Watchman: Difference between revisions
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*Amplatz Super Stiff .035x260 1cm tip | *Amplatz Super Stiff .035x260 1cm tip | ||
*Cordis 150J | *Cordis 150J | ||
*.032 x 260 | |||
====Standby==== | ====Standby==== | ||
*190 Supracore | *190 Supracore | ||
*Wholey / Versacore | *Wholey / Versacore | ||
| Line 98: | Line 98: | ||
#MPA and SL1 removed | #MPA and SL1 removed | ||
#14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve | #14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve | ||
#5 Fr Str Pigtail advanced | #5 Fr Str Pigtail advanced to the LAA | ||
#Hook pigtail up to manifold for angiogram of LAA | #Hook pigtail up to manifold for angiogram of LAA | ||
#Measure and select size of Watchman device | #Measure and select size of Watchman device | ||
Revision as of 21:34, 25 January 2022
| Watchman - Left Atrial appendage closure | |||
|---|---|---|---|
| Anesthesia | Imaging | Access | ACIST/manifold |
| General | Fluoro and TEE |
|
One manifold with contrast |
| Pre-Procedure Watchouts | |||
|
PRE PROCEDURE: Type and Screen | |||
Type and Screen
Sheaths:
Open
- 8.5fr SL1 sheath
- 8fr sheath (dilator used pre-Perclose)
- 16fr dilator
Standby
- 4 or 5fr Pinnacle for Arterial line
Wires:
Open
- Amplatz Super Stiff .035x260 1cm tip
- Cordis 150J
- .032 x 260
Standby
- 190 Supracore
- Wholey / Versacore
Baylis/TransSeptal:
Open
- Baylis generator from EP
- Large curve C1 Baylis needle
- Baylis cable
- Grounding pad
Misc Supplies:
Open
- Micropuncture
- Probe cover
- Closure
- Perclose
- 0-Prolene or 0-PDS (Spies)
- 5fr Straight Pigtail
- 5fr MPA2 (Spies)
- 3-port manifold
Watchman supplies:
- 14fr Watchman access sheath (Open as requested after TEE)
- Watchman device (Size as requested after TEE)
PROCEDURE
- Basic table set up ONLY until it is determined by TEE that case will proceed.
- TEE performed. Procedure aborted if clot
- Prep bilateral groins and drape once probe has been inserted.
- Micropuncture ultrasound-guided RFV access
- 5 Fr Micropuncture sheath
- Baby J wire from sheath
- 8 Fr dilator
- 6 Fr Perclose pre-close RFV. .032 wire inserted after preclosure deployment.
- 8.5 Fr SL 1 Sheath
- Baylis needle inserted
- TEE & fluoro guided transeptal access & images of Left Atrial Appendage
- Anesthesia gives Heparin IV. ACT GOAL >250-300
- Transeptal puncture
- Needle removed and .032 wire inserted to advance SL1 into LA
- Measure LA pressure
- MPA preloaded with J wire inserted through SL1
- J wire removed and 260cm SS Amplatz advanced to LA (preshaped by MD)
- Straight 260cm Super Stiff Amplatz wire to LUPV
- MPA and SL1 removed
- 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
- 5 Fr Str Pigtail advanced to the LAA
- Hook pigtail up to manifold for angiogram of LAA
- Measure and select size of Watchman device
- Open and prep Watchman Device -
- Open touhy
- Exercise delivery
- Advance feet of device to just inside of marker
- Leave touhy open and attach to manifold with pressurized hep saline open, close touhy and flush to device. Tap through delivery system while flushing. (Size: 21, 24, 27, 30, 33mm)
- Pigtail removed just prior to delivery system insertion.
- Insert delivery with a wet-to-wet connection (leaving pressurized saline on)
- Once inserted, begin filling delivery system with contrast. Delivery system takes 20ml to fill.
- Deploy Device. Confirm placement to meet PASS criteria: Position Anchor, Size, Seal. Can be recaptured/reposition. Fully unscrew to deploy device.
- Placement confirmed by LA angiogram
- Delivery system removed as MD tamps perclose knot.
- If access is clean, Dermabond. If bleeding, woggle.
APPROVED: MD initials MM/YY
