Perc. Transvenous Mitral Commissurotomy: Difference between revisions

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Mitral Valvuloplasty - DRAFT
==DRAFT==
Device:
<br />
Standby
{| class="wikitable"
Toray INOUE-Balloon Kit (usually 28 mm, but need 26 and 30 mm available)
|-
!Anesthesia
!Imaging
!Access
!Pre-Procedure
!Billing
|-
|None
|Fluoro, TTE, and ICE<BR> possible TEE
|Femoral Vein x 2
|
|
|}<br />
===Device:===


Sheaths:
*Toray INOUE-Balloon Kit
Open
9frx20 Brite tip
8frx10 Pinnacle
8.5 SL1 transseptal


Wires:
Size determined using the equation (height in cm/10 +10), but verify with MD because body habitus is also a factor.
Open
Amplatz Super Stiff 260cm 1cm tip
Cordis 150J
Standby
.032 wire for SL1 sheath


Catheters:
===Sheaths:===
Open
5fr MPA2


Baylis/TransSeptal:
====Open====
Open
Baylis generator from EP
Large curve C1 Baylis needle
Baylis cable
Grounding pad


Misc Supplies:
*9frx25cm Pinnacle (if using ICE)
Open
*8frx10cm Pinnacle (if doing RHC)
Micropuncture
*8.5 SL1 transseptal
US probe cover
(2) 3-port manifolds
Closure
0-Prolene or 0-PDSII (Spies)
Perclose (Not Spies)
25g blue lido needle (Daniels)
60cc syringe
Stopcock


Pericardiocentesis (Standby):
===Wires:===
Call Echo


Open:
====Open====
Eye drape
Chiba biopsy needle 10cm 18g
Skater introducer set
Bard locking pigtail (6f or 8f)
(3) 60ml luer lock syringe
Standard .035 150cm j wire
Amplatz super stiff .035 180cm wire
Probe cover
Stopcock
Accordion drainage bag
Emergency Standby:
IABP


(Toray INOUE - Balloon)
*.035 150J (if needed for RHC)
*.032 260cm J


1 RFV Access. X2
===TransSeptal Equipment:===
====Open====


Conscious sedation by RN
*Baylis generator from EP
*Large curve C1 Baylis needle
*Baylis cable
*Grounding pad


TTE and ICE guidance (need sonographer)


Prerequisite: TEE done in Echo lab morning of to exclude LAA thrombus
===Catheters:===


Sheaths: •1 Probe Cover •1 5Fr VS Micropuncture Kit •1 9 Fr x >20 cm sheath RFV access •1 8 Fr Short sheath •1 8.5 Fr SL 1 transseptal sheath
*6F Swan (if recent RHC has not been performed)
*8F Accunav (If using ICE))


===Misc Supplies:===


Closure: •1 6Fr Perclose •1 Extra sterile mosquitos for Perclose
====Open====


*Micropuncture
*US probe cover
*3-port manifold
*Stopcock for woggle


2 Manifold Set Up: No ACIST •2 3-port manifold
====Have Prepped:====
*Cup with full strength contrast
*Bowl with 80/20 saline/contrast mixture




===Procedure:===


Wires: •1 cm Straight Tip Amplatz Super Stiff 260 cm
*Dual venous access with micropuncture and ultrasound. 
 
**8F standard sheath for Swan insertion if necessary. If no RHC directly with SL1
 
**9F 25cm sheath for ICE catheter
•Cordis “J” Wire 0.035 x 150 cm
*Swan advanced for RHC pressures (if needed)
 
*ICE advanced
 
*Transseptal equipment advanced and septostomy performed
 
*LA pressure measurement
Standby Items: •
*Probable LA-gram (10ml Full strength contrast)
 
*Balloon Prepped on back table
 
**80/20 saline to contrast concentration
Catheters: •1 5Fr. Multipurpose catheter
**Vent port cleared with contrast solution until solution flows from main inflating channel.
 
