Tricuspid Clip: Difference between revisions

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Femoral Vein
Femoral Vein
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*80 cm from sub-xyphoid, or
*85 from mid-sternum for stool placement
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*Pre procedure TEE imaging performed
*Pre procedure TEE imaging performed


*Prior to prepping patient, place MitraClip Plate (plexiglass board – hinge side up) under patient’s leg off center to the right. Place MitralClip Lift (step stool) over patients right leg, angled down towards the head. Measure 80cm from subxyphoid to leading edge of stool. Make sure there is direct contact between stool and plate.
*Prior to prepping patient, place MitraClip Plate (plexiglass board – hinge side up) under patient’s leg off center to the right. Place MitralClip Lift (step stool) over patients right leg, angled down towards the head. Measure 80cm from subxyphoid, or 85 from mid-sternum to leading edge of stool. Make sure there is direct contact between stool and plate.


*Prep patient and drape per usual. Drape anesthesia pole and/or xray shield.
*Prep patient and drape per usual. Drape anesthesia pole and/or xray shield.
*Obtain RFV access, dilate with 8F, preclose. .032 wire inserted into perclose.
*Obtain RFV access, dilate with 8F, preclose. .035 wire inserted into perclose.
*SL1 introduced over .032 wire.
*Exchange for MPA
*Baylis needle inserted and echo imaging performed. Transseptal puncture performed.
*Baylis needle removed. .032wire inserted. Dilator removed
*MPA advanced over the wire to pulmonary vein. LA pressure measured. Give MD Amplatz SuperStiff to shape.
*MPA advanced over the wire to pulmonary vein. LA pressure measured. Give MD Amplatz SuperStiff to shape.
*Amplatz SuperStiff advanced.
*Amplatz SuperStiff advanced.
*MPA removed.
*MPA removed.
*SL1 removed
*20F dilator inserted and removed
*20F dilator inserted and removed
*MitraClip Guide inserted.
*MitraClip Guide inserted.
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*When clip is being deployed turn room lights up and drips up. Place bowl below to catch drips while deploying.
*When clip is being deployed turn room lights up and drips up. Place bowl below to catch drips while deploying.
*Hand MD 60ml syringe with extension tubing for aspiration while delivery system is removed.
*Hand MD 60ml syringe with extension tubing for aspiration while delivery system is removed.
*LA pressure measured. Set up for subsequent clips if needed.
*Vicryl used for groin closure.
*Vicryl used for groin closure.


==Tricuspid Procedure==


*MicroPuncture/US access
*Obtain RFV access, dilate with 8F, preclose.
*MPA2 loaded with J wire inserted. J wire removed for Amplatz Super Stiff.
*MPA2 removed.
*20F dilator inserted and removed
*MitraClip Guide inserted.
*Proceed with normal case




Revision as of 21:33, 22 June 2020

DRAFT

Tricuspid Clip
Anesthesia Imaging Access Pre-Procedure
General Fluoro, TEE, and ICE

Femoral Vein

  • 80 cm from sub-xyphoid, or
  • 85 from mid-sternum for stool placement


Big Equipment:

Open

  • Cath pack
  • Lift / Footstool / Support base
  • Clear Plexiglass base support
  • Sterile System Stabilizer
  • ICE 8fr. and SwiftLink cover
    • 9fr x 23cm Pinnacle for ICE

Wires:

Open

  • 150J
  • Amplatz SS 1cm

Catheters:

Open

  • 5F MPA2

Misc supplies:

Open

  • (4) 108cm High pressure IV Lines
  • (8) Stopcocks
  • 8F Sheath for dilator - (also used as a backup sheath)
  • (1)Perclose
  • 4-0 Vicryl/monocryl
  • Pickups (Either from a suture removal kit or individual from SPD)
  • (2) 60cc syringe
  • (2) 12” extension (Keep stickers to label flush tubing)
  • Sterile towel pack for back table
  • Fluoro cover to anesthesia IV pole or moving xray shield
  • 20F Dilator
  • Micropuncture
  • U/S probe cover

Standby

  • Additional Perclose
  • Pericardiocentesis supplies

Non-Sterile Supplies

  • (4) Liter bags of heparinized saline
  • (4) Liter sized pressure bags

Procedure

  • Anesthesia will obtain radial art line prior to draping.
  • Pre procedure TEE imaging performed
  • Prior to prepping patient, place MitraClip Plate (plexiglass board – hinge side up) under patient’s leg off center to the right. Place MitralClip Lift (step stool) over patients right leg, angled down towards the head. Measure 80cm from subxyphoid, or 85 from mid-sternum to leading edge of stool. Make sure there is direct contact between stool and plate.
  • Prep patient and drape per usual. Drape anesthesia pole and/or xray shield.
  • Obtain RFV access, dilate with 8F, preclose. .035 wire inserted into perclose.
  • Exchange for MPA
  • MPA advanced over the wire to pulmonary vein. LA pressure measured. Give MD Amplatz SuperStiff to shape.
  • Amplatz SuperStiff advanced.
  • MPA removed.
  • 20F dilator inserted and removed
  • MitraClip Guide inserted.
  • Setup stabilizer and silicone sheet. Hand MD 60ml syringe with short extension tubing for aspiration.
  • Amplatz wire and dilator removed. Clip inserted.
  • Drips should be maintained at 1 drip every 3 seconds. If bubbles are seen on echo, turn drips down.
  • When clip is being deployed turn room lights up and drips up. Place bowl below to catch drips while deploying.
  • Hand MD 60ml syringe with extension tubing for aspiration while delivery system is removed.
  • Vicryl used for groin closure.



BACK TABLE SETUP

  • 108" Tubing spikes handed off to circulator, keep rollers on sterile field.
  • Follow Rep instructions for device prep.


APPROVED: MD initials MM/YY

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