Tricuspid Clip: Difference between revisions

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[[File:AntSeptTricuspidClip.jpeg|thumb|150px|right|Anterior Septal imaging for Tricuspid clip|link={{filepath:AntSeptTricuspidClip.jpeg}}]]
==DRAFT==
==DRAFT==
{| class="wikitable"
{| class="wikitable"
! colspan="6" |Mitral Clip
! colspan="6" |Tricuspid Clip
|-
|-
!Anesthesia
!Anesthesia
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|-
|-
|General
|General
|Fluoro, TEE, and ICE
|
|
Femoral Vein
*Fluoro
*TEE
*ICE on standby
|
|
*Primary access is patient dependent
*5F Venous sheath LFV for ACT's and potential ICE access
|
*80 cm from sub-xyphoid, or
*85 from mid-sternum for stool placement
|}
|}


===Procedural Gems:===
* It is a good idea to have the Guide prepped around time-out since there is no transeptal; they need the guide much sooner than we're used to. <br />
 
*When using the PDOII plug In MitraClip setting use TorqView 180 (smaller cable needed)
 
===Big Equipment:===
===Big Equipment:===
====Open====
====Open====
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*Clear Plexiglass base support
*Clear Plexiglass base support
*Sterile System Stabilizer
*Sterile System Stabilizer
*Baylis generator (Mitral only)
*ICE 8fr. and SwiftLink cover (Tricuspid only)
**9fr x 23cm Pinnacle for ICE


===Baylis/transseptal:===
====Standby====
'''Not used for Tricuspid clipping'''
====Open====


*SL1 TransSeptal sheath
*ICE 8fr. and SwiftLink cover
*Large curve Baylis needle
*9fr x 23cm Pinnacle for ICE
*Baylis cable
*150cm J wire
*Grounding pad


===Wires:===
===Wires:===
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====Open====
====Open====


*.032 X 260 “J” wire
*Amplatz SS 7cm x 260
*Amplatz SuperStiff 1cm Tip
*150J
 
===Catheters:===
 
====Open====
 
*5F MPA2<br />
 
===Misc supplies:===
===Misc supplies:===


====Open====
====Open====


*(2) 108cm High pressure IV Lines
*(4) 108cm High pressure IV Lines
*(5) Stopcocks
*(8) Stopcocks
*8F Sheath for dilator - (also used as a backup sheath)
*8F Sheath for dilator - (also used as a backup sheath)
*(1)Perclose
*(1) Perclose
*5F MPA2
*4-0 Vicryl/monocryl
*4-0 Vicryl/monocryl
*Pickups (Either from a suture removal kit or individual from SPD)
*Pickups (Either from a suture removal kit or individual from SPD)
*(2) 60cc syringe
*(2) 60cc syringe
*12” extension (Keep stickers to label flush tubing)
*(2) 12” extension (Keep stickers to label flush tubing)
**One for 60cc syringe, one for 3-port manifold
*Sterile towel pack for back table
*Sterile towel pack for back table
*3 port manifold to measure LA pressure only  (not needed for Tricuspid)
*Fluoro cover to anesthesia IV pole or moving xray shield
*Fluoro cover to anesthesia IV pole or moving xray shield
*20F Dilator
*20F Dilator
*Micropuncture
*Micropuncture
*U/S probe cover
*U/S probe cover
*3 Port Manifold to record Pre/Post RA pressures


====Standby====
====Standby====


*20fr. DrySeal for recovering wire to LUPV
*Additional Perclose
*Additional Perclose
*Pericardiocentesis supplies
*Pericardiocentesis supplies
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===Non-Sterile Supplies===
===Non-Sterile Supplies===


*(2) Liter bags of heparinized saline
*'''Set-up 2 IV poles to facilitate quick device changeover.'''
*(2) Liter sized pressure bags
*(4) Liter bags of heparinized saline
*(4) Liter sized pressure bags


==Procedure==
==Procedure==


*Anesthesia will obtain radial art line prior to draping.
#Anesthesia will obtain radial art line prior to draping.
*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, 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 FV access, dilate with 8F, preclose. .035 wire inserted into perclose.
#Amplatz SS advanced through perclose to RV
#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
 


*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 75cm from subxyphoid 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.
==Off Label Tricuspid Clip Notes==
*Obtain RFV access, dilate with 8F, preclose. .032 wire inserted into perclose.
*SL1 introduced over .032 wire.
*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.
*Amplatz SuperStiff advanced.
*MPA removed.
*SL1 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.
*LA pressure measured. Set up for subsequent clips if needed.
*Vicryl used for groin closure.


