TEER with PASCAL: Difference between revisions

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|General
|Fluoro, TEE
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4F Femoral Vein for drawing ACT's
<nowiki>**</nowiki> If functional MR/low EF Anesthesia to obtain A line and femoral vein sheath not necessary.
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! colspan="3" |Pre-Procedure Watchouts
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|colspan="3" |* ''' Tidal volume during time-out! '''
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===Big Equipment:===
===Big Equipment:===
*Cath pack
*Cath pack

Revision as of 20:05, 19 January 2023

Big Equipment:

  • Cath pack
  • Clear Plexiglass base support
  • Non-Sterile stabilizer provided by Rep
  • Baylis generator

Baylis Transseptal:

  • SL1 TransSeptal sheath
  • Large curve Baylis needle
  • Baylis cable
  • Grounding pad

Wires:

  • .032 X 260 “J” wire
  • Amplatz SuperStiff 1cm Tip 260cm

Catheters:

  • 5F MPA2

Misc supplies:

  • 4fr. Pinnacle sheath for ACT (not needed if anesthesia has an A line.)
  • Micropuncture
  • 8F Sheath for dilator only
  • (1)Perclose
  • 0-prolene Suture for woggle
  • (2) 60cc syringe
  • Sterile towel pack for back table
  • Naked 3-port manifold to measure LA pressure only
  • Fluoro cover to anesthesia IV pole or moving xray shield
  • U/S probe cover
  • back table cover
  • Large and small bowl for back table

Standby

  • 20fr. DrySeal for recovering wire to LUPV
  • 8x40 135cm Mustang balloon
  • 12fr. Short Cook sheath

Procedure

  • Anesthesia will obtain radial art line prior to draping.
  • Pre procedure TEE imaging performed
  • Prior to prepping patient, place MitraClip Plate (plexiglass board – hinge side up) under patient’s leg off center to the right. Place PASCAL Lift (step stool) over patients right leg. Make sure there is direct contact between stool and plate.
  • Prep patient and drape per usual. Drape anesthesia pole and/or xray shield.
  • GUIDE and CLIP prepped by rep.
  • Obtain RFV access, dilate with 8F, preclose. .032 wire inserted into perclose.
  • SL1 introduced over .032 wire.
  • Baylis needle inserted and echo imaging performed. Transseptal puncture performed.
  • Baylis needle removed. .032wire inserted. Dilator removed
  • MPA advanced over the wire to pulmonary vein. LA pressure measured. Give MD Amplatz SuperStiff to shape.
  • Amplatz superStiff advanced.
  • MPA removed.
  • Setup stabilizer.
  • SL1 removed.
  • PASCAL Guide sheath inserted. Asperate 45ml of blood with a 60 cc syringes than flush with 45ml of hep saline.
  • Amplatz wire and dilator removed. Clip inserted.
  • Set up for subsequent clips if needed.
  • Vicryl used for groin closure.

BACK TABLE SETUP

Rep's will need (2) 60 mL syringes, (1) 10 mL syringe, a large and small bowl.

All equipment prepped by reps.

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