper supplies; replace the helium tank if it shows 100 psi or less.²

   The pump cannot start with the tank off or empty, and a low tank will run out during therapy.

6. Checklist, Helium Supply: read the HE gauge. Green or Red needs no further action (Red: be prepared to change the tank); Black means turn on or change the tank. Verify the tank pressure in the upper right of the display when the item shows a green check.³

   Helium availability is one of the three functions the pump requires before it will enable Start Pump.

7. Checklist, Trigger Present: connect the 5-lead ECG cable or the bedside-monitor signal and/or an AP source, then verify a waveform is present, the heart rate is correct and the red heart flashes for each trigger.⁴

   The pump purges and times to the cardiac cycle, so it needs a reliable per-beat trigger before it will start.

8. AC3 Optimus™ with a FiberOptix™ balloon: zero the FOS before IAB insertion using the FOS checklist. Connect the CAL key (not needed for an RFID Yellow slider), connect the FOS slider (two beeps), wait about 5 to 15 seconds for the auto-zero, and insert the IAB only after the four-beep tone.^5,6

   The FiberOptix™ sensor can only be zeroed in air, before insertion; once the balloon is in, the zero can never be done and the pressure numbers can only be corrected with FOS MAP CAL.

9. Checklist, IAB Connected: connect the IAB volume connector to the pump and verify the IAB volume shown is correct, changing it with the Volume key if necessary.⁴

   The pump sets full volume from the connector's coding, so a wrong connector or a stale volume setting delivers the wrong helium volume.

10. When all items show green checks and the Start Pump key turns Blue, press the Start Pump hardkey or the Pump ON touchscreen control.³

    The blue key confirms the three required functions are satisfied.

11. Allow the purge to complete: on the first start after power up the pump purges ambient air and fills with helium in a special purge cycle, and pumping begins when the balloon pressure waveform appears.⁷

    Air in the pneumatic loop slows helium shuttle speed, so the pump replaces it before assisting.

12. Assess triggering: the HR display matches the patient's heart rate, white bands on the ECG are present and match the assist ratio, and the trigger mode is displayed in the Trigger tab.⁸

    A wrong or unstable trigger puts inflation and deflation in the wrong part of every beat.

13. Assess timing: verify the automatic timing is acceptable, select 1:2 and compare the assisted and unassisted AP waveforms, and change the Deflation Timing method in the Trigger tab if needed (AutoPilot™, ALWAYS R-Wave or NEVER R-Wave).⁸

    Only side-by-side assisted and unassisted beats show whether augmentation, end-diastolic unloading and systolic unloading are being achieved.

14. Check the balloon pressure waveform: verify IAB sizing by comparing AUG to the BPW plateau, verify the BPW shape, then set the assist ratio to 1:1 for full support and the IAB volume to 100 percent, both as ordered by the physician.⁸

    The plateau-to-AUG comparison catches an oversized or undersized balloon, and the waveform shape reveals kinks, sheath entrapment and leaks.

15. Optional: print a Therapy Status Report by touching the hemodynamic area of the display and then the Print key.⁸

    The report documents the starting settings and hemodynamics for the record.

16. Verify the alarms are ON and set an AP alarm if required.⁹

    Main alarms are preset ON but AP alarms are preset OFF at power-on, so no low-pressure or disconnect alarm exists until the clinician sets one.

Cautions

• Only medical personnel trained in IABP use and acting under a physician's orders should operate the system.¹⁰
• Do NOT touch the IABP system during defibrillation; possibility of electric shock.¹⁰
• Be prepared to maintain IABP operation in critical situations by having a backup IABP system and extra helium tanks ready.²
• Do not use solvents such as acetone or other degreasing agents to prepare the skin; they may damage the IAB catheter or other plastic components.²
• The AP FOS sensor MUST be zeroed prior to IAB insertion; all other AP sources can be zeroed after insertion.⁴
• If ALWAYS R-Wave is selected, monitor the patient closely; late deflation can result.⁸
• If the pump starts on battery, ensure adequate battery time; a fully charged battery powers the system for a minimum of 90 minutes.¹

Related knowledge

• Default operation mode at power-on (ST-001)
• Preset assist ratio at power-on (ST-002)
• Preset AP source by model (ST-004)
• Power-on alarm presets (ST-005)
• Three required functions for pump start (ST-008)
• Checklist symbols and Start Pump key color (ST-009)
• Helium gauge color actions on the checklist (ST-010)
• Helium tank replacement threshold (ST-011)
• Battery runtime and the battery power icon (ST-012)
• Always zero the FiberOptix™ before insertion; an un-zeroed balloon can still pump (ST-013)
• FOS connection and zero-complete tones (ST-016)
• Pump On fill pressure and first-start purge (TT-001)
• Verifying triggering: three checks and the white markers (TT-024)
• Timing assessment rules (TT-026)
• Balloon sizing by AUG versus BPW plateau (TT-030)

References

1. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 100.
2. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 108.
3. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 101.
4. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 102.
5. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 104.
6. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 46.
7. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 132.
8. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 106.
9. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 107.
10. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 98.
11. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. pp 98-108.
12. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 125.