Impella: Difference between revisions

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(room 14 workflow)
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*Enter an order for CCL in EPIC
*Enter an order for CCL in EPIC
*Open x-ray and McKesson using entered order.
*Open x-ray and McKesson using entered order.
*Procedure in McKesson is “(33990)INSERT VAD ARTERY ACCESS”
*DO NOT CHARGE FOR THE PROCEDURE.  This is OR's procedure.
*CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!!!!!!!!!!!!!!!!!!!!!!!!!!
*Free-Text note that McKesson is open for billing and equipment only, not procedural charting. See Anesthesia and OR nurses notes.
*Free-Text note that McKesson is open for billing and equipment only, not procedural charting. See Anesthesia and OR nurses notes.
*Put input 4in1 B on V-integration 2 for TTE on the fluoro screen.
*Put input 4in1 B on V-integration 2 for TTE on the fluoro screen.
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*Remove the other thing (ECMO / Balloon pump / Impella)
*Remove the other thing (ECMO / Balloon pump / Impella)
*Statlock is for the chest/abdomen loop of the Impella similar to Leave in swan.
*Statlock is for the chest/abdomen loop of the Impella similar to Leave in swan.
*Document times and doses in McKesson - Write down for book.
*Document times and doses in McKesson and log book.
*Reminder:::  CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!!!!!!!!!!!!!!!!!!!!!!!!!!
*Save 2 stickers
*Save 2 stickers
*Close x-ray and archive to EMIM_CATH
*Close x-ray and archive to EMIM_CATH
*Capture charges for McKesson
*Capture charges for McKesson
*Generate and sign McKesson, then print device list in CCL.
*Print device usage.
*Sticker goes in room 6 book for tracking, second sticker is for device list
*Sticker goes in room 14 log book for tracking, second sticker is for device list
*Bill device list in Epic





Revision as of 16:50, 9 June 2021

Note Note: Good article on Single access and sheaths: Impella Single Access

Daniels/Spies single access Impella - DRAFT

Equipment

  • 16F Dryseal
  • 8fr guide
  • 6fr Shuttle 90cm

Hybrid OR Impella via Subclavian conduit

Equipment

  • Pack*
  • JR4
  • Angled Pigtail
  • .025 exchange for BP removal
  • Perclose
  • .035 exchange
  • 6-8.5 statlock
  • 18” cover for foot pedal*
  • 500ml bag heparinized saline
*Trust me on this...

Procedure

  • Enter an order for CCL in EPIC
  • Open x-ray and McKesson using entered order.
  • DO NOT CHARGE FOR THE PROCEDURE. This is OR's procedure.
  • CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!!!!!!!!!!!!!!!!!!!!!!!!!!
  • Free-Text note that McKesson is open for billing and equipment only, not procedural charting. See Anesthesia and OR nurses notes.
  • Put input 4in1 B on V-integration 2 for TTE on the fluoro screen.
  • Open and cut femoral drape across entire width at the level of the femoral fenestrations.
  • Place over legs after surgical draping using remaining adhesive area to secure.
  • Put OR light camera in place to see the surgical site to monitor progress from control room.
  • Tuck surgical drapes under mattress to expose controls.
  • Ask OR for 1 pack Ray-Tec sponges for wipes.
  • Do the thing (Insert 5.0 Impella)
  • Remove the other thing (ECMO / Balloon pump / Impella)
  • Statlock is for the chest/abdomen loop of the Impella similar to Leave in swan.
  • Document times and doses in McKesson and log book.
  • Reminder::: CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!!!!!!!!!!!!!!!!!!!!!!!!!!
  • Save 2 stickers
  • Close x-ray and archive to EMIM_CATH
  • Capture charges for McKesson
  • Print device usage.
  • Sticker goes in room 14 log book for tracking, second sticker is for device list


Axillary Impella/IABP - DRAFT

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

Equipment

  • Micropuncture
  • Probe Cover
  • 4/5F slender radial sheath
  • Amplatz extra stiff 260cm wire (on standby for Spies)
  • .035 150cm J wire
  • 5f pigtail catheter
  • 5f JR4 diagnostic catheter (on standby for Spies)
  • IABP kit
  • 8 23cm safesheath (ep)(Romick) / 8fr x 23 brite-tip sheath (Spies)
  • Perclose
  • TR band
  • Biopatch
  • 0-Ethibond suture
  • Tournaquick (carrot top)
  • 3 Port Manifold

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 if unable to be directed to abdominal 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.