Impella: Difference between revisions
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===Equipment=== | ===Equipment=== | ||
*Pack | *Pack | ||
*Cath Lab to-go cart | *Cath Lab to-go cart | ||
*JR4 | *JR4 | ||
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*Perclose | *Perclose | ||
*.035 exchange | *.035 exchange | ||
*500ml bag heparinized saline | *500ml bag heparinized saline | ||
*D5W 1000ml | *D5W 1000ml (with 12,500 U of heparin added) | ||
=== Room Setup and Procedure === | === Room Setup and Procedure === | ||
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*Open x-ray and McKesson using entered order. | *Open x-ray and McKesson using entered order. | ||
*DO NOT CHARGE FOR THE PROCEDURE. This is OR's procedure. | *DO NOT CHARGE FOR THE PROCEDURE. This is OR's procedure. | ||
*CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1 | *CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!! | ||
*Free-Text note that McKesson is open for billing and equipment only, not procedural charting. See Anesthesia and OR nurses notes. | *Free-Text note that McKesson is open for billing and equipment only, not procedural charting. See Anesthesia and OR nurses notes. | ||
*Put input 4in1 B on V-integration 2 for TTE on the fluoro screen. | *Put input 4in1 B on V-integration 2 for TTE on the fluoro screen. | ||
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*Remove the other thing (ECMO / Balloon pump / Impella) | *Remove the other thing (ECMO / Balloon pump / Impella) | ||
*Document times and doses in McKesson and log book. | *Document times and doses in McKesson and log book. | ||
*Reminder::: CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1 | *Reminder::: CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!! | ||
*Save 2 stickers | *Save 2 stickers | ||
*Close x-ray and archive to EMIM_CATH | *Close x-ray and archive to EMIM_CATH | ||
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*Amplatz extra stiff 260cm wire (on standby for Spies) | *Amplatz extra stiff 260cm wire (on standby for Spies) | ||
*.035 150cm J wire | *.035 150cm J wire | ||
* | *5Fr pigtail catheter | ||
* | *5Fr JR4 diagnostic catheter (on standby for Spies) | ||
*IABP kit | *IABP kit | ||
* | *8Fr 23cm safesheath (ep)(Romick) / 8fr x 23 brite-tip sheath (Spies) | ||
*Perclose | *Perclose | ||
*TR band | *TR band | ||
Revision as of 21:22, 18 July 2022
Note: Good article on Single access and sheaths: Impella Single Access
Daniels/Spies single access Impella - DRAFT
Equipment
- 16F Dryseal
- 8fr guide
- 6fr Shuttle 90cm
Hui single access Impella - DRAFT
Double stick Impella sheath
Equipment
- Micropuncture
- 6/7 Short slender sheath
- 7fr. Guide
Hybrid OR Impella via Subclavian conduit
Note: Change location of supplies to Cath Lab 1!
Equipment
- Pack
- Cath Lab to-go cart
- JR4
- Angled Pigtail
- .025 exchange for BP removal
- Perclose
- .035 exchange
- 500ml bag heparinized saline
- D5W 1000ml (with 12,500 U of heparin added)
Room Setup and Procedure
- Enter an order for CCL in EPIC
- Open x-ray and McKesson using entered order.
- DO NOT CHARGE FOR THE PROCEDURE. This is OR's procedure.
- CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!
- Free-Text note that McKesson is open for billing and equipment only, not procedural charting. See Anesthesia and OR nurses notes.
- Put input 4in1 B on V-integration 2 for TTE on the fluoro screen.
- Place drape over legs after surgical draping to cover abdomen.
- Put OR light camera in place to see the surgical site to monitor progress from control room.
- Ask OR for 1 pack Ray-Tec sponges for wipes.
- Do the thing (Insert 5.0 Impella)
- Pass off sheath and clamps to surgeon. Once sheath is inserted in the conduit, JR4 and J wire advanced for valve crossing. Exchanged for pigtail, IMPELLA wire retained in LV. Impella advanced under fluoro and echo guidance. Save image. Surgeon/ Interventionist discuss whether to removed additional support or leave in place. Surgeon closes.
- Remove the other thing (ECMO / Balloon pump / Impella)
- Document times and doses in McKesson and log book.
- Reminder::: CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!
- Save 2 stickers
- Close x-ray and archive to EMIM_CATH
- Capture charges for McKesson
- Print device usage.
- Sticker goes in room 14 log book for tracking, second sticker is for device list
Axillary Impella/IABP - DRAFT
If left subclavian is occluded or otherwise inaccessible procedure is aborted. IABP should not be inserted through right subclavian per CT surgery.
Equipment
- Micropuncture
- Probe Cover
- 4/5F slender radial sheath
- Amplatz extra stiff 260cm wire (on standby for Spies)
- .035 150cm J wire
- 5Fr pigtail catheter
- 5Fr JR4 diagnostic catheter (on standby for Spies)
- IABP kit
- 8Fr 23cm safesheath (ep)(Romick) / 8fr x 23 brite-tip sheath (Spies)
- Perclose
- TR band
- Biopatch
- 0-Ethibond suture
- Tournaquick (carrot top)
- 3 Port Manifold
Procedure
- Prep left side neck and chest (ear to nipple and shoulder to midline).
- Note: The access site is not an absolute (may become axillary or subclavicular) hence the large site prep.
- Prep left radial.
- Left radial accessed and 4/5f slender sheath inserted.
- Pigtail advanced and angiogram performed. Pigtail left in place and used as reference for subclavian access.
- Subclavian accessed with ultrasound and fluoro guidance using micropuncture kit and radial sheath inserted.
- Pigtail catheter removed.
- J wire and JR4 inserted and directed to descending aorta if unable to be directed to abdominal aorta
- Catheter and sheath removed, 8f dilator inserted, and perclose advanced for pre-closure.
- Amplatz wire advanced, perclose removed, 8f sheath advanced.
- IABP inserted.
- Sheath peeled away. (Romick)
- IABP secured with suture and site dressed.
- Radial sheath removed and TR band applied.
