David Daniels M.D.

Glove size	7 *CHECK DD's PROCEDURAL PLAN IN H&P FOR SUPPLIES
Access	U/s and micropuncture
Radial Setup	4/5 angiocath dx only 5/6 angiocath pci Tig4 260J
Radial Cocktail	200 mcg NTG 2.5mg Verapamil 60u/kg Heparin
Groin Setup	6fr sheath 5FR. JL4 / JR4
Closure Device	Perclose
Right Heart Setup	Manifold 6fr wedge cath 5/6 slender angiocath .035 wire RN to put brachial IV in Biopsy - Jaws ALWAYS
Intervention Setup
Phone Number	1-415-385-9243
Pager Number

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Notes:

LHC for Renal Transplant

See Pre-Kidney Heart Cath

• Femoral access
• U/S probe cover
• Micropuncture
• 6frx10cm Pinnacle sheath
• 6fr. JL4 guide
• 6fr. JR4 guide
• Runthrough
• Co-Pilot
• Wire introducer
• .035x150 J
• Perclose
• ACIST setup
• Biplane

Protip: Make sure arms and armboards are tucked-in as much as possible!

Sequence

1. Access with Micropuncture and U/s.
2. JL4 - trade out J-wire for Runthrough.
3. Isocenter
4. He will use Runthrough to confirm engagement.
5. 4 for 6 on the ACIST, once he fills the guide note the contrast count. This is zero.
6. Biplane to RAO/Cranial and LAO/Caudal
7. Take the shot
8. Exchange L4 for R4
9. 2 for 3 on the ACIST
10. Same as Left for engagement and contrast.
11. Perclose

CTO

• Preclose
• 8fr. x 45 Brite Tip sheath
• Assume bilateral groins
• ACIST and 3-port manifold
• Watchdogs

• Retrograde channel on McKesson in red.
• Left groin will have retrograde guide.
• Right groin will have antegrade guide

FFR

• Adenosine IC 10 mcg/ml concentration

Post Heart Transplant LHC/IVUS with DD

• 4/5 Glide Sheath
• 5F JR4 Diagnostic
• 5F EBU3.5
• Runthrough
• IVUS

R/L Heart for AS no Langston

• Micropuncture
• 7F 70cm Shuttle Sheath or Ansel 70cm
• 5F angled pigtail
• 6F 10cm pinnacle
• 2x manifold transducers
  • Dr. is OK with using a manifold for the case, no ACIST necessary
• 6fr. PA catheter
• 5F JL4/JR4
• Short straight stiff glidewire for valve crossing
• 5fr AL1
• Exchange length J wire

Radial with Eaucath

• Eaucath
• His blue angiocath
• Micropuncture set
• 260 J-wire

Sequence

1. Access with angiocath
2. MP wire
3. MP sheath
4. Radial drugs
5. 260J-wire
6. Eaucath

R/L Heart for AS with Langston

• 2x 5/6 slender radial sheaths with angiocath
  • (Santa Rosa)1 7 Fr slender radial sheath with angiocath, 1 6 Fr Prelude sheath with stiff micropuncture set
• 2x manifold transducers
  • Dr. is OK with using a manifold for the case, no ACIST necessary
• 6fr. PA catheter
• 5fr. Tig
• 7fr. Langston catheter
• Short straight stiff glidewire
• 5fr AL1
• Exchange length J wire

Sequence

1. Access ultrasound guided vein
2. Standard Radial access
3. PA catheter for pressures
4. Tig for cors
5. Exchange over long wire Tig for AL1
6. J out for Glidewire
7. Cross valve
8. Exchange over long wire AL1 for Langston
9. Use standard transducers for accuracy, do not use ACIST

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