Carotid TAVI: Difference between revisions

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*Carotid cutdown
*Carotid cutdown
*Femoral Vein x1
*Contralateral Radial
*Femoral Artery x1
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==Equipment==
==Equipment==
In addition to standard TAVR equipment the OR team will need:


*Micropuncture
*Micropuncture (for Sheridan)
*6F 10cm Pinnacle Sheath
*6F 10cm Pinnacle Sheath (for Sheridan)
*5/6 Slender
*.035 x 150 J wire
*.035 x 260 J wire
*5F AL1
*5F Angled Pigtail
*Alligator pacing cable
*Safari wire - if using commander delivery system


<br />We will need:
*180 Amplatz SS 4cm tip - if using certitude delivery system, in the TAVR cart
 
*180 Amplatz SS with 4cm tip is in the TAVR cart.
*Can get away with 1 short J wire





Revision as of 00:56, 28 April 2022


Carotid TAVR
Anesthesia Imaging Access
General Fluoro and TEE
  • Carotid cutdown
  • Contralateral Radial
Pre-Procedure Watchouts
  • Transcutaneous O2 Sat
  • MAP above 100


Equipment

  • Micropuncture (for Sheridan)
  • 6F 10cm Pinnacle Sheath (for Sheridan)
  • 5/6 Slender
  • .035 x 150 J wire
  • .035 x 260 J wire
  • 5F AL1
  • 5F Angled Pigtail
  • Alligator pacing cable
  • Safari wire - if using commander delivery system
  • 180 Amplatz SS 4cm tip - if using certitude delivery system, in the TAVR cart


Setup- Right Sided Carotid

  • Anesthesia to get left sided A line
  • Table at 30 degrees
  • Bring C arm in perpendicular to table
  • Echo at head of bed (TEE)
  • OR will do prep. (Include groins and right wrist)
  • First assist to stand at head of bed on the left
  • CT surgeon on right side with scrub RN
  • Cath Lab will have standard 2 tables plus high table for valve delivery.
    • mayo stand to bridge the gap between valve table and access site
  • Cover Fluoro Pedal and Base of C-arm
  • 2 venous extensions needed for Anesthesia
  • Leave large boom to the side of the room. Use Monitors 3 &4 for pigtail and pacer.
    • 3 Live and 4 McKesson
  • When DD moves to the head to assist with valve crossing bring in monitors 3 &4
    • 3- echo 4-Mckesson 1- Live 2- Anesthesia Vitals
    • Right wall monitor with quad view
    • boom with standard tavr display


Procedure- Right Sided

  • Sheridan will start with cutdown.
  • DD will obtain radial access for pigtail and femoral venous for Pacer
  • AOgram per usual
  • CTS inserts 6F sheath
  • One CL tech stays at foot of bed for injections and pigtail pull
  • Preloaded AL1 and Stiff glide inserted
  • stiff glide exchanged for SAFARI
  • E sheath inserted
  • Valve delivered
  • Venous sheath removed and figure 8 with prolene
  • TR Band applied after OR finished closing.