TMVI - Encircle Sapien M3: Difference between revisions
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{{Protip|Need Alcohol in lab for this procedure!}} | {{Protip|Need Alcohol in lab for this procedure!}} | ||
{{Warn|<BR>THIS IS A RESEARCH PROCEDURE. ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM.<BR> DO NOT THROW AWAY ANY BOXES.}} | {{Warn|<BR>THIS IS A RESEARCH PROCEDURE. ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM.<BR> DO NOT THROW AWAY ANY BOXES. DOCUMENTATION NOTES IN RESEARCH HELPER IN CUPID. }} | ||
{{Warn|If broadcasting case:<BR>DO NOT PUT PATIENT INFO INTO | {{Warn|If broadcasting case:<BR>DO NOT PUT PATIENT INFO INTO XRAY. PHI CANNOT BE STREAMED. <BR>CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE. PLEASE DO NOT SUBMIT CHARGES, ROSALIE WILL DO THEM. }} | ||
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| | | | ||
*General Anesthesia | *General Anesthesia | ||
*A-line | *A-line (per protocol) | ||
*Possible Swan | *Possible Swan | ||
| | | | ||
*Single plane fluoro | *Single plane fluoro | ||
*Rampart ? (depends on deployment angle) | |||
*100% contrast in ACIST | *100% contrast in ACIST | ||
*Naked manifold for possible RHC | |||
*TEE | *TEE | ||
| | | | ||
* RFV pre-closed x 1 | * 28 F RFV pre-closed x 1 | ||
| | | | ||
*Stabilizer placement prior to draping | *Stabilizer placement prior to draping: brought by rep, 80cm from mid-sternum | ||
|} | |} | ||
*Micropuncture set | ==Open:== | ||
===Sheaths:=== | |||
*Micropuncture set (for woggle with Daniels, or Access and Woggle for Spies) | |||
*8f Pinnacle | *8f Pinnacle | ||
===Wires:=== | |||
==Wires | |||
*(1) .035 150cm J wire | *(1) .035 150cm J wire | ||
*(1) .035 260cm J wire | *(1) .035 260cm J wire | ||
*(1) Safari Wire | *(1) Safari Wire | ||
* | ===Catheters:=== | ||
*6F Straight Pigtail | |||
===Pacing:=== | |||
'''Unipolar pacing setup''' | |||
* Alligator cables | |||
'''Bipolar on standby''' | |||
* Alligator Pacing Cable (open) | |||
*(1) | *5F Josephson Pacing Cable (Standby) | ||
*(1) | *EP Quad Cable (Standby) | ||
* | *Remington Pacing Cable (Standby) | ||
*8F 35cm BriteTip Sheath (Standby) | |||
===Misc:=== | |||
*Back table needs 5 bowls total. Use TAVR pack, and drop 2 extra small bowls. (3 of 0.9% Saline, 1 large bowl hep-saline, 1 contrast mix 15%) | |||
*(2) 60ml Syringe | |||
*(4) High Pressure stopcock | |||
*(1) 84" tubing to connect with pump off table (same as A-line anesthesia tubing) | |||
*3 port manifold (For a gradient at the end) | |||
*(1) Perclose (If Spies is primary, NO perclose if Daniles is primary.) | |||
*0-Prolene for woggle | |||
== | === * NEW - Baylis Transseptal source === | ||
* | * VersaCross system | ||
* | * Grounding pad | ||
= | === Bellow items on standby! === | ||
* | * SL1 sheath | ||
* | * Large curve Baylis needle | ||
* | * Baylis cable | ||
*( | * (1) 0.32 260 J-wire | ||
* 5F MPA | |||
* (1) Amplatz SS 260cm 1cm Tip | |||
= | ===Standby:=== | ||
*Baylis ProTrack wire | |||
*6F ballon wedge | |||
*2530 Edwards indeflator | |||
*14X4 Armada Balloon | |||
= | |||
* | |||
* | |||
* | |||
*14X4 Armada Balloon | |||
*PRESTO INDEFLATOR | *PRESTO INDEFLATOR | ||
*TORQUEVUE | *TORQUEVUE 45 DEGREE DELIVERY SYSTEM (9F OR 10F) | ||
*10MM, 14MM, 18MM SEPTAL OCCLUDER | *10MM, 14MM, 18MM SEPTAL OCCLUDER | ||
= | ==Nurse Notes:== | ||
== | |||
*ACIST- '''100% CONTRAST''' | *ACIST- '''100% CONTRAST''' | ||
* | *1L Hep Saline on PLUM IV pump set at: Pressure: 400 mmHg Rate: 400ml/hr - [[Alaris Pump Pressure|Click this link to see pressure adjustment process]] | ||
