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Infographics › From decision to full support: AC3 Optimus™ startup and initiation

From decision to full support: AC3 Optimus™ startup and initiation

The order of work from the moment a physician decides on an intra-aortic balloon pump (IABP) to full support at 1:1, with what normal looks like at each stage and what to do when it doesn't. Every line is cited; each problem links to the full procedure.

Written for the clinician running the console. The decision to use an IABP, and the insertion itself, belong to the physician and the IAB catheter Instructions for Use.

  1. 1

    Decision made: bring the equipment

    Whole team · Before the patient is ready

    Do

    • Bring the console, the balloon the physician chose, and a backup IABP with extra helium tanks.1
    • Confirm the balloon size against the patient's height on the box: 30 cc for 4 ft 10 in to 5 ft 4 in, 40 cc for 5 ft 4 in to 6 ft, 50 cc for taller than 5 ft 8 in.2
    • Confirm the console had an operational checkout recently, generally within one week.3

    Expect

    • Box label, connector and the volume you will see on screen all name the same size.4

    If not

    No backup console or spare helium on the unit
    Get them now. A failed pump with no backup leaves a motionless balloon in the aorta.1 Pump stopped: protecting the balloon
  2. 2

    Power up the console

    Console clinician · About 1 minute

    Do

    • Lock the wheel brakes and plug into AC power first, so you are not running on battery.1,3
    • Press the power switch at the lower right of the interface panel.1

    Expect

    • Console starts in AutoPilot™ at 1:1 assist.5,6
    • The Getting Started checklist appears with red X marks until each item is ready.7
    • Helium tank pressure and battery status show in the upper right of the display.1

    If not

    Helium icon is black
    Open the tank valve or change the tank.7 Change the helium tank
    Tank at 100 psi or less
    Replace the tank before you start.1 Change the helium tank
    Running on battery
    A full battery gives at least 90 minutes. Find an outlet; check the DC breaker is ON.3,8 Annual battery load test
  3. 3

    Connect the patient signals

    Console clinician · 1 to 2 minutes

    Do

    • Connect a 5-lead skin ECG cable (green Nicolay connector), or slave the ECG from the bedside monitor.9,10
    • Connect an arterial pressure (AP) source if one is available.11

    Expect

    • Checklist item Trigger Present turns green: a waveform, a correct heart rate, and the red heart flashing on each trigger.11
    • With the skin cable, the console starts on lead II.6

    If not

    No ECG waveform
    Check the selected source first, then the cable and electrodes.12
    Slaving from a monitor
    The monitor's output delay must be 20 ms or less, or timing will be wrong.10
    3-lead cable on hand
    It will not work properly; get a 5-lead cable.9
  4. 4

    Zero the FiberOptix™ sensor, before insertion

    Console clinician, with the sterile field · About 5 to 15 seconds

    Always zero before insertion. It takes about 5 to 15 seconds and can never be done once the balloon is in the patient.13,14

    Do

    • Leave the balloon in its tray. The sterile field passes the sensor connector (slider) off to you.15
    • Insert the CAL key (not needed for a yellow RFID slider). Push the slider in, Arrow® logo facing left, until it clicks.14,16

    Expect

    • Two beeps when the slider seats; four beeps when the zero is done. Arterial pressure reads 0 mmHg.14,17
    • Only now is the balloon handed back for insertion.13

    If not

    No four-beep tone after about 15 seconds
    Check the CAL key or RFID was read, that the sensor sees no pressure, and that the pump is not assisting; then zero manually.14,17 Zero the FiberOptix™ sensor before insertion
    Balloon went in un-zeroed
    It cannot be zeroed now. Timing still works; correct the numbers with FOS MAP CAL against an accurate line.18,19 FOS MAP calibration against a reference line
  5. 5

    Insertion and positioning

    Physician · Per the IAB Instructions for Use · covered by the IAB catheter Instructions for Use, not this course

    Do

    • The physician inserts and positions the balloon following the IAB catheter Instructions for Use.20
    • The sheath is pulled back so the whole membrane is outside it.21

    Expect

    • Position confirmed by the imaging your protocol requires.22

    If not

    —

  6. 6

    Connect the balloon and reconcile the volume

    Console clinician · Under 1 minute

    Do

    • Connect the extender tubing from the IAB to the balloon connector port. Check the connector is marked Arrow® or Kontron® with a 30, 35, 40 or 50 cc code.23,24
    • Read the Volume key and compare it with the box and the connector.4,25

    Expect

    • All three checklist items are green and the Start Pump key turns blue.7

    If not

    Volume on screen doesn't match the box
    Stop. Find out which is wrong before pumping. A connector coded larger than the balloon over-drives it.26 Connect the IAB and start counterpulsation
    Volume shows dashes
    No connector is being read. Reseat it and check the marking.6
  7. 7

    Start pumping and let the balloon unwrap

    Console clinician · First 2 to 3 minutes

    Do

    • Press Start Pump (hard key) or Pump ON (touchscreen).7

    Expect

    • First start after power-up: a purge cycle, then the balloon pressure waveform appears and pumping begins.27,28
    • A high plateau that keeps falling is the balloon unwrapping. The console allows up to 300 beats (about 2½ minutes).21
    Normal balloon pressure waveform: fill overshoot, flat plateau, deflation undershoot, baseline near zero

