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Infographics › Helium leak test: find which side of the clamp is leaking

Helium leak test: find which side of the clamp is leaking

What to do after Possible HE Loss 2, Possible HE Loss 3 or LARGE HE LEAK, or a helium tank that drains too fast. Clamp the driveline, pump against the clamp, and watch the balloon pressure baseline: if it falls, the leak is on the pump side of the clamp.

The console clinician runs this test under constant observation. Any blood in the tubing ends the test at stage 1.

  1. 1

    Look for blood before anything else

    Console clinician · Seconds

    Blood in the tubing, even rust-colored flecks or coffee-ground material? Stop here. Disconnect the IAB connector from the pump, clamp the tubing, do not resume pumping, call the physician and prepare to remove the IAB.1

    Do

    • Inspect the IAB catheter and the driveline tubing along their whole length.1
    • If the alarm is Possible HE Loss 3, switch to 1:2 first and see whether it persists.2

    Expect

    • Clear tubing, no blood. Only then is a leak test appropriate.1
    • HE Loss 3 that clears at 1:2 points to a kink, a high heart rate or timing rather than a leak.2

    If not

    Blood seen
    The balloon membrane has breached. Pumping helium into it risks gas embolism. Do not resume pumping.1 Pump stopped: protecting the balloon
  2. 2

    Get ready and suspend the pneumatic alarms

    Console clinician · 1 minute

    Do

    • Have two rubber-shod hemostats and a spare IAB volume connector and driveline tubing of the same size (color).1,3
    • Silence the alarm with the corner switch.3
    • Alarms tab, set the timer to 10 minutes, press ALARMS OFF.3

    Expect

    • The pump keeps running and shows messages, but won't stop or print on a pneumatic alarm while they're suspended.4

    If not

    No one can stay at the console
    Don't turn alarms off. They may only be off under constant observation, briefly, while you correct the problem.4 Suspend and restore alarms
  3. 3

    Clamp 1: patient side off, pump against it

    Console clinician · Watch a few beats

    Baseline steady? The pump side holds gas, so the leak is probably on the patient side: the catheter or the balloon. Consider stopping, removing the catheter and inserting another. Baseline falling? Go to stage 4.3

    Do

    • Clamp the driveline tubing between the quick connect and the IAB bifurcation. Never clamp the IAB catheter itself.3
    • Press ON to start pumping against the clamp.3

    Expect

    • Watch the balloon pressure baseline.3
    Leak pattern on the balloon pressure waveform: the baseline sags below the −10 mmHg line as helium escapes

    If not

    Clamped the catheter by mistake
    Clamping the catheter can damage it and force replacement. Move the clamp to the driveline.3
  4. 4

    Clamp 2: move the clamp next to the console

    Console clinician · 1 minute

    Baseline still falling? The leak is in the pump or at the IAB volume connector. Go to stage 5.3

    Do

    • Press PUMP OFF and remove the hemostat.3
    • Clamp again just above the IAB connector, close to the console.3
    • Press PUMP ON and watch the baseline.3

    Expect

    • With almost all the tubing clamped off, only the console and the connector joint are left as the source.3

    If not

    Fell at clamp 1 but steady at clamp 2
    The leak is in the driveline between the two clamp positions. The manual doesn't spell this out; it follows from where the clamps sit. Check that tubing and the quick connect as in stage 5.3
  5. 5

    Fix the connector side, then test again

    Console clinician · A few minutes

    Baseline steady on retest? The leak is fixed; resume pumping and go to stage 7. Still falling? Go to stage 6.3

    Do

    • Check the O-rings on the balloon connector and wipe away debris.3
    • Make sure the quick connect at the IAB bifurcation is tight; look for stretched tubing at the connector and catheter junction.3
    • If O-rings are damaged or missing, replace the driveline tubing to the connector with one of the same size (color).3
    • Repeat: alarms off, clamp, pump on, watch.3

    Expect

    • A steady baseline after the repair.3

    If not

    Replacement connector is a different color
    Don't use it. A different size code changes the balloon volume the pump delivers.3
  6. 6

    Cut and refit the connector

    Console clinician · A few minutes

    Baseline steady? Fixed. Still falling? Possible internal console leak: call Arrow® for service and switch to the backup pump.5

    Do

    • Press PUMP OFF and remove the hemostat.5
    • Remove the balloon connector, cut off ½ inch of tubing, refit the connector.5
    • Repeat: alarms off, clamp, pump on, watch.5

    Expect

    • A fresh cut gives the connector an undamaged seal.5

    If not

    Still leaking after the cut
    Call the 24-hour IAB hotline, +1 800 447 4227, and move the patient to the backup pump.5,6,7 Pump stopped: protecting the balloon
  7. 7

    Turn the alarms back on

    Console clinician · Seconds

    Do

    • If the alarms are still off, press ON in the alarms screen.5
    • Press ALARM RESET to clear the old messages.5

    Expect

    • Alarms are active again; the pump will stop and print on a new pneumatic alarm.5

    If not

    You meant to wait for the 10-minute timer
    Don't. Until it runs out, a real leak won't stop the pump or print a strip.5 Suspend and restore alarms
  8. ✓

    Leak fixed, alarms back on

    Baseline steady with the clamp off, pneumatic alarms re-enabled, alarm messages cleared.

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 215.
  2. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 190.
  3. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 218.
  4. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 181.
  5. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 220.
  6. Teleflex Inc. Arrow Intra-Aortic Balloon Pump Series: Timing Guidelines [trifold]. MC-004848 Rev 1. Wayne, PA: Teleflex Inc; December 2019. p 1.
  7. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 108.
  8. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. pp 215-221.

Learn IABP · Not a substitute for the Operator's Manual, the IAB catheter Instructions for Use, or institutional training.