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What This Guide Helps With
Troubleshooting ECG or pressure trigger loss caused by leads, cables, transducers, connections, signal quality, or trigger setup.
Step-by-Step Troubleshooting
Ensure Patient Safety First
Confirm whether the AutoCAT 2 WAVE is actively supporting a patient.
If the pump is in use and ECG or arterial pressure triggering is unreliable, notify clinical staff immediately. Have qualified clinical staff assess the patient, verify balloon timing, and prepare alternate support if needed.
Expected outcome: The patient remains supported while the trigger problem is evaluated safely.
If trigger failure causes unsafe timing or loss of assist, stop bedside troubleshooting and escalate immediately.
Confirm the Reported Trigger Problem
Verify whether the issue is related to:
- ECG trigger not detected
- ECG signal present but trigger marker absent or inconsistent
- Pressure trigger not detected
- Arterial pressure waveform unstable or dampened
- Trigger source switching unexpectedly
- Pump assist timing irregular
- Trigger failure only during patient movement or transport
Expected outcome: The failure is identified as ECG-related, pressure-related, or both.
Check the Selected Trigger Source
Review the current trigger mode selected on the AutoCAT 2 WAVE.
Confirm whether the pump is set to ECG trigger, pressure trigger, or an automatic/assisted mode that depends on signal recognition.
Expected outcome: The selected trigger source matches the signal clinical staff expect the pump to use.
If the wrong trigger source was selected and correcting it restores stable triggering, stop and document the setup issue.
Inspect the ECG Lead Setup
Check that ECG electrodes are properly attached to the patient, fresh, and placed on clean, dry skin.
Look for loose electrodes, dried gel, poor skin contact, excessive hair, or lead placement that could create artifact.
Expected outcome: A clean ECG waveform is visible and consistent enough for trigger detection.
If replacing or repositioning electrodes restores ECG triggering, stop and document the corrective action.
Inspect the ECG Patient Cable and Lead Wires
Check the ECG trunk cable, lead wires, and connector at the AutoCAT 2 WAVE.
Look for bent pins, loose connections, cracked insulation, taped repairs, strain damage, fluid contamination, or intermittent signal when the cable is moved.
Expected outcome: ECG signal remains stable when the cable and lead wires are gently repositioned.
If swapping to a known good ECG cable or lead set resolves the trigger issue, remove the defective accessory from service and stop.
Verify ECG Signal Quality Before Blaming the Pump
Confirm that the ECG waveform is not excessively noisy, low amplitude, wandering, or interrupted.
Artifact may come from patient movement, poor electrode contact, electrosurgical equipment, external monitors, bed movement, or damaged cables.
Expected outcome: The ECG waveform is clean enough for consistent trigger recognition.
If the waveform remains poor across multiple lead sets or electrode placements, escalate clinically before assuming a pump fault.
Check the Arterial Pressure Connection
If pressure trigger is failing, inspect the arterial pressure cable, pressure transducer connection, and interface cable between the pressure source and the AutoCAT 2 WAVE.
Make sure all connectors are fully seated and not under tension.
Expected outcome: The AutoCAT 2 WAVE receives a stable arterial pressure signal.
If reseating the cable restores pressure trigger, stop and document the loose connection.
Assess the Pressure Waveform Quality
Verify that the arterial pressure waveform is present, appropriately scaled, and not severely dampened, over-damped, flat, or full of artifact.
A poor pressure waveform can prevent reliable trigger detection even if the pump electronics are functional.
Expected outcome: The pressure waveform has a clear systolic upstroke and stable rhythm.
If the waveform is clinically dampened or questionable, have clinical staff evaluate the arterial line, flush system, transducer position, and patient condition.
Verify Transducer Leveling and Zeroing Status
Confirm with clinical staff that the arterial pressure transducer has been properly leveled and zeroed according to facility practice.
Clinical Engineering should not manipulate invasive lines unless permitted by facility policy and clinical staff are present.
