Intrepid valve: Difference between revisions

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{{Note|CALL MILENA AS SOON AS PATIENT IS IN THE ROOM!! 415-368-3094}}</BR>[[File:Intrepid_supply_list.pdf|thumb|page=1|right|Supply list from Medtronic]]
 
[[File:IntrepidTable1.jpg|thumb|150px|right|Intrepid table Setup]]
 
[[File:IntrepidTable2.jpg|thumb|150px|right|Intrepid table Setup]]
 
[[File:IntrepidTable3.jpg|thumb|150px|right|Intrepid table Setup]]
__NOINDEX__
===Setup Notes===
*Reps prep - ~ 1 hour!
*Reps prep - ~ 1 hour!
**6 liters cold saline
**6 liters cold saline
**Pressure bags x2 for device drips
**Pressure bags x2 for device drips
**Open ECMO tray for reps
**Open 1 extra pickups (suture removal kit)
**Mitra-clip plate and stool
**Mitra-clip plate and stool provided by reps
 
*Use Coban to attach long table to short table end-to-end to make extra long table(drape first).
*Surgical access
*Surgical access
**Neptune and Bovie
**Neptune and Bovie
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*A/V access on opposite side  
*A/V access on opposite side  
*Monopolar pacing in LV via arterial access with epicardial stitch in groin
*Monopolar pacing in LV via arterial access with Safari and apical pacing patch
*Stool edge is 100cm from mid-sternum
 
===Open===
*TAVR pack
*Back table cover
*6fr. Pinnacle
*8fr. Pinnacle
*Micropuncture
*0.035x150 J-wire
*5fr. JR4 diagnostic catheter
*Lunderquist J-wire 260cm
*Watchdog (10/6/22 DD tested RV pacing, may not need don't drop)
*Alligator clip pacing cable (Black clip stays on table; pass off red and plug to circ.)
*Perclose
*2 Roto-tubing(for back table)
*2 60ml syringes (for back table)
*2 20ml syringes (for back table)
*Acist setup with 100% contrast for RV or LV gram
 
===Procedure===
#Surgical cutdown to RFV
#LFA access with micropuncture -> 6fr. Sheath
#18 gauge entry needle access -> 8fr. Sheath to RFV
#Maybe Pigtail advanced for RV-gram (Reference image. Lunderquist advanced thru pigtail if used.)
#150 J loaded in JR4 inserted
#J-wire removed for Lunderquist
#Intrepid sheath inserted over Lunderquist
#Manipulate valve to pre-deployment position
#150J loaded in JR4 -> LFA to cross Aortic valve
#J-wire out for Safari
#Safari positioned in LV and alligator clip attached (black to back)
#Pacing threshold tested
#Final positioning of valve and deployed while pacing.
#Safari and JR4 removed
#Intrepid sheath removed and surgically closed
#Perclose to LFA
 
 
[[Category:Procedures]]

Latest revision as of 19:36, 19 January 2024

Note Note: CALL MILENA AS SOON AS PATIENT IS IN THE ROOM!! 415-368-3094
File:Intrepid supply list.pdf

Intrepid table Setup
Intrepid table Setup
Intrepid table Setup

Setup Notes

  • Reps prep - ~ 1 hour!
    • 6 liters cold saline
    • Pressure bags x2 for device drips
    • Open 1 extra pickups (suture removal kit)
    • Mitra-clip plate and stool provided by reps
  • Use Coban to attach long table to short table end-to-end to make extra long table(drape first).
  • Surgical access
    • Neptune and Bovie
    • OR setup like carotid
    • Cut-down with plegeted purse-string
  • A/V access on opposite side
  • Monopolar pacing in LV via arterial access with Safari and apical pacing patch
  • Stool edge is 100cm from mid-sternum

Open

  • TAVR pack
  • Back table cover
  • 6fr. Pinnacle
  • 8fr. Pinnacle
  • Micropuncture
  • 0.035x150 J-wire
  • 5fr. JR4 diagnostic catheter
  • Lunderquist J-wire 260cm
  • Watchdog (10/6/22 DD tested RV pacing, may not need don't drop)
  • Alligator clip pacing cable (Black clip stays on table; pass off red and plug to circ.)
  • Perclose
  • 2 Roto-tubing(for back table)
  • 2 60ml syringes (for back table)
  • 2 20ml syringes (for back table)
  • Acist setup with 100% contrast for RV or LV gram

Procedure

  1. Surgical cutdown to RFV
  2. LFA access with micropuncture -> 6fr. Sheath
  3. 18 gauge entry needle access -> 8fr. Sheath to RFV
  4. Maybe Pigtail advanced for RV-gram (Reference image. Lunderquist advanced thru pigtail if used.)
  5. 150 J loaded in JR4 inserted
  6. J-wire removed for Lunderquist
  7. Intrepid sheath inserted over Lunderquist
  8. Manipulate valve to pre-deployment position
  9. 150J loaded in JR4 -> LFA to cross Aortic valve
  10. J-wire out for Safari
  11. Safari positioned in LV and alligator clip attached (black to back)
  12. Pacing threshold tested
  13. Final positioning of valve and deployed while pacing.
  14. Safari and JR4 removed
  15. Intrepid sheath removed and surgically closed
  16. Perclose to LFA
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