TMVI: Difference between revisions

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DANIELS
Daniels


Sapien M3
Transcather Mitral Valve Replacement


'''GENERAL ANESTHESIA, TEE, BIPLANE'''
'''GENERAL ANESTHESIA AND TEE IMAGING'''


'''ACCESS 2 FEMORAL VEINS (ESHEATH AND PACER), 1 FEMORAL ARTERY'''  
'''ACCESS 2 FEMORAL VEINS (TAVR AND PACER), 1 FEMORAL ARTERY (ANESTESIA)'''


'''TRIPLE LUMEN AND RADIAL ARTERY ACCESS BY ANESTHESIA'''
'''PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN'''  
 
'''STABILIZER PLACEMENT PRIOR TO DRAPING'''


= SHEATHS: =
= SHEATHS: =


* (1) 5F MICROPUNCTURE KIT
* (1) 5F MICROPUNCTURE KIT
* (1) 6F 10CM SHEATH  
* (1) 5F 10CM SHEATH  
*** '''OR''' 6F IF CORONARY IMAGING NECESSARY
* (1) 8F 10CM SHEATH  
* (1) 8F 10CM SHEATH  
* (1) 8F 35CM BRITE TIP SHEATH  
* (1) 8F 35CM BRITE TIP SHEATH  
* (1) 9F 10CM SHEATH  
* (1) 9F 10CM SHEATH  
* (1) 8.5F 63CM SL1 TRANSSEPTAL SHEATH
* (1) 8.5F 63CM SL1 TRANSSEPTAL SHEATH
* (1) 8.5F AGILIS SMALL CURL


= WIRES: =
= WIRES: =
Line 25: Line 25:


* (2) .035 150CM J WIRE
* (2) .035 150CM J WIRE
* (1) .035 260CM J WIRE
* (1) SAFARI 2 WIRE
* (1) SAFARI 2 WIRE
* (1) AMPLATZ SUPER STIFF 1CM TIP


== '''Standby''' ==
== '''Standby''' ==


* Baylis ProTrack wire
* .035 260CM J WIRE
* AMPLATZ SUPER STIFF 1CM TIP
* SUPRACORE 190CM


= CATHETERS =
= CATHETERS =
Line 38: Line 38:


* 6F STRAIGHT PIGTAIL 110CM
* 6F STRAIGHT PIGTAIL 110CM
* 6F ANGLED PIGTAIL 110CM
* 5F MPA1


== '''Standby''' ==
== '''Standby''' ==


* 6F MPA1 125cm
* 6F LANGSTON
* 5.2F ANGLED PIGTAIL
* 5F MPA
* 5F JL4 AND JR4 (FOR CORONARIES)


= PACING =
= PACING =
Line 54: Line 55:
= VALVE TABLE =
= VALVE TABLE =


* (5) STERILE BOWLS (2- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
* (4) STERILE BOWLS (2- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
* (1) 90 INCH DRAPE  
* (1) 90 INCH DRAPE (OR)
* 1L NORMAL SALINE IRRIGATION
* 1L NORMAL SALINE IRRIGATION
* 500ML HEPARINIZED SALINE
* 500ML HEPARINIZED SALINE
* (2) 60ML SYRINGE
* (1) 60ML SYRINGE
* (1) HIGH PRESSURE STOPCOCK
* (1) HIGH PRESSURE STOPCOCK
* (1) 20ML SYRINGE
* (1) 20ML SYRINGE
* 30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION)
* 30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION)
* 12 INCH EXTENSION
* ROTO TUBING


== '''VALVE- SUPPLIED BY EDWARDS''' ==
== '''FOR EDWARDS VALVE''' ==


* INDEFLATOR
* INDEFLATOR
Line 84: Line 83:
== '''Open''' ==
== '''Open''' ==


* 14X4 ATLAS GOLD- 135 CM SHAFT PREFERRED
* 12X4X75 MUSTANG '''OR''' 14X4 XXL BALLOON (FROM IR)
 
''SIZE DEPENDENT ON VALVE- CHECK WITH DANIELS BEFORE OPENING''


* PRESTO INDEFLATOR
* PRESTO INDEFLATOR
Line 90: Line 91:
== '''Standby''' ==
== '''Standby''' ==


