TMVI - Encircle Sapien M3: Difference between revisions
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*TEE | *TEE | ||
| | | | ||
* | * RFV pre-closed x 1 | ||
*Radial | * R Radial, slave to anesthesia if no A-line | ||
* LFV for Pacer | |||
| | | | ||
*Stabilizer placement prior to draping | *Stabilizer placement prior to draping | ||
| Line 35: | Line 36: | ||
*Micropuncture set | *Micropuncture set | ||
* | *6/7 Slender Daniels sheath | ||
*8f Pinnacle | *8f Pinnacle | ||
*8fr x 35cm Brite-Tip | *8fr x 35cm Brite-Tip | ||
*8.5fr SL1 transseptal sheath | *8.5fr SL1 transseptal sheath | ||
*20 or 22F dilator (whichever) | |||
==Wires:== | ==Wires:== | ||
===Open:=== | ===Open:=== | ||
*( | *(1) .035 150cm J wire | ||
*(1) .035 260cm J wire | *(1) .035 260cm J wire | ||
*(1) .032 260cm J wire | *(1) .032 260cm J wire | ||
| Line 56: | Line 58: | ||
=='''Open'''== | =='''Open'''== | ||
*(1) 6F Straight Pigtail | *(1) 6F Straight Pigtail 125cm | ||
*(1) | *(1) 4F Straight Pigtail 110cm | ||
*5F MPA1 | *5F MPA1 125cm | ||
=='''Standby'''== | =='''Standby'''== | ||
*6F MPA1 125cm | *6F MPA1 125cm | ||
*6F ballon wedge | |||
=PACING= | =PACING= | ||
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*BAYLIS CABLE | *BAYLIS CABLE | ||
*GROUNDING PAD | *GROUNDING PAD | ||
=='''Standby'''== | =='''Standby'''== | ||
*14X4 Armada Balloon | *14X4 Armada Balloon | ||
*PRESTO INDEFLATOR | *PRESTO INDEFLATOR | ||
*TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F) | *TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F) | ||
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* (3-4) 20ml syringes for flush (For DDS and sheath) | * (3-4) 20ml syringes for flush (For DDS and sheath) | ||
*ACIST- '''100% CONTRAST''' | *ACIST- '''100% CONTRAST''' | ||
* | *0-Prolene | ||
*2L Hep Saline on Alaris IV pump set at 425 mmHg - [[Alaris Pump Pressure|Click this link to see pressure adjustment process]] | *2L Hep Saline on Alaris IV pump set at 425 mmHg - [[Alaris Pump Pressure|Click this link to see pressure adjustment process]] | ||
*(2) Alaris pump | *(2) Alaris pump | ||
*(2) Heparin tubing | *(2) Heparin tubing | ||
*(2) 72” pressure tubing | *(2) 72” pressure tubing | ||
=MEDICATIONS= | =MEDICATIONS= | ||
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*Patient prepped from '''navel to knees''' in sterile fashion. | *Patient prepped from '''navel to knees''' in sterile fashion. | ||
*Access obtained with u/s | *Access obtained with u/s | ||
*Need 20 and 60 cc flush on front table for the delivery system. | |||
Typical sites | Typical sites: | ||
***6F Right radial for Pigtail | ***6F Right radial for Pigtail | ||
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**After hookup and flush, Swiftlink cover can be slid over heparin tubing for additional slack on the table. | **After hookup and flush, Swiftlink cover can be slid over heparin tubing for additional slack on the table. | ||
*Dock Delivery System (DDS) advanced through GS | *Dock Delivery System (DDS) advanced through GS | ||
*Dock deployed in a timely fashion ;) | *Dock deployed in a timely fashion ;) | ||
*Temp pacer inserted and tested. | *Temp pacer inserted and tested. | ||
| Line 177: | Line 174: | ||
*J wire exchanged for Safari 2 | *J wire exchanged for Safari 2 | ||
*Pigtail and GS removed | *Pigtail and GS removed | ||
*Balloon removed | *Balloon removed | ||
*Valve delivery system advanced | *Valve delivery system advanced | ||
*Valve deployed. Septum evaluated with echo for shunting and PVL. | *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. | **remind MD to lower FIO2*** Delivery system removed and MPA inserted for LA pressure measurement. | ||
*RHC performed with 6F swan to evaluate ASD | *(RHC performed with 6F swan to evaluate ASD) | ||
*All equipment removed | *All equipment removed | ||
*Preclosure closed and stitch to RFV, manual pressure LFV | *Preclosure closed and stitch to RFV, manual pressure LFV | ||
Revision as of 19:10, 12 August 2021
Protip: Need Alcohol in lab for this procedure!
