TMVI: Difference between revisions

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{{Protip|Need Alcohol in lab for this procedure!}}
 
'''TransCatheter Mitral Valve Repair/Replacement'''
'''TransCatheter Mitral Valve Repair/Replacement'''


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#Use the barcode on Mckesson screen in Lab 1 – Mitraclip (Abbott) bundle consists of (1) Steerable Guide Catheter, (2) NTR Clip Delivery System & (1) XTR Clip Delivery System.
#Use the barcode on Mckesson screen in Lab 1 – Mitraclip (Abbott) bundle consists of (1) Steerable Guide Catheter, (2) NTR Clip Delivery System & (1) XTR Clip Delivery System.
{| class="wikitable"
|+
! colspan="4" |TMVR
|-
!Anesthesia
!Imaging
!Access
!Pre-Procedure
|-
|
* General Anesthesia


* A-Line Always!
|
* Single Plane Fluoro


'''GENERAL ANESTHESIA AND TEE IMAGING, RADIAL ART LINE BY ANESTHESIA'''
* TEE


'''ACCESS 2 FEMORAL VEINS (TAVR AND PACER)'''
* No Acist
* Unipolar pacing
|


'''PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN'''
* RVF pre-closed x 1
 
|
==SHEATHS:==
* Type and Cross


* Aspirin Given
|}
==Open:==
===SHEATHS:===
*Micropuncture
*Micropuncture
*8fr Pinnacle for Perclose
*8fr Pinnacle for Perclose
*8x35 Brite tip
*Perclose (If Spies is primary, NO perclose if Daniles is primary.)
*8.5 SL1
*8. 5F Agilis
*8.5 Tourguide
*16F E sheath, '''always''', regardless of valve size.
==WIRES:==
 
===Open===


=== WIRES: ===
*150 J wire
*150 J wire
*.'''032''' x 260 J-wire
*Safari 2
*Safari 2
*Amplatz Super Stiff 1cm tip


==CATHETERS==
===* NEW - Baylis Transseptal===
 
* VersaCross system
* Grounding pad
 
===Bellow items on standby!===*SL1 sheath
* Large curve Baylis needle
*Baylis cable
*0.32 x 260 J-wire
=== MISC: ===
*Naked 3 Port Manifold
*Alligator pacing cable


===Open===
=== CATHETERS: ===


*6fr. Straight Pig
*6fr. Straight Pig
*5fr. MPA2
==PACING==


=== SEPTAL DILATION: ===
*12X4X75 MUSTANG '''for 23mm and 26mm Sapien OR''' 14mm Armada '''for 29mm Sapien'''
*PRESTO INDEFLATOR
===BIPOLAR PACING ON STANDBY:===
*8x35 Brite tip
*5F Josephson Pacing Cable
*5F Josephson Pacing Cable
*EP Quad Cable
*EP Quad Cable
*Remington Pacing Cable
*Remington Pacing Cable
*(2) Pacer Boxes
*(2) Pacer Boxes
 
===FOR EDWARDS VALVE:===
==VALVE TABLE==
*Indeflator (Second Indeflator on standby)
 
*Crimper
*(4) STERILE BOWLS (2- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
*E-sheath (Second E-Sheath on standby)
*(1) 90 INCH DRAPE (OR)
*Delivery system (Second delivery on standby)
*1L NORMAL SALINE IRRIGATION
*Valve
*500ML HEPARINIZED SALINE
==Standby==
*(1) 60ML SYRINGE
*(1) HIGH PRESSURE STOPCOCK
*(1) 20ML SYRINGE
*30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION)
 
==FOR EDWARDS VALVE==
 
*INDEFLATOR
*CRIMPER
*E SHEATH
*DELIVERY SYSTEM
*VALVE
 
==TRANS SEPTAL==
 
*BAYLIS NEEDLE LARGE CURVE C1
*BAYLIS MACHINE
*BAYLIS CABLE
*GROUNDING PAD
 
==SEPTAL DILATION==
 
===Open===
 
*12X4X75 MUSTANG '''OR''' 14X4 XXL (Ask before opening)
*PRESTO INDEFLATOR
 
===Standby===
 
*9X4X75 MUSTANG
*9X4X75 MUSTANG
*14, 16 XXL Balloons
*14, 16 XXL Balloons
Line 90: Line 92:
*10MM, 14MM, 18MM SEPTAL OCCLUDER
*10MM, 14MM, 18MM SEPTAL OCCLUDER


