Impella: Difference between revisions
From Bay Area Structural Heart Wiki
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{{Note|Change location of supplies to Cath Lab 1!}} | {{Note|Change location of supplies to Cath Lab 1!}} | ||
===Equipment=== | ===Equipment=== | ||
===Open=== | |||
*Pack | *Pack | ||
*Cath Lab to-go cart | *Cath Lab to-go cart | ||
*ECMO cart | *ECMO cart | ||
*.025 exchange - if removing IABP | |||
*Perclose - if removing IABP/ECMO | |||
*500ml bag heparinized saline | |||
*D5W 1000ml (with 12,500 U of heparin and/or bicarb, confirm with surgeon) | |||
====Standby=== | |||
*JR4 | *JR4 | ||
*6F *Cordis* Angled Pigtail | *6F *Cordis* Angled Pigtail | ||
Line 33: | Line 38: | ||
*.035 exchange | *.035 exchange | ||
*Straight stiff glide | *Straight stiff glide | ||
Sheridan - | Sheridan - | ||
Revision as of 20:24, 12 August 2024
Note: Good article on Single access and sheaths: Impella Single Access
Daniels single access Impella/PCI
Equipment
- 7F Destination
- 2 Percloses
- Micropuncture
- 18G Cook need to stick Impella diaphragm for Destination advancement
Hui single access Impella - DRAFT
Double stick Impella sheath
Equipment
- Micropuncture
- 6/7 Short slender sheath
- 7fr. Guide
Hybrid OR 5.5 Impella via Subclavian conduit
Note: Change location of supplies to Cath Lab 1!
Equipment
Open
- Pack
- Cath Lab to-go cart
- ECMO cart
- .025 exchange - if removing IABP
- Perclose - if removing IABP/ECMO
- 500ml bag heparinized saline
- D5W 1000ml (with 12,500 U of heparin and/or bicarb, confirm with surgeon)
=Standby
- JR4
- 6F *Cordis* Angled Pigtail
- AL1
- .035 exchange
- Straight stiff glide
Sheridan -
- 6F Angled Pig
- 6F 260 J
Spies -
- 6F JR4 with .035 J
Romick -
- 6F JR4 with .035 J
- Pigtail with .035 J
Daniels -
- AL1 with .035 J
- AL1 with Straight Stiff Glide
Room Setup and Procedure
- Enter an order for CCL in EPIC
- Open x-ray and McKesson using entered order.
- DO NOT CHARGE FOR THE PROCEDURE. This is OR's procedure.
- CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!
- Free-Text note that McKesson is open for billing and equipment only, not procedural charting. See Anesthesia and OR nurses notes.
- Put input 4in1 B on V-integration 2 for TTE on the fluoro screen.
- Always prep for femoral access in the event of emergent ECMO.
- Place drape over legs after surgical draping to cover abdomen.
- Put OR light camera in place to see the surgical site to monitor progress from control room.
- Ask OR for 1 pack Ray-Tec sponges for wipes.
- Do the thing (Insert 5.0 Impella)
- Pass off sheath and clamps to surgeon. Once sheath is inserted in the conduit, JR4 and J wire advanced for valve crossing. IMPELLA wire retained in LV. Impella advanced under fluoro and echo guidance. Save image. Surgeon/ Interventionist discuss whether to removed additional support or leave in place. Surgeon closes.
- Remove the other thing (ECMO / Balloon pump / Impella)
- Document times and doses in McKesson and log book.
- Reminder::: CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!
- Close x-ray and archive to EMIM_CATH
- Capture charges for McKesson
- Print device usage.
- Sticker goes in room 14 log book for tracking OR lab 1 log book, NEVER both.
Axillary Impella/IABP - DRAFT
If left subclavian is occluded or otherwise inaccessible procedure is aborted. IABP should not be inserted through right subclavian per CT surgery.
Equipment
- Micropuncture
- Probe Cover
- 4/5F slender radial sheath
- Amplatz extra stiff 260cm wire (on standby for Spies)
- .035 150cm J wire
- 5Fr pigtail catheter
- 5Fr JR4 diagnostic catheter (on standby for Spies)
- IABP kit
- 8Fr 23cm safesheath (ep)(Romick) / 8fr x 23 brite-tip sheath (Spies)
- Perclose
- TR band
- Biopatch
- 0-Ethibond suture
- Tournaquick (carrot top)
- 3 Port Manifold
Procedure
- Prep left side neck and chest (ear to nipple and shoulder to midline).
- Note: The access site is not an absolute (may become axillary or subclavicular) hence the large site prep.
- Prep left radial.
- Left radial accessed and 4/5f slender sheath inserted.
- Pigtail advanced and angiogram performed. Pigtail left in place and used as reference for subclavian access.
- Subclavian accessed with ultrasound and fluoro guidance using micropuncture kit and radial sheath inserted.
- Pigtail catheter removed.
- J wire and JR4 inserted and directed to descending aorta if unable to be directed to abdominal aorta
- Catheter and sheath removed, 8f dilator inserted, and perclose advanced for pre-closure.
- Amplatz wire advanced, perclose removed, 8f sheath advanced.
- IABP inserted.
- Sheath peeled away. (Romick)
- IABP secured with suture and site dressed.
- Radial sheath removed and TR band applied.