Expected outcome: The pressure source is valid and appropriate for trigger use.
If proper clinical setup restores pressure trigger recognition, stop and document the external setup cause.
Swap External Signal Accessories When Safe
When the patient is not actively dependent on the suspect setup, test with known good ECG cables, pressure cables, or compatible interface cables.
Do not disconnect active patient monitoring or invasive pressure lines without clinical approval.
Expected outcome: The issue follows a cable/accessory or remains with the pump.
If the issue follows the cable, remove the defective accessory from service.
Check for Intermittent Failure During Movement
Gently move external cables near the strain reliefs and connectors while observing ECG and pressure signal stability.
Do not pull on patient-connected lines or disturb active invasive connections.
Expected outcome: Signal remains stable during normal cable movement.
If the signal drops out when a cable or connector is moved, remove the suspect cable or device from service.
Verify Alarm Behavior and Messages
Record the exact alarm, message, or trigger warning shown on the AutoCAT 2 WAVE.
Note whether the alarm occurs during startup, patient connection, active pumping, transport, or only with one trigger source.
Expected outcome: The alarm behavior is clearly documented for repair evaluation if needed.
Test the Pump Away From Patient Use
If available and permitted by facility procedure, test the AutoCAT 2 WAVE using approved simulator signals or bench test accessories.
Confirm whether ECG and pressure inputs are recognized under controlled conditions.
Expected outcome: The pump recognizes stable simulated inputs.
If simulated ECG or pressure signals are not recognized, the issue is likely internal or input-circuit related.
Do Not Continue Clinical Use With Unreliable Triggering
If ECG or pressure trigger detection remains inconsistent after external checks, remove the pump from service.
Expected outcome: A device with unresolved trigger reliability concerns is not returned to patient care.
If the Problem Persists
If ECG leads, electrodes, pressure transducer setup, cables, connections, signal quality, and trigger settings have been ruled out, the issue is likely internal to the signal acquisition or trigger processing system.
The AutoCAT 2 WAVE should be:
- Removed from service
- Labeled Out of Service
- Sent for repair or bench evaluation
Knowing when to stop is proper troubleshooting. An IABP with unreliable trigger recognition should not be used for patient support until the fault is fully evaluated and corrected.
Clinical Use Tip
Do not troubleshoot trigger failure on an unstable active patient unless clinical staff are directly managing therapy. If timing or assist becomes unsafe, move the patient to another verified IABP or alternate support path first, then evaluate the suspect device.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"Clinical staff reported that the Teleflex AutoCAT 2 WAVE would not consistently trigger from ECG or arterial pressure during IABP therapy."
Cause
What was observed during troubleshooting.
Example:
"Troubleshooting found an intermittent ECG trunk cable connection causing waveform dropout and missed trigger detection."
Resolution
What action was taken.
Example:
"Replaced the ECG trunk cable with a known good cable, confirmed stable ECG trigger recognition, and removed the defective cable from service."
Helpful Details to Include (If Known)
- Patient connected or bench evaluation only
- Trigger source selected
- ECG trigger behavior
- Pressure trigger behavior
- Exact alarm or message displayed
- ECG waveform quality
- Arterial pressure waveform quality
- Electrodes replaced
- ECG cable swapped
- Pressure cable swapped
- Transducer setup verified by clinical staff
- Trigger failure intermittent or constant
- Failure during movement or transport
- Indicator lights or input status
- Any unusual sounds, heat, or smell
- Final device status
Final Thought
Trigger failure on an intra-aortic balloon pump must be handled carefully because poor signal recognition can affect balloon timing and patient support. Start with patient safety, then verify the simplest external causes first: leads, electrodes, cables, pressure setup, waveform quality, and trigger selection. If those checks do not restore reliable triggering, remove the pump from service and document the complaint, cause, and resolution clearly.
That is successful troubleshooting.