    If not

    PURGE FAILURE
    Check there is a trigger and the balloon is connected; then look for leaks or low helium.29,30 Helium leak test
    HIGH PRESSURE after the unwrap window
    Look for a kink, a balloon still in the sheath, or one too high, too low or too large. Don't just turn the volume down.21,31 Confirm balloon position and function from the console
    HIGH BASELINE
    The balloon isn't emptying. If it may be partly inflated, disconnect and aspirate with a 60 cc syringe.32 Confirm balloon position and function from the console
  8. 8

    Confirm the trigger

    Console clinician · 30 seconds

    Do

    • Compare the displayed heart rate with the patient's. Look for a white marker on every triggered beat, matching the assist ratio.33

    Expect

    • The trigger mode shows in the Trigger tab. Pattern for a regular rhythm; AutoPilot™ switches to Peak for wide or fast complexes.30,33

    If not

    Two markers on some beats, or timing that wanders
    Choose a lead with one tall R-wave and small P and T waves.30
    Heart rate wrong
    Fix the trigger before touching timing; timing is set relative to the trigger.34
  9. 9

    Check timing at 1:2

    Console clinician · 1 to 2 minutes

    Do

    • Switch to 1:2. Judge timing on the arterial waveform (the FiberOptix™ trace if connected), never the ECG.27,35

    Expect

    • Inflation just before the dicrotic notch, so AUG is higher than SYS.36
    • Assisted end-diastolic pressure lower than unassisted (ADIA < DIA); assisted systole lower than unassisted (ASYS < SYS).36
    Arterial pressure landmarks DIA, SYS, DN, AUG, ADIA, ASYS with the three timing rules

    If not

    AUG not higher than SYS
    Look for late inflation; then check balloon size and position.30 Assess timing on the arterial waveform
    ADIA not lower than DIA
    Late deflation. Under R-Wave deflation, switch to NEVER R-Wave or adjust in Operator mode.30,37 Assess timing on the arterial waveform
    AutoPilot™ timing looks wrong
    Select Operator mode and move inflation and deflation by hand, watching each change on the arterial waveform.27,38 Assess timing on the arterial waveform
  10. 10

    Check the balloon, then go to full support

    Console clinician · 1 minute, then ongoing

    Do

    • Put the cursor on the balloon pressure plateau and compare it with AUG.39
    • Return to 1:1 and full volume as ordered. Confirm alarms are ON and set an arterial pressure alarm if required.37,40
    • Optional: print a Therapy Status report for the record.37

    Expect

    • Plateau within 25 mmHg of AUG.36,41
    • Full mechanical support at 1:1. Re-check the console after any patient move.22,37
    Arterial pressure over balloon pressure with AUG and plateau levels and the ±25 mmHg band

    If not

    Plateau more than 25 mmHg above AUG
    Balloon may be too large. Reducing volume may need a physician order; never below two-thirds of capacity.42,43 Protective Pumping™ balloon sizing check
    Plateau agrees with AUG, but AUG is well below SYS
    Balloon may be too small or too low. Check position before changing settings.42 Protective Pumping™ balloon sizing check
    Pump stops and won't restart
    Get the backup. After 15 to 30 minutes without pumping, cycle the balloon by hand with a 50–60 cc syringe.44,45 Pump stopped: protecting the balloon
  11. ✓

    Full mechanical support

    1:1, full volume as ordered, alarms on, timing and balloon checked. Re-check after every patient move.

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 108.
  2. Teleflex Inc. Intra-Aortic Balloon Catheters: Proactively Meeting Your Counterpulsation Needs [brochure]. MC-000164 Rev 5. Wayne, PA: Teleflex Inc; March 2025.
  3. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 100.
  4. Arrow FiberOptix IAB shelf-stock box labels, REF IAB-05840-LWS-SC (40 cc) and IAB-05850-LWS-SC (50 cc), lots 2025 [photograph]. Course author's photograph; October 2026.
  5. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 98.
  6. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 99.
  7. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 101.
  8. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 242.
  9. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 15.
  10. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 116.
  11. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 102.
  12. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 166.
  13. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 46.
  14. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 104.
  15. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 48.
  16. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 105.
  17. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 47.
  18. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 118.
  19. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 120.
  20. Teleflex Inc. Arrow Intra-Aortic Balloon Catheter Options: Proactively Meeting Your Counterpulsation Needs [brochure]. MC-000164 Rev 2. Wayne, PA: Teleflex Inc; November 2017. p 5.
  21. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 191.
  22. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. pp 226-227.
  23. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 79.
  24. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 23.
  25. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 125.
  26. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026. Warning 34.
  27. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 132.
  28. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 60.
  29. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. pp 194-195.
  30. Teleflex Inc. Arrow Intra-Aortic Balloon Pump Series: Timing Guidelines [trifold]. MC-004848 Rev 1. Wayne, PA: Teleflex Inc; December 2019. p 2.
  31. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. pp 224-225.
  32. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 192.
  33. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 126.
  34. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 133.
  35. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026. Warning 43.
  36. Teleflex Inc. Arrow Intra-Aortic Balloon Pump Series: Timing Guidelines [trifold]. MC-004848 Rev 1. Wayne, PA: Teleflex Inc; December 2019. p 1.
  37. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 106.
  38. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026. Warning 9.
  39. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 136.
  40. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 107.
  41. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 224.
  42. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 134.
  43. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026. Warning 33.
  44. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 112.
  45. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026. Warning 26.
  46. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. pp 98-137.
  47. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. pp 191-195.
  48. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026.
  49. Teleflex Inc. Arrow Intra-Aortic Balloon Pump Series: Timing Guidelines [trifold]. MC-004848 Rev 1. Wayne, PA: Teleflex Inc; December 2019. pp 1-2.

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