==ADDITIONAL SUPPLIES==
==MEDICATIONS==


===Open===
*BUPIVACAINE
*EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
*ROTAGLIDE 10ML (EDWARDS VALVE)


*2xPERCLOSE
==PROCEDURE:==
*3 PORT MANIFOLD - No contrast
*PROBE COVER
*PROLENE 2-0
*FLUORO DRAPE
*CHLORAPREP AND PREP TRAY


===Standby===
*Patient prepped from '''navel to knees''' in sterile fashion.  
*Access obtained with u/s
*Dilate with 8F dilator
*Preclose, Versacross pigtail wire advanced through perclose
*Versacross sheath inserted
*Transeptal puncture, then pigtail wire advanced
*Versacross sheath removed
*Agilis advanced and directed to mitral valve.
*Pigtail and Safari2 inserted through Agilis for valve crossing.
*Safari2 wire inserted to ventricle. Simultaneous LA/LV pressure recorded.
*Pigtail and Agilis removed.
*12mm/14mm balloon advanced for septostomy and possible BAV
*Balloon removed, valve delivery system advanced.
*When valve is in place, black alligator cable attached and pacing tested.
*Valve deployed. Septum evaluated with echo for shunting.
*Delivery removed and SL1 re-advanced.
*Pigtail advanced to LV, wire removed and simultaneous LA/LV pressures recorded (maybe).
*Pigtail and SL1 removed.
*Pacer removed.
*Preclosure completed and stitch to RFV
*Dermabond access site, no dressings needed.


*150ML CONTRAST (FOR CORONARIES)
*BIOPATCH
*8F ANGIOSEAL
*0 SILK SUTURE
*EXTRA PERCLOSE


==MEDICATIONS==
== STANDBY EMERGENCY ECMO SUPPLIES ==


*BUPIVACAINE
* 16F ARTERIAL CANNULA
*EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
*ROTAGLIDE 10ML (EDWARDS VALVE)


==STANDBY EMERGENCY ECMO SUPPLIES==
*16F ARTERIAL CANNULA
*21F VENOUS CANNULA
*21F VENOUS CANNULA
*(2) PERCLOSE
*(2) PERCLOSE
Line 132: Line 141:
*STOPCOCK
*STOPCOCK
*AMPLATZ SUPER STIFF 180CM
*AMPLATZ SUPER STIFF 180CM
==PROCEDURE:==
*Patient prepped from '''navel to knees''' in sterile fashion.  
*Access obtained with u/s
Typical sites:
***14F OR 16F RFV E-sheath for valve delivery
****Dilate with 8F
****Preclose
*SL1 inserted over .032 260cm J
*Baylis needle inserted through SL1 and atrial septum puncture performed.
*Needle removed, .032 wire advanced to pulmonary vein
*Agilis advanced and directed to mitral valve
*Pigtail inserted through agilis for valve crossing.
*Safari2 wire inserted to ventricle.
*Pigtail and agilis removed.
*12mm/14mm balloon advanced for septostomy and possible BAV
*Balloon removed, valve delivery system advanced.
*When valve is in place, temp pacer inserted and tested.
*Valve deployed. Septum evaluated with echo for shunting.
*Pacer removed. Delivery system removed.
*Preclosure closed and stitch to RFV
*8F vein pulled and manual pressure applied
*Tegaderm both sides.


<br>
<br>

Latest revision as of 22:13, 9 May 2024

Note Warning: This page needs revision!
Note Protip: Need Alcohol in lab for this procedure!

TransCatheter Mitral Valve Repair/Replacement

Per Rosalie:

TAVR/TMVI

  1. Edwards Sapien 3 Ultra (20, 23 & 26mm) and Sapien 3 (29mm) – scan the valve barcode (box) in McKesson for documentation and charges.  Bundle includes valve, delivery system, crimper, e sheath intro set, balloon cath & locking syringe.  With the new inventory system (POU) space is limited in entering item full description.   If pre dilatation Edwards balloon is necessary free text the balloon used in procedure notes (McKesson).
  2. Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).

