View source for TMVI - Encircle Sapien M3

__NOTOC__
{{Protip|Need Alcohol in lab for this procedure!}}

{{Warn|<BR>THIS IS A RESEARCH PROCEDURE.  ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM.<BR> DO NOT THROW AWAY ANY BOXES. DOCUMENTATION NOTES IN RESEARCH HELPER IN MCKESSON. }}

{{Warn|If broadcasting case:<BR>DO NOT PUT PATIENT INFO INTO MCKESSON OR XRAY. PHI CANNOT BE STREAMED. <BR>CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE. PLEASE DO NOT SUBMIT CHARGES, ROSALIE WILL DO THEM. }}


{| class="wikitable"
! colspan="6" |Sapien M3
|-
!Anesthesia
!Imaging
!Access
!Pre-Procedure
|-
|
*General Anesthesia
*A-line (per protocol) 
*Possible Swan
|
*Single plane fluoro
*No rampart
*100% contrast in ACIST
*TEE
|
* 28 F RFV pre-closed x 1
|
*Stabilizer placement prior to draping: brought by rep, 80cm from mid-sternum
|}



==Open:==
===Sheaths:===
*Micropuncture set (for woggle with Daniels, or Access and Woggle for Spies)
*8f Pinnacle
===Wires:===
*(1) .035 150cm J wire
*(1) .035 260cm J wire
*(1) Safari Wire
===Catheters:===
*6F Straight Pigtail
===Pacing:===
Unipolar pacing setup with Bipolar on standby

* Alligator Pacing Cable (open) 

*5F Josephson Pacing Cable (Standby)
*EP Quad Cable (Standby)
*Remington Pacing Cable (Standby)
*8F 35cm BriteTip Sheath (Standby)
===Misc:===
*Extra Sterile Bowl (3- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
*(3) 60ml Syringe
*(3) 20ml Syringe
*(4) High Pressure stopcock
*(2) 30” pressure tubing (updated with new device)
*3 port manifold (For a gradient at the end)
*(1) Perclose (If Spies is primary, NO perclose if Daniles is primary.)
*0-Prolene for woggle 
*(1) Large Bowl for hep saline on back table

=== * NEW - Baylis Transseptal source ===

* VersaCross system
* Grounding pad

=== Bellow items on standby! source ===

* SL1 sheath
* Large curve Baylis needle
* Baylis cable
* (1) 0.32 260 J-wire
* 5F MPA
* (1) Amplatz SS 260cm 1cm Tip

===Standby:===
*Baylis ProTrack wire
*6F ballon wedge 
*2530 Edwards indeflator
*14X4  Armada Balloon
*PRESTO INDEFLATOR
*TORQUEVUE 45 DEGREE DELIVERY SYSTEM (9F OR 10F)
*10MM, 14MM, 18MM SEPTAL OCCLUDER

==Nurse Notes:==
*ACIST- '''100% CONTRAST'''
*1L Hep Saline on PLUM IV pump set at: Pressure: 400 mmHg Rate: 400ml/hr - [[Alaris Pump Pressure|Click this link to see pressure adjustment process]]
*Grounding pad
*Baylis machine
*(2) Pacer Boxes
*Patient prepped from '''navel to knees''' in sterile fashion.  
*(1) Plum pump

===MEDICATIONS===
*Bupivicaine/Lidocaine Mixed 10mL each
*Epinephrine 10mcg/mL in red syringe on back table

== Back Table Set Up ==

* (3) bowls with 500 ml of NS
* (1) large bowl with 1000 ml of hep saline
* (4) HP stock cocks
* (2) 30" extension tubing
* (1) bowl with 15 ml of contrast (not 30!) 
* (2) 60 ml syringes
* (1) 10 ml syringe 

==PROCEDURE==
*Access obtained with u/s
*Need 20 and 60 cc flush on front table for the delivery system.
*(Possible) 8F 35cm LFV for transcutaneous pacing
*RFV Access
*Dilate with 8F
*Preclose
*Versacross Sheath inserted
*Versacross pigtail wire inserted
*Transeptal puncture, pigtail wire advanced
*Versacros sheath exchanged for 28F Delivery sheath over pigtail wire
*Pigtail advanced across the mitral valve and LV gram @ 15/45 performed
*Mitral annulus denoted on live monitor screen by Rep. 
*DDS prepped
**1L Hep. Saline (2U/ml) bag with pressure bag spiked with heparin tubing, flushed, and attached to pump
**Alaris settings 400ml/hr occlusion pressure limit 400mm Hg
**Pressure tubing attached to stopcock and DDS
*Dock Delivery System (DDS) advanced through GS
*Dock deployed in a timely fashion ;)
*DDS removed and Pigtail inserted over exchange  J for valve crossing
*J wire exchanged for Safari 2
*Pigtail and GS removed
*Valve delivery system advanced
*Valve deployed. Septum evaluated with echo for shunting and PVL.
**remind MD to lower FIO2*** Delivery system removed and MPA inserted for LA pressure measurement.
*(RHC performed with 6F swan to evaluate ASD)
*Safari retained across septum until shunt is evaluated
*All equipment removed
*Preclosure closed and stitch to RFV, manual pressure LFV if accessed
*Woggle vs Dermabond depending on Protamine

==STANDBY EMERGENCY ECMO SUPPLIES==
*16F Arterial Cannula
*21F Venous Cannula
*(2) Perclose
*ECMO Instrument Tray
*Amplatz SS 7cm tip 

==STANDBY PERICARDIOCENTESIS SUPPLIES==
*EYE DRAPE
*CHIBA NEEDLE 10CM 18G
*SKATER INTRODUCER SET
*BARD LOCKING PIGTAIL 6F OR 8F
*(3) 60ML SYRINGES
*STOPCOCK
*AMPLATZ SUPER STIFF 180CM

==STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES==
[[Paravalvular leak- Mitral|SEE MITRAL PARAVALVULAR LEAK REPAIR]]
*AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE

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[[Category:Procedures]]
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APPROVED: MD initials MM/YY