View source for Left Subclavian IABP


'''If left subclavian is occluded or otherwise inaccessible procedure is aborted. IABP should not be inserted through right subclavian per CT surgery.''' 

=Equipment=

*Micropuncture
*(2) 4/5f slender radial sheath
*Amplatz extra stiff 260cm wire
*.035 150cm Jwire
*5f pigtail catheter
*5f JR4 diagnostic catheter
*IABP kit
*8f 23cm safesheath (ep)(Romick) / 8fr x 23 brite-tip sheath (Spies)
*Perclose
*TR band
*Biopatch
*0-Ethibond suture

=Procedure=

*Prep left side neck and chest (ear to nipple and shoulder to midline).
**'''Note:''' The access site is not an absolute (may become axillary or subclavicular) hence the large site prep.

*Prep left radial.
*Left radial accessed and 4/5f slender sheath inserted.
*Pigtail advanced and angiogram performed. Pigtail left in place and used as reference for subclavian access.
*Subclavian accessed with ultrasound and fluoro guidance using micropuncture kit and radial sheath inserted.
*Pigtail catheter removed.
*J wire and JR4 inserted and directed to descending aorta.
*Catheter and sheath removed, 8f dilator inserted, and perclose advanced for pre-closure.
*Amplatz wire advanced, perclose removed, 8f sheath advanced.
*IABP inserted.
*Sheath peeled away.(Romick)
*IABP secured with suture and site dressed.
*Radial sheath removed and TR band applied.

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[[category:procedures]]
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Approved: md initials mm/yy