* 9X4X135 MUSTANG
* TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
* TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
* 10MM, 14MM, 18MM SEPTAL OCCLUDER
* 10MM, 14MM, 18MM SEPTAL OCCLUDER
Line 99: Line 101:
* (2) PERCLOSE
* (2) PERCLOSE
* 3 PORT MANIFOLD  
* 3 PORT MANIFOLD  
* ACIST- 70/30 MIX
* ACIST- FULL STRENGTH CONTRAST OK
* PROBE COVER
* PROBE COVER
* DUMP BAG
* DUMP BAG
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* TAVR INSTRUMENT TRAY
* TAVR INSTRUMENT TRAY
* CHLORAPREP AND PREP TRAY
* CHLORAPREP AND PREP TRAY
* A LINE TUBING AND VENOUS EXTENSION FOR ANESTHESIA
* DERMABOND
* DERMABOND
* (2) FLUORO DRAPES (FOR LATERAL BASE AND ANESTHESIA POLE)
 
* 36X36 BANDBAG (FOR LATERAL DETECTOR)
== '''Standby''' ==
* 1L HEP SALINE ON PRESSURE BAG HUNG FROM IVY POLE
 
* 150ML CONTRAST (FOR CORONARIES)
* BIOPATCH
* FLUORO DRAPE
* 8F ANGIOSEAL
* 0 SILK SUTURE
* EXTRA PERCLOSE


= MEDICATIONS =
= MEDICATIONS =


* BUPIVACAINE/LIDOCAINE MIX
* BUPIVACAINE  
* EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
* EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
* ROTAGLIDE 10ML (PRE VALVE)
* ROTAGLIDE 10ML (EDWARDS VALVE)


= STANDBY EMERGENCY ECMO SUPPLIES =
= STANDBY EMERGENCY ECMO SUPPLIES =
Line 135: Line 144:
* STOPCOCK
* STOPCOCK
* AMPLATZ SUPER STIFF 180CM
* AMPLATZ SUPER STIFF 180CM
= STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES =
'''SEE MITRAL PARAVALVULAR LEAK REPAIR'''
* AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE


= PROCEDURE: =
= PROCEDURE: =


* Patient prepped from '''navel to knees''' in sterile fashion.  
* Patient prepped from '''navel to knees''' in sterile fashion.  
* ISOCENTER XRAY
* Access obtained with u/s  
* Access obtained with u/s  


Typical sites:
Typical sites:  


*** 6F LFA for Pigtail
*** 5F LFA for anesthesia monitoring
*** 8F 35cm LFV for transcutaneous pacing
*** 8F 35cm LFV for transcutaneous pacing
*** 20F RFV E-sheath for valve delivery
*** 14F OR 16F RFV E-sheath for valve delivery
**** Dilate with 8F  
**** Dilate with 8F  
**** Preclose
**** Preclose
* Pigtail advanced through 6F sheath and LVgram performed
* Mitral annulus denoted on live monitor screen in A plane
* SL1 inserted over .032 kit wire
* SL1 inserted over .032 kit wire
* Baylis needle inserted through SL1 and atrial septum puncture performed.
* Baylis needle inserted through SL1 and atrial septum puncture performed.
* Needle removed
* Needle removed, .032 wire advanced to pulmonary vein
* 5F MPA and standard J wire advanced to pulmonary vein
* Agilis advanced and directed to mitral valve
* 1cm Amplatz Super Stiff advanced and MPA and SL1 removed
* Pigtail inserted through agilis for valve crossing.
* Edwards Guide Sheath (GS) advanced
* Safari2 wire inserted to ventricle.
* Dock Delivery System (DDS) advanced through GS
* Pigtail and agilis removed.
* Dock deployed in a timely fashion ;)
* 12mm/14mm balloon advanced for septostomy and possible BAV
* DDS removed and MPA inserted over exchange  J for valve crossing
* Balloon removed, valve delivery system advanced.
* J wire exchanged for Safari 2 and MPA removed
* 14mm balloon advanced for septostomy
* Balloon and GS removed
* Valve delivery system advanced
* When valve is in place, temp pacer inserted and tested.
* When valve is in place, temp pacer inserted and tested.
* Valve deployed. Septum evaluated with echo for shunting and PVL.
* Valve deployed. Septum evaluated with echo for shunting.
* Delivery system removed and MPA inserted for LA pressure measurement.
* Pacer removed. Delivery system removed.
* All equipment removed
* Preclosure closed and stitch to RFV
* Preclosure closed and stitch to RFV
* Perclose LFA
* Perclose LFA
* 8F vein exchanged for 9F 10cm sheath
* 8F vein exchanged for 9F 10cm sheath
* Secure sheath with Statlock. Tegaderm both sides.
* Secure sheath with Statlock. Tegaderm both sides.
Did you notice we wrote IVY pole instead of IV? Delirious.
The End.