**Balloon sizing verified by filling and measuring with enclosed calipers
 
**Slenderizer inserted to elongate balloon
•1 5 Fr Arrow Swan
**MD will shape stylet to match LA anatomy
 
*Inoue Guidewire advanced to LA
 
*SL1 removed. ICE catheter removed.
Standby Items: •
*Black dilator advanced and removed
 
*Balloon advanced
•
*Verification by TTE for acceptable Mitral valve crossing
 
*Balloon inflation performed and gradients measured by echo
 
*Inflation repeated if necessary
Transeptal Access Supplies •Large Curve C1 71cm Baylis Trans-septal Needle
*Guidewire and slenderizer reinserted
 
*Possible gradient measured with SL1 and 6fr PA catheter.
 
*Figure 8 stitch around sheath. Sheath removed. Plan for Woggle.
•Baylis Cable
 
 
•Baylis Machine
 
 
•Orange Grounding Pad
 
 
 
Device Table •1 Toray INOUE-Balloon Kit (usually 28 mm, but need 26 and 30 mm available)
 
 
•2 1L bag Heparinized Saline (Both on pressured bag hanging on IV pole)
 
 
•1 Large Sterile Bowl filled with 1L Heparinized Saline for device use only
 
 
•2 60 ml luer-lock syringe
 
 
•5 High-Pressure stopcock
 
 
•50 ml Visipaque contrast for balloon prep. RATIO 1:5
 
 
 
Emergency Pericardiocentesis Supplies •Pericardiocentesis Tray
 
 
•Pericardiocentesis Supplies:
 
 
•5Fr VS Micropuncture
 
 
•Dilators
 
 
•0.035 J Wire 150 cm
 
 
•60 ml syringe
 
 
•Pericardiocenteis drainage bag
 
 
•Bard Pigtail drainage catheter size per MD request
 
 
Emergency Plug Dislodgement/Retrieval Supplies •NA
 
 
•IABP is device of choice for complication of severe mitral regurgitation


<br />
[[Category:Procedures]]
[[Category:Procedures]]
 
<HR />
APPROVED: MD initials MM/YY
APPROVED: MD initials MM/YY

Latest revision as of 17:40, 29 October 2021

DRAFT


Anesthesia Imaging Access Pre-Procedure Billing
None Fluoro, TTE, and ICE
possible TEE 		Femoral Vein x 2


Device:

  • Toray INOUE-Balloon Kit

Size determined using the equation (height in cm/10 +10), but verify with MD because body habitus is also a factor.

Sheaths:

Open

  • 9frx25cm Pinnacle (if using ICE)
  • 8frx10cm Pinnacle (if doing RHC)
  • 8.5 SL1 transseptal

Wires:

Open

  • .035 150J (if needed for RHC)
  • .032 260cm J

TransSeptal Equipment:

Open

  • Baylis generator from EP
  • Large curve C1 Baylis needle
  • Baylis cable
  • Grounding pad


Catheters:

  • 6F Swan (if recent RHC has not been performed)
  • 8F Accunav (If using ICE))

Misc Supplies:

Open

  • Micropuncture
  • US probe cover
  • 3-port manifold
  • Stopcock for woggle

Have Prepped:

  • Cup with full strength contrast
  • Bowl with 80/20 saline/contrast mixture


Procedure:

  • Dual venous access with micropuncture and ultrasound.
    • 8F standard sheath for Swan insertion if necessary. If no RHC directly with SL1
    • 9F 25cm sheath for ICE catheter
  • Swan advanced for RHC pressures (if needed)
  • ICE advanced
  • Transseptal equipment advanced and septostomy performed
  • LA pressure measurement
  • Probable LA-gram (10ml Full strength contrast)
  • Balloon Prepped on back table
    • 80/20 saline to contrast concentration
    • Vent port cleared with contrast solution until solution flows from main inflating channel.
    • Balloon sizing verified by filling and measuring with enclosed calipers
    • Slenderizer inserted to elongate balloon
    • MD will shape stylet to match LA anatomy
  • Inoue Guidewire advanced to LA
  • SL1 removed. ICE catheter removed.
  • Black dilator advanced and removed
  • Balloon advanced
  • Verification by TTE for acceptable Mitral valve crossing
  • Balloon inflation performed and gradients measured by echo
  • Inflation repeated if necessary
  • Guidewire and slenderizer reinserted
  • Possible gradient measured with SL1 and 6fr PA catheter.
  • Figure 8 stitch around sheath. Sheath removed. Plan for Woggle.


APPROVED: MD initials MM/YY

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