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What This Guide Helps With
Troubleshoots poor augmentation associated with signal quality, timing, catheter connections, tubing restrictions, positioning, settings, or external setup problems.
Step-by-Step Troubleshooting
1. Protect the Patient and Treat Poor Augmentation as Clinically Significant
Low augmentation can represent ineffective circulatory support. Notify the clinical team immediately if the patient is dependent on the IABP and assisted pressure is unexpectedly inadequate.
Do not perform extended equipment troubleshooting while the patient depends on unreliable counterpulsation. Arrange alternate verified support when required.
Expected outcome: The patient's hemodynamic support is maintained while equipment troubleshooting proceeds safely.
2. Confirm the Reported Hemodynamic Problem
Review the displayed arterial pressure waveform, assisted beats, augmentation appearance, trigger source, and timing markers. Determine whether the complaint is continuous or intermittent and whether it began after transport, repositioning, a connection change, or a change in patient condition.
Clinical Engineering should not diagnose the patient's cardiovascular condition.
Expected outcome: The equipment-related symptom is clearly defined. If augmentation is normal and stable following verification, troubleshooting can stop.
3. Verify the Balloon Catheter Connections
Inspect accessible balloon catheter and pneumatic connections for incomplete seating, looseness, kinks, compression, damage, or disconnected adapters.
Do not manipulate the catheter insertion site.
Expected outcome: The external pneumatic path is securely connected and unobstructed. If correcting an external connection restores expected augmentation, verify stability and stop troubleshooting.
4. Check the Arterial Pressure Signal Quality
Inspect the pressure waveform used for monitoring and timing. A dampened, noisy, or missing waveform may make augmentation appear abnormal or interfere with timing assessment.
Check accessible cables, transducer connections, stopcocks, pressure tubing, and monitor interfaces within Clinical Engineering scope.
Expected outcome: A clean and physiologically plausible pressure waveform is displayed. If restoring signal quality resolves the issue, troubleshooting can stop.
5. Check the ECG or Selected Trigger Signal
Verify that the selected trigger source is available and stable. Inspect external ECG leads, cables, connectors, and electrode condition when ECG triggering is in use.
Expected outcome: Triggering is consistent and synchronized with the displayed cardiac signal. If correcting the trigger signal restores augmentation, troubleshooting can stop.
6. Verify Timing and Operating Controls
Observe the inflation and deflation markers and confirm that the system is operating in the intended timing mode selected by the clinical team. Do not independently alter clinical timing parameters beyond authorized Clinical Engineering testing.
If automatic timing is unreliable, investigate signal quality before assuming an internal timing failure.
Expected outcome: Timing markers are consistent and stable. If proper timing returns after correcting an external signal problem, troubleshooting can stop.
7. Inspect for External Restrictions
Trace accessible pneumatic tubing and related connections for bends, pinching, entrapment in bed hardware, or damage that could interfere with balloon inflation and deflation.
Expected outcome: Tubing is unrestricted and properly positioned. If removing an external restriction restores expected operation, verify performance and stop troubleshooting.
8. Compare Equipment Function With an Approved Test Setup
Once the pump is no longer supporting a patient, use appropriate manufacturer-approved test equipment or simulation to evaluate trigger response, pumping operation, and displayed augmentation behavior.
Expected outcome: The Cardiosave performs normally under controlled test conditions. Normal bench performance suggests that patient-side signal, catheter, positioning, or clinical factors require further clinical assessment.
9. Perform Final Functional Verification
Following any equipment correction, verify stable triggering, pumping, displayed pressure signals, alarms, controls, and required operational checks using approved procedures.
Expected outcome: The system operates consistently and passes required return-to-service testing. Troubleshooting can stop.
10. Escalate Persistent Poor Pump Performance
If low augmentation persists during controlled testing after external connections, signals, tubing, and configuration have been verified, remove the unit from service.
Expected outcome: The Cardiosave is referred for qualified service evaluation rather than subjected to deeper unauthorized troubleshooting.
If the Problem Persists
External signal, tubing, catheter connection, and configuration causes have been evaluated. Remaining possibilities include internal pneumatic performance problems, timing circuitry or software issues, pressure-processing problems, or another service-level fault.
The device should be:
- Removed from service
- Labeled Out of Service
- Sent for repair or bench evaluation
- Evaluated using appropriate Getinge documentation and approved test equipment
- Repaired or configured only by qualified personnel
Complete applicable functional, alarm, pressure, pneumatic, and electrical safety testing before return to service.
Knowing when to stop external troubleshooting is proper troubleshooting.
Clinical Use Tip
Do not assume poor augmentation is purely an equipment failure; maintain patient support while the clinical team evaluates patient condition and catheter position independently of Clinical Engineering testing.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"Clinical staff reported low augmentation and little improvement in assisted arterial pressure."
Cause
What was observed during troubleshooting.
Example:
"Clinical Engineering found the ECG trigger signal was intermittent because of a loose external patient-cable connection."
Resolution
What action was taken.
Example:
"Clinical Engineering secured the connection, verified stable triggering and expected simulated pumping performance, completed functional testing, and returned the unit to service."
Helpful Details to Include (If Known)
- Assisted pressure and augmentation behavior observed
- Trigger source
- ECG and arterial waveform quality
- Timing behavior
- Catheter and pneumatic connection condition
- External tubing position
- Whether issue followed transport or repositioning
- Results with approved simulator or test equipment
- Final functional test results
- Final device status
- Assisted pressure and augmentation behavior observed
- Trigger source
- ECG and arterial waveform quality
- Timing behavior
- Catheter and pneumatic connection condition
- External tubing position
- Whether issue followed transport or repositioning
- Results with approved simulator or test equipment
- Final functional test results
- Final device status
Final Thought
Poor augmentation requires immediate attention because effective patient support may be compromised. Verify connections, signal quality, trigger stability, timing, and external pneumatic conditions before suspecting an internal failure, then escalate unresolved problems and document the findings clearly.
That is successful troubleshooting.