TEER with PASCAL: Difference between revisions
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!Anethesia | |||
!Imaging | |||
!Access | |||
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|General | |||
|Fluoro, TEE | |||
|4F Femoral Vein for drawing ACT's | |||
<nowiki>**</nowiki>If functional MR/low EF Anesthesia to obtain A line and femoral venous sheath not needed | |||
|- | |||
! 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 | ||
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*Grounding pad | *Grounding pad | ||
{{Note| When using the Philips 4D ICE probe use a 10F sheath for ACT draws. }} | {{Note| When using the Philips 4D ICE probe use a 10F 30 cm (from EP) sheath for ACT draws. }} | ||
===Wires:=== | ===Wires:=== | ||
*.032 X 260 “J” wire | *.032 X 260 “J” wire | ||
Revision as of 19:02, 23 January 2023
| Anethesia | Imaging | Access |
|---|---|---|
| General | Fluoro, TEE | 4F Femoral Vein for drawing ACT's
**If functional MR/low EF Anesthesia to obtain A line and femoral venous sheath not needed |
| Pre-Procedure Watchouts | ||
| ** Tidal Volume during time-out! | ||
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
Note: When using the Philips 4D ICE probe use a 10F 30 cm (from EP) sheath for ACT draws.
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.