*Grounding pad | |||
*(2) | *Baylis machine | ||
* | *(2) Pacer Boxes | ||
*( | *Patient prepped from '''navel to knees''' in sterile fashion. | ||
*(1) Plum pump | |||
===MEDICATIONS=== | |||
*Bupivicaine/Lidocaine Mixed 10mL each | *Bupivicaine/Lidocaine Mixed 10mL each | ||
*Epinephrine 10mcg/mL in red syringe on back table | *Epinephrine 10mcg/mL in red syringe on back table | ||
= | == Back Table Set Up == | ||
* (3) bowls with 500 ml of NS | |||
* (1) large bowl with 1000 ml of hep saline | |||
* (4) HP stock cocks | |||
* (1) 84" tubing | |||
* (1) bowl with 15 ml of contrast (not 30!) | |||
* (2) 60 ml syringes | |||
* (1) 10 ml syringe | |||
* (1) forcep/kelly | |||
* (1) blade or scissor | |||
* (1) tegaderm (pop tart size) | |||
==PROCEDURE== | |||
*Access obtained with u/s | |||
*Need 20 and 60 cc flush on front table for the delivery system. | |||
*(Possible) 8F 35cm LFV for transcutaneous pacing | |||
*RFV Access | |||
*Dilate with 8F | |||
*Preclose | |||
*Versacross Sheath inserted | |||
*Versacross pigtail wire inserted | |||
*Transeptal puncture, pigtail wire advanced | |||
*Versacros sheath exchanged for 29F Delivery sheath over pigtail wire | |||
*Pigtail advanced across the mitral valve and LV gram @ 15/45 performed | |||
*Mitral annulus denoted on live monitor screen by Rep. | |||
*DDS prepped | |||
**1L Hep. Saline (2U/ml) bag with pressure bag spiked with heparin tubing, flushed, and attached to pump | |||
**Alaris settings 400ml/hr occlusion pressure limit 400mm Hg | |||
**Pressure tubing attached to stopcock and DDS | |||
*Dock Delivery System (DDS) advanced through GS | |||
*Dock deployed in a timely fashion ;) | |||
*DDS removed and Pigtail inserted over exchange J for valve crossing | |||
*J wire exchanged for Safari 2 | |||
*Pigtail and GS removed | |||
*Valve delivery system advanced | |||
*Valve deployed. Septum evaluated with echo for shunting and PVL. | |||
**remind MD to lower FIO2*** Delivery system removed and MPA inserted for LA pressure measurement. | |||
*(RHC performed with 6F swan to evaluate ASD) | |||
*Safari retained across septum until shunt is evaluated | |||
*All equipment removed | |||
*Preclosure closed and stitch to RFV, manual pressure LFV if accessed | |||
*Woggle vs Dermabond depending on Protamine | |||
==STANDBY EMERGENCY ECMO SUPPLIES== | |||
*16F Arterial Cannula | *16F Arterial Cannula | ||
*21F Venous Cannula | *21F Venous Cannula | ||
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*Amplatz SS 7cm tip | *Amplatz SS 7cm tip | ||
=STANDBY PERICARDIOCENTESIS SUPPLIES= | ==STANDBY PERICARDIOCENTESIS SUPPLIES== | ||
*EYE DRAPE | *EYE DRAPE | ||
*CHIBA NEEDLE 10CM 18G | *CHIBA NEEDLE 10CM 18G | ||
Line 135: | Line 161: | ||
*AMPLATZ SUPER STIFF 180CM | *AMPLATZ SUPER STIFF 180CM | ||
=STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES= | ==STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES== | ||
[[Paravalvular leak- Mitral|SEE MITRAL PARAVALVULAR LEAK REPAIR]] | |||
*AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE | *AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE | ||
<br /> | <br /> |
Latest revision as of 22:40, 27 August 2024
Protip: Need Alcohol in lab for this procedure!
Warning:
THIS IS A RESEARCH PROCEDURE. ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM.
DO NOT THROW AWAY ANY BOXES. DOCUMENTATION NOTES IN RESEARCH HELPER IN CUPID.
Warning: If broadcasting case:
DO NOT PUT PATIENT INFO INTO XRAY. PHI CANNOT BE STREAMED.
CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE. PLEASE DO NOT SUBMIT CHARGES, ROSALIE WILL DO THEM.
