Watchman: Difference between revisions
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*Micropuncture | *Micropuncture | ||
*8fr sheath (dilator used pre-Perclose) | *8fr sheath (dilator used pre-Perclose) | ||
*Probe cover | *Probe cover | ||
*1 Perclose | *1 Perclose | ||
**0-Prolene or 0-PDS (Spies will add a suture after perclose if site is oozing. If no ooze Exofin.) | **0-Prolene or 0-PDS (Spies will add a suture after perclose if site is oozing. If no ooze Exofin.) | ||
* Cordis 150J | * Cordis 150J | ||
*5fr Straight Pigtail | *5fr Straight Pigtail | ||
*3-port manifold | *3-port manifold | ||
* | *Baylis VersaCross Access System (purple box in structural cart) | ||
*Grounding pad | *Grounding pad | ||
*(Spies - Lido with EPI) | |||
====Standby==== | ====Standby==== | ||
| Line 69: | Line 62: | ||
#8 Fr dilator | #8 Fr dilator | ||
#6 Fr Perclose pre-close RFV. .032 wire inserted after preclosure deployment. | #6 Fr Perclose pre-close RFV. .032 wire inserted after preclosure deployment. | ||
# | #.035 J wire from versacross system advanced thru perclose for Baylis sheath advancement. | ||
# | #.035 J wire removed, VersaCross RF pigtail wire advanced for transeptal puncture. | ||
#TEE & fluoro guided transeptal access & images of Left Atrial Appendage | #TEE & fluoro guided transeptal access & images of Left Atrial Appendage | ||
#Anesthesia gives Heparin IV. ACT GOAL >250-300 | #Anesthesia gives Heparin IV. ACT GOAL >250-300 | ||
#Transeptal puncture | #Transeptal puncture, ACT drawn from LA. | ||
#Measure LA pressure | #Measure LA pressure | ||
# | #15 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve | ||
#Backloaded 5 Fr Str Pigtail advanced to the LAA | |||
#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 | ||
| Line 94: | Line 82: | ||
#Deploy Device. Confirm placement to meet PASS criteria: '''P'''osition '''A'''nchor, '''S'''ize, '''S'''eal. Can be recaptured/reposition. Fully unscrew to deploy device. | #Deploy Device. Confirm placement to meet PASS criteria: '''P'''osition '''A'''nchor, '''S'''ize, '''S'''eal. Can be recaptured/reposition. Fully unscrew to deploy device. | ||
#Placement confirmed by LA angiogram | #Placement confirmed by LA angiogram | ||
#Delivery system removed as MD tamps perclose knot. | #Delivery system removed as MD tamps perclose knot. | ||
#If access is clean, Dermabond. If bleeding, [[woggle]]. | #If access is clean, Dermabond. If bleeding, [[woggle]]. | ||
Latest revision as of 19:32, 18 November 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
Open
- Micropuncture
- 8fr sheath (dilator used pre-Perclose)
- Probe cover
- 1 Perclose
- 0-Prolene or 0-PDS (Spies will add a suture after perclose if site is oozing. If no ooze Exofin.)
- Cordis 150J
- 5fr Straight Pigtail
- 3-port manifold
- Baylis VersaCross Access System (purple box in structural cart)
- Grounding pad
- (Spies - Lido with EPI)
Standby
- 4 or 5fr Pinnacle for Arterial line
- 190 Supracore
- Wholey / Versacore
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.
- .035 J wire from versacross system advanced thru perclose for Baylis sheath advancement.
- .035 J wire removed, VersaCross RF pigtail wire advanced for transeptal puncture.
- TEE & fluoro guided transeptal access & images of Left Atrial Appendage
- Anesthesia gives Heparin IV. ACT GOAL >250-300
- Transeptal puncture, ACT drawn from LA.
- Measure LA pressure
- 15 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
- Backloaded 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