Warning:
THIS IS A RESEARCH PROCEDURE. ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM.
DO NOT THROW AWAY ANY BOXES.
Warning: If broadcasting case:
DO NOT PUT PATIENT INFO INTO MCKESSON OR XRAY. PHI CANNOT BE STREAMED.
CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE.
| Sapien M3 | |||||
|---|---|---|---|---|---|
| Anesthesia | Imaging | Access | Pre-Procedure | ||
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Sheaths:
Open:
- Micropuncture set
- 6/7 Slender Daniels sheath
- 8f Pinnacle
- 8fr x 35cm Brite-Tip
- 8.5fr SL1 transseptal sheath
- 20 or 22F dilator (whichever)
Wires:
Open:
- (1) .035 150cm J wire
- (1) .035 260cm J wire
- (1) .032 260cm J wire
- (1) Safari Wire
- (1) Amplatz SS 260cm 1cm Tip
Standby
- Baylis ProTrack wire
CATHETERS
Open
- (1) 6F Straight Pigtail 125cm
- (1) 4F Straight Pigtail 110cm
- 5F MPA1 125cm
Standby
- 6F MPA1 125cm
- 6F ballon wedge
PACING
- 5F Josephson Pacing Cable
- EP Quad Cable
- Remington Pacing Cable
- (2) Pacer Boxes
VALVE TABLE
- (5) Sterile Bowls (3- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
- (1) 90 inch drape
- 1.5L Normal Saline
- 500ml Heparanized Saline
- (3) 60ml Syringe
- (3) 20ml Syringe
- (2) High Pressure stopcock
- 30mL Contrast (mixed with 170ml Hep Saline for 15% concentration)
TRANS SEPTAL
- BAYLIS NEEDLE LARGE CURVE C1
- BAYLIS MACHINE
- BAYLIS CABLE
- GROUNDING PAD
Standby
- 14X4 Armada Balloon
- PRESTO INDEFLATOR
- TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
- 10MM, 14MM, 18MM SEPTAL OCCLUDER
ADDITIONAL SUPPLIES
Open
- (2) Perclose
- (3-4) 20ml syringes for flush (For DDS and sheath)
- ACIST- 100% CONTRAST
- 0-Prolene
- 2L Hep Saline on Alaris IV pump set at 425 mmHg - Click this link to see pressure adjustment process
- (2) Alaris pump
- (2) Heparin tubing
- (2) 72” pressure tubing
MEDICATIONS
- Bupivicaine/Lidocaine Mixed 10mL each
- Epinephrine 10mcg/mL in red syringe on back table
- Rotaglide 10mL for sheath before valve is inserted
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
SEE MITRAL PARAVALVULAR LEAK REPAIR
- AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE
PROCEDURE
- Patient prepped from navel to knees in sterile fashion.
- Access obtained with u/s
- Need 20 and 60 cc flush on front table for the delivery system.
Typical sites:
- 6F Right radial for Pigtail
- 8F 35cm LFV for transcutaneous pacing
- 20F RFV E-sheath for valve delivery
- Dilate with 8F
- Preclose
- SL1 inserted over .032 kit wire
- Baylis needle inserted through SL1 and atrial septum puncture performed.
- Needle removed
- 5F MPA advanced over .032 wire
- 1cm Amplatz Super Stiff advanced and MPA and SL1 removed
- Edwards Guide Sheath (GS) advanced
- Pigtail advanced through 6F sheath and LVgram @ 15/45 performed
- Change ACIST to 5/5 after lvgram
- Mitral annulus denoted on live monitor screen in A plane
- DDS prepped
- 1L Hep. Saline (2U/ml) bags with pressure bags spiked with heparin tubing, flushed, and attached to pump
- Alaris settings 200ml/hr occlusion pressure limit 300mm Hg
- Pressure tubing attached to stopcock and DDS
- Swiftlink cover installed over pressure tubing and secured ~18” from off-table end
- After hookup and flush, Swiftlink cover can be slid over heparin tubing for additional slack on the table.
- Dock Delivery System (DDS) advanced through GS
- Dock deployed in a timely fashion ;)
- Temp pacer inserted and tested.
- DDS removed and Pigtail inserted over exchange J for valve crossing
- J wire exchanged for Safari 2
- Pigtail and GS removed
- Balloon 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)
- All equipment removed
- Preclosure closed and stitch to RFV, manual pressure LFV
- Woggle vs Dermabond depending on Protamine
APPROVED: MD initials MM/YY
