Embolization

From Bay Area Structural Heart Wiki

Note Warning: CONFIRM WITH PHYSICIAN REGARDING CATHETERS AND USE OF INJECTOR

  • Injector set up 100% contrast for Dr Olorunsola. The rest of the MD’s are 50/50
  • 100% Contrast (hand injection) unless the Physician states otherwise.
  • Heparinized Saline 1000 ml

Open

  • Angio pack
  • Gloves
  • Fluoro drape
  • U/S Prober cover
  • Turtle shell cover
  • 5Fr x 11cm sheath
  • 3-way stopcock
  • Tuohy
  • 3cc Blue Medallion syringe
  • (2) Green or Purple Medallion syringe for contrast
  • 3J x 145cm guidewire
  • Glide wire 180cm
  • Fathom Guidewire
  • Torque Device (if needed)
  • One way or blue cap
  • (2) 12cc syringe
  • RIM (Postpartum bleed)
  • RBT catheter (Postpartum bleed)

Emobolization methods

Coils

  • Detacher – If using Concerto coils

Coil Deployment Steps

  1. Make sure the introducer sheath is nice and hubbed (seated) in microcatheter.
  2. Take orange lock off – discard
  3. Start advancing wire
  4. Remove sheath with 5-10cm left
  5. Save sheath just in case you want to recapture coil
  6. Dr takes over and when happy with coil – snap and pull two white markers on back end
  7. Check under fluoro that coil is fully out of microcatheter and that nothing moves when you go to deploy.


ONYX Liquid Embolic System

  • Onyx 18 or Onyx 34 (Neuro cart)
  • Shaker machine (Neuro cart)
  • Need a clean surface or extra table
  • New gloves
  • (2) 18G needles, one for drawing up Onyx and one for drawing up DMSO


Obsidio

  • EP Fridge (Sterile core)


Embospheres

Note Protip: Make sure to let the beads settle against the plunger before wasting extra liquid

  • 100 - 300
  • 300 – 500
  • 500 – 700
  • 700 – 900
  • (2) 1cc White Medallion syringe, for bead injection
  • (2) 10cc syringes with contrast (100%)
  • 3-way stopcock

Trufil Glue

  • Clean surface or extra table
  • ¾ sheet (if using a separate table)
  • 5% Dextrose 500ml saline bag
  • Blue bowl
  • Medicine cup (Overstock cart – sterile core)
  • Gloves
  • (2) White 1cc medallion syringe
  • (2) 20cc syringes
  • (3) 3cc syringes
  • (3) 6cc syringes
  • (2) 18G needle

GEL FOAM

  • Pharmacy cart (ask RN)
  • 3-way stopcock
  • 10cc syringe
  • 6cc syringe
  • 3cc Medallion syringe
  • Postpartum Bleed – 20cc syringe with 7ml of contrast attach to 10cc syringe with gel foam (mix)


Bronzo

  • SOS2 80cm catheter
  • STS Straight Microcatheter
  • Hummingbird technique (Insertion tool attach to 20cc Hep saline syringe)
  • Starclose (ask)


Dare

  • Cobra2 75cm catheter
  • Hi-Flo Microcatheter
  • Closure device (ask)


Raj

  • Shape guidewire himself

Open

  • Flow switch
  • Bentson guidewire
  • Hummingbird technique (cut micro puncture dilator and attach to 20cc Hep saline syringe)
  • Extra Prep stick (closure)
  • Mynx
  • Omniflush (Postpartum Bleed)


Brittany

  • Always set up Injector

Open

  • Starclose
  • C2 catheter (for Liver Embo)
  • Renegade HiFlo micro catheter
  • Fathom wire
  • Extra Prep stick for closure
  • Extra gloves for closure


Evan

  • Micropuncture kit (Cook)


Samir

Lynne

Open

  • Flow switch
  • Hummingbird technique (cut micro puncture dilator and attach to 20cc Hep saline syringe)
  • Bentson guidewire
  • C2 catheter
  • 2.0 Fr True Select
  • Synchro Soft guidewire
  • Extra Prep stick (closure)
  • Mynx

Standby

  • 2.4 Fr Microcatheter
  • SOS 2