==Tricuspid Procedure==
*Left femoral venous access (height and septal hugger)
*Guide upside down to start
*180 degree mis key, blue line at 11 o clock
*Steer down with A "A is F"
*"Negative is L"
*Create a septal hugger by adding M
*Rotation of clip Counter clockwise to decrease septal hugger


*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




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[[Category:Procedures]]
[[Category:Procedures]]
[[Category:Crazy Gems]]
<hr />
<hr />
APPROVED: MD initials MM/YY
APPROVED: MD initials MM/YY

Latest revision as of 21:24, 10 December 2021

Anterior Septal imaging for Tricuspid clip


DRAFT

Tricuspid Clip
Anesthesia Imaging Access Pre-Procedure
General
  • Fluoro
  • TEE
  • ICE on standby
  • Primary access is patient dependent
  • 5F Venous sheath LFV for ACT's and potential ICE access
  • 80 cm from sub-xyphoid, or
  • 85 from mid-sternum for stool placement
  • It is a good idea to have the Guide prepped around time-out since there is no transeptal; they need the guide much sooner than we're used to.

Big Equipment:

Open

  • Cath pack
  • Lift / Footstool / Support base
  • Clear Plexiglass base support
  • Sterile System Stabilizer

Standby

  • ICE 8fr. and SwiftLink cover
  • 9fr x 23cm Pinnacle for ICE
  • 150cm J wire

Wires:

Open

  • Amplatz SS 7cm x 260

Misc supplies:

Open

  • (4) 108cm High pressure IV Lines
  • (8) Stopcocks
  • 8F Sheath for dilator - (also used as a backup sheath)
  • (1) Perclose
  • 5F MPA2
  • 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)
    • One for 60cc syringe, one for 3-port manifold
  • Sterile towel pack for back table
  • Fluoro cover to anesthesia IV pole or moving xray shield
  • 20F Dilator
  • Micropuncture
  • U/S probe cover
  • 3 Port Manifold to record Pre/Post RA pressures

Standby

  • Additional Perclose
  • Pericardiocentesis supplies

Non-Sterile Supplies

  • Set-up 2 IV poles to facilitate quick device changeover.
  • (4) Liter bags of heparinized saline
  • (4) Liter sized pressure bags

Procedure

  1. Anesthesia will obtain radial art line prior to draping.
  2. Pre procedure TEE imaging performed
  3. 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.
  4. Prep patient and drape per usual. Drape anesthesia pole and/or xray shield.
  5. Obtain FV access, dilate with 8F, preclose. .035 wire inserted into perclose.
  6. Amplatz SS advanced through perclose to RV
  7. 20F dilator inserted and removed
  8. MitraClip Guide inserted.
  9. Setup stabilizer and silicone sheet. Hand MD 60ml syringe with short extension tubing for aspiration.
  10. Amplatz wire and dilator removed. Clip inserted.
  11. Drips should be maintained at 1 drip every 3 seconds. If bubbles are seen on echo, turn drips down.
  12. When clip is being deployed turn room lights up and drips up. Place bowl below to catch drips while deploying.
  13. Hand MD 60ml syringe with extension tubing for aspiration while delivery system is removed.
  14. Vicryl used for groin closure


Off Label Tricuspid Clip Notes

  • Left femoral venous access (height and septal hugger)
  • Guide upside down to start
  • 180 degree mis key, blue line at 11 o clock
  • Steer down with A "A is F"
  • "Negative is L"
  • Create a septal hugger by adding M
  • Rotation of clip Counter clockwise to decrease septal hugger


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