MITRAL CLIP (Mitral/Tricuspid):

  1. Use the barcode on Mckesson screen in Lab 1 – Mitraclip (Abbott) bundle consists of (1) Steerable Guide Catheter, (2) NTR Clip Delivery System & (1) XTR Clip Delivery System.
TMVR
Anesthesia Imaging Access Pre-Procedure
  • General Anesthesia
  • A-Line Always!
  • Single Plane Fluoro
  • TEE
  • No Acist
  • Unipolar pacing
  • RVF pre-closed x 1
  • Type and Cross
  • Aspirin Given

Open:

SHEATHS:

  • Micropuncture
  • 8fr Pinnacle for Perclose
  • Perclose (If Spies is primary, NO perclose if Daniles is primary.)
  • 8. 5F Agilis
  • 16F E sheath, always, regardless of valve size.

WIRES:

  • 150 J wire
  • Safari 2

* NEW - Baylis Transseptal

  • VersaCross system
  • Grounding pad

===Bellow items on standby!===*SL1 sheath

  • Large curve Baylis needle
  • Baylis cable
  • 0.32 x 260 J-wire

MISC:

  • Naked 3 Port Manifold
  • Alligator pacing cable

CATHETERS:

  • 6fr. Straight Pig

SEPTAL DILATION:

  • 12X4X75 MUSTANG for 23mm and 26mm Sapien OR 14mm Armada for 29mm Sapien
  • PRESTO INDEFLATOR

BIPOLAR PACING ON STANDBY:

  • 8x35 Brite tip
  • 5F Josephson Pacing Cable
  • EP Quad Cable
  • Remington Pacing Cable
  • (2) Pacer Boxes

FOR EDWARDS VALVE:

  • Indeflator (Second Indeflator on standby)
  • Crimper
  • E-sheath (Second E-Sheath on standby)
  • Delivery system (Second delivery on standby)
  • Valve

Standby

  • 9X4X75 MUSTANG
  • 14, 16 XXL Balloons
  • TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
  • 10MM, 14MM, 18MM SEPTAL OCCLUDER

MEDICATIONS

  • BUPIVACAINE
  • EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
  • ROTAGLIDE 10ML (EDWARDS VALVE)

PROCEDURE:

  • Patient prepped from navel to knees in sterile fashion.  
  • Access obtained with u/s
  • Dilate with 8F dilator
  • Preclose, Versacross pigtail wire advanced through perclose
  • Versacross sheath inserted
  • Transeptal puncture, then pigtail wire advanced
  • Versacross sheath removed
  • Agilis advanced and directed to mitral valve.
  • Pigtail and Safari2 inserted through Agilis for valve crossing.
  • Safari2 wire inserted to ventricle. Simultaneous LA/LV pressure recorded.
  • Pigtail and Agilis removed.
  • 12mm/14mm balloon advanced for septostomy and possible BAV
  • Balloon removed, valve delivery system advanced.
  • When valve is in place, black alligator cable attached and pacing tested.
  • Valve deployed. Septum evaluated with echo for shunting.
  • Delivery removed and SL1 re-advanced.
  • Pigtail advanced to LV, wire removed and simultaneous LA/LV pressures recorded (maybe).
  • Pigtail and SL1 removed.
  • Pacer removed.
  • Preclosure completed and stitch to RFV
  • Dermabond access site, no dressings needed.


STANDBY EMERGENCY ECMO SUPPLIES

  • 16F ARTERIAL CANNULA
  • 21F VENOUS CANNULA
  • (2) PERCLOSE
  • ECMO INSTRUMENT TRAY
  • AMPLATZ SUPER STIFF

STANDBY PERICARDIOCENTESIS SUPPLIES

  • EYE DRAPE
  • CHIBA NEEDLE 10CM 18G
  • SKATER INTRODUCER SET
  • BARD LOCKING PIGTAIL 6F OR 8F
  • (3) 60ML SYRINGES
  • STOPCOCK
  • AMPLATZ SUPER STIFF 180CM


APPROVED: MD initials MM/YY

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