Revision as of 15:54, 25 September 2019

Daniels

Transcather Mitral Valve Replacement

GENERAL ANESTHESIA AND TEE IMAGING

ACCESS 2 FEMORAL VEINS (TAVR AND PACER), 1 FEMORAL ARTERY (ANESTESIA)

PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN

SHEATHS:

  • (1) 5F MICROPUNCTURE KIT
  • (1) 5F 10CM SHEATH
      • OR 6F IF CORONARY IMAGING NECESSARY
  • (1) 8F 10CM SHEATH
  • (1) 8F 35CM BRITE TIP SHEATH
  • (1) 9F 10CM SHEATH
  • (1) 8.5F 63CM SL1 TRANSSEPTAL SHEATH
  • (1) 8.5F AGILIS SMALL CURL

WIRES:

Open

  • (2) .035 150CM J WIRE
  • (1) SAFARI 2 WIRE

Standby

  • .035 260CM J WIRE
  • AMPLATZ SUPER STIFF 1CM TIP
  • SUPRACORE 190CM

CATHETERS

Open

  • 6F STRAIGHT PIGTAIL 110CM

Standby

  • 6F LANGSTON
  • 5.2F ANGLED PIGTAIL
  • 5F MPA
  • 5F JL4 AND JR4 (FOR CORONARIES)

PACING

  • 5F JOSEPHSON PACING CATHETER
  • EP QUAD CABLE
  • DUAL RED/BLACK REMINGTON PACING CABLE
  • (2) PACER BOXES

VALVE TABLE

  • (4) STERILE BOWLS (2- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
  • (1) 90 INCH DRAPE (OR)
  • 1L NORMAL SALINE IRRIGATION
  • 500ML HEPARINIZED SALINE
  • (1) 60ML SYRINGE
  • (1) HIGH PRESSURE STOPCOCK
  • (1) 20ML SYRINGE
  • 30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION)

FOR EDWARDS VALVE

  • INDEFLATOR
  • CRIMPER
  • E SHEATH
  • DELIVERY SYSTEM
  • VALVE

TRANS SEPTAL

  • BAYLIS NEEDLE LARGE CURVE C1
  • BAYLIS MACHINE
  • BAYLIS CABLE
  • GROUNDING PAD

SEPTAL DILATION

Open

  • 12X4X75 MUSTANG OR 14X4 XXL BALLOON (FROM IR)

SIZE DEPENDENT ON VALVE- CHECK WITH DANIELS BEFORE OPENING

  • PRESTO INDEFLATOR

Standby

  • 9X4X135 MUSTANG
  • TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
  • 10MM, 14MM, 18MM SEPTAL OCCLUDER

ADDITIONAL SUPPLIES

Open

  • (2) PERCLOSE
  • 3 PORT MANIFOLD  
  • ACIST- FULL STRENGTH CONTRAST OK
  • PROBE COVER
  • DUMP BAG
  • 25g 1½ INCH NEEDLE
  • STAT LOCK WITH STRING SECUREMENT
  • PROLENE 2-0
  • TAVR INSTRUMENT TRAY
  • CHLORAPREP AND PREP TRAY
  • A LINE TUBING AND VENOUS EXTENSION FOR ANESTHESIA
  • DERMABOND

Standby

  • 150ML CONTRAST (FOR CORONARIES)
  • BIOPATCH
  • FLUORO DRAPE
  • 8F ANGIOSEAL
  • 0 SILK SUTURE
  • EXTRA PERCLOSE

MEDICATIONS

  • BUPIVACAINE
  • EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
  • ROTAGLIDE 10ML (EDWARDS VALVE)

STANDBY EMERGENCY ECMO SUPPLIES

  • 16F ARTERIAL CANNULA
  • 21F VENOUS CANNULA
  • (2) PERCLOSE
  • ECMO INSTRUMENT TRAY
  • AMPLATZ SUPER STIFF

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

PROCEDURE:

  • Patient prepped from navel to knees in sterile fashion.  
  • Access obtained with u/s

Typical sites:

      • 5F LFA for anesthesia monitoring
      • 8F 35cm LFV for transcutaneous pacing
      • 14F OR 16F 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, .032 wire advanced to pulmonary vein
  • Agilis advanced and directed to mitral valve
  • Pigtail inserted through agilis for valve crossing.
  • Safari2 wire inserted to ventricle.
  • Pigtail and agilis removed.
  • 12mm/14mm balloon advanced for septostomy and possible BAV
  • Balloon removed, valve delivery system advanced.
  • When valve is in place, temp pacer inserted and tested.
  • Valve deployed. Septum evaluated with echo for shunting.
  • Pacer removed. Delivery system removed.
  • Preclosure closed and stitch to RFV
  • Perclose LFA
  • 8F vein exchanged for 9F 10cm sheath
  • Secure sheath with Statlock. Tegaderm both sides.
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