Impella

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

Note: Change location of supplies to Cath Lab 1!

Equipment

• Pack*
• Cath Lab to-go cart
• JR4
• Angled Pigtail
• .025 exchange for BP removal
• Perclose
• .035 exchange
• 18” cover for foot pedal*
• 500ml bag heparinized saline

*Trust me on this..

Room Setup and 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.
• Place drape over legs after surgical draping to cover abdomen.
• Put OR light camera in place to see the surgical site to monitor progress from control room.
• Ask OR for 1 pack Ray-Tec sponges for wipes.
• Do the thing (Insert 5.0 Impella)
  • Pass off sheath and clamps to surgeon. Once sheath is inserted in the conduit, JR4 and J wire advanced for valve crossing. Exchanged for pigtail, IMPELLA wire retained in LV. Impella advanced under fluoro and echo guidance. Save image. Surgeon/ Interventionist discuss weather to removed additional support or leave in place. Surgeon closes.
• Remove the other thing (ECMO / Balloon pump / Impella)
• 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.