Sapien M3 | |||||
---|---|---|---|---|---|
Anesthesia | Imaging | Access | Pre-Procedure | ||
|
|
|
|
Open:
Sheaths:
- Micropuncture set (for woggle with Daniels, or Access and Woggle for Spies)
- 8f Pinnacle
Wires:
- (1) .035 150cm J wire
- (1) .035 260cm J wire
- (1) Safari Wire
Catheters:
- 6F Straight Pigtail
Pacing:
Unipolar pacing setup
- Alligator cables
Bipolar on standby
- Alligator Pacing Cable (open)
- 5F Josephson Pacing Cable (Standby)
- EP Quad Cable (Standby)
- Remington Pacing Cable (Standby)
- 8F 35cm BriteTip Sheath (Standby)
Misc:
- Back table needs 5 bowls total. Use TAVR pack, and drop 2 extra small bowls. (3 of 0.9% Saline, 1 large bowl hep-saline, 1 contrast mix 15%)
- (2) 60ml Syringe
- (4) High Pressure stopcock
- (1) 84" tubing to connect with pump off table (same as A-line anesthesia tubing)
- 3 port manifold (For a gradient at the end)
- (1) Perclose (If Spies is primary, NO perclose if Daniles is primary.)
- 0-Prolene for woggle
* NEW - Baylis Transseptal source
- VersaCross system
- Grounding pad
Bellow items on standby!
- SL1 sheath
- Large curve Baylis needle
- Baylis cable
- (1) 0.32 260 J-wire
- 5F MPA
- (1) Amplatz SS 260cm 1cm Tip
Standby:
- Baylis ProTrack wire
- 6F ballon wedge
- 2530 Edwards indeflator
- 14X4 Armada Balloon
- PRESTO INDEFLATOR
- TORQUEVUE 45 DEGREE DELIVERY SYSTEM (9F OR 10F)
- 10MM, 14MM, 18MM SEPTAL OCCLUDER
Nurse Notes:
- ACIST- 100% CONTRAST
- 1L Hep Saline on PLUM IV pump set at: Pressure: 400 mmHg Rate: 400ml/hr - Click this link to see pressure adjustment process
- Grounding pad
- Baylis machine
- (2) Pacer Boxes
- Patient prepped from navel to knees in sterile fashion.
- (1) Plum pump
MEDICATIONS
- Bupivicaine/Lidocaine Mixed 10mL each
- Epinephrine 10mcg/mL in red syringe on back table
Back Table Set Up
- (3) bowls with 500 ml of NS
- (1) large bowl with 1000 ml of hep saline
- (4) HP stock cocks
- (1) 84" tubing
- (1) bowl with 15 ml of contrast (not 30!)
- (2) 60 ml syringes
- (1) 10 ml syringe
- (1) forcep/kelly
- (1) blade or scissor
- (1) tegaderm (pop tart size)
PROCEDURE
- Access obtained with u/s
- Need 20 and 60 cc flush on front table for the delivery system.
- (Possible) 8F 35cm LFV for transcutaneous pacing
- RFV Access
- Dilate with 8F
- Preclose
- Versacross Sheath inserted
- Versacross pigtail wire inserted
- Transeptal puncture, pigtail wire advanced
- Versacros sheath exchanged for 29F Delivery sheath over pigtail wire
- Pigtail advanced across the mitral valve and LV gram @ 15/45 performed
- Mitral annulus denoted on live monitor screen by Rep.
- DDS prepped
- 1L Hep. Saline (2U/ml) bag with pressure bag spiked with heparin tubing, flushed, and attached to pump
- Alaris settings 400ml/hr occlusion pressure limit 400mm Hg
- Pressure tubing attached to stopcock and DDS
- Dock Delivery System (DDS) advanced through GS
- Dock deployed in a timely fashion ;)
- DDS removed and Pigtail inserted over exchange J for valve crossing
- J wire exchanged for Safari 2
- Pigtail and GS removed
- Valve delivery system advanced
- Valve deployed. Septum evaluated with echo for shunting and PVL.
- remind MD to lower FIO2*** Delivery system removed and MPA inserted for LA pressure measurement.
- (RHC performed with 6F swan to evaluate ASD)
- Safari retained across septum until shunt is evaluated
- All equipment removed
- Preclosure closed and stitch to RFV, manual pressure LFV if accessed
- Woggle vs Dermabond depending on Protamine
STANDBY EMERGENCY ECMO SUPPLIES
- 16F Arterial Cannula
- 21F Venous Cannula
- (2) Perclose
- ECMO Instrument Tray
- Amplatz SS 7cm tip
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
STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES
SEE MITRAL PARAVALVULAR LEAK REPAIR
- AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE
APPROVED: MD initials MM/YY