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 MCKESSON OR XRAY. PHI CANNOT BE STREAMED. <BR>CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE.}}
{{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
* LFV for Pacer
|
|
*Stabilizer placement prior to draping: 69cm from mid-sternum
*Stabilizer placement prior to draping: brought by rep, 80cm from mid-sternum
|}
|}






===Open:===
==Open:==
*Micropuncture set
===Sheaths:===
*Micropuncture set (for woggle with Daniels, or Access and Woggle for Spies)
*8f Pinnacle
*8f Pinnacle
*8fr x 35cm Brite-Tip
===Wires:===
*8.5fr SL1 transseptal sheath
*22F coons dilator (or larger if we have it)
*(1) .035 150cm J wire
*(1) .035 150cm J wire
*(1) .035 260cm J wire
*(1) .035 260cm J wire
*(1) .032 260cm J wire
*(1) Safari Wire
*(1) Safari Wire
*(1) Amplatz SS 260cm 1cm Tip
===Catheters:===
*(1) 6F Straight Pigtail  
*6F Straight Pigtail
*5F MPA1 125
===Pacing:===
*5F Josephson Pacing Cable
'''Unipolar pacing setup'''
*EP Quad Cable
 
*Remington Pacing Cable
* Alligator cables
*Extra Sterile Bowl (3- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
 
*1.5L Normal Saline
'''Bipolar on standby'''
*500ml Heparinized Saline
 
*(3) 60ml Syringe
* Alligator Pacing Cable (open)
*(3) 20ml Syringe
 
*(2) High Pressure stopcock
*5F Josephson Pacing Cable (Standby)
*Baylis needle
*EP Quad Cable (Standby)
*Baylis cable
*Remington Pacing Cable (Standby)
*(1) Heparin tubing (updated with new device)
*8F 35cm BriteTip Sheath (Standby)
*(1) 72” pressure tubing (updated with new device)
===Misc:===
*Extra manifold (For a gradient at the end)
*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%)
*Perclose  
*(2) 60ml Syringe
*(3-4) 20ml syringes for flush (For DDS and sheath)
*(4) High Pressure stopcock
*0-Prolene
*(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:===
===Standby:===
Line 74: Line 90:
==Nurse Notes:==
==Nurse Notes:==
*ACIST- '''100% CONTRAST'''
*ACIST- '''100% CONTRAST'''
*1L Hep Saline on Alaris IV pump set at: Pressure: 400 mmHg Rate: 400ml/hr - [[Alaris Pump Pressure|Click this link to see pressure adjustment process]]
*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
*Grounding pad
*BAYLIS MACHINE
*Baylis machine
*(2) Pacer Boxes
*(2) Pacer Boxes
*Patient prepped from '''navel to knees''' in sterile fashion.  
*Patient prepped from '''navel to knees''' in sterile fashion.  
*(1) Alaris pump (updated with new device)
*(1) Plum pump


===MEDICATIONS===
===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
*Rotaglide 10mL for sheath before valve is inserted


==STANDBY EMERGENCY ECMO SUPPLIES==
== Back Table Set Up ==
*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==
* (3) bowls with 500 ml of NS
[[Paravalvular leak- Mitral|SEE MITRAL PARAVALVULAR LEAK REPAIR]]
* (1) large bowl with 1000 ml of hep saline
*AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE
* (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==
==PROCEDURE==
*Access obtained with u/s
*Access obtained with u/s
*Need 20 and 60 cc flush on front table for the delivery system.  
*Need 20 and 60 cc flush on front table for the delivery system.
*8F 35cm LFV for transcutaneous pacing
*(Possible) 8F 35cm LFV for transcutaneous pacing
*RFV
*RFV Access
*Dilate with 8F
*Dilate with 8F
*Preclose
*Preclose
*SL1 inserted over .032x260 wire
*Versacross Sheath inserted
*Baylis needle inserted through SL1 and atrial septum puncture performed.
*Versacross pigtail wire inserted
*Needle removed
*Transeptal puncture, pigtail wire advanced
*5F MPA advanced over .032 wire
*Versacros sheath exchanged for 29F Delivery sheath over pigtail wire
*1cm Amplatz Super Stiff advanced and MPA and SL1 removed
*Pigtail advanced across the mitral valve and LV gram @ 15/45 performed
*23fr. Delivery sheath(GS) - Used for Doc and valve advanced
*Mitral annulus denoted on live monitor screen by Rep.
*Pigtail advanced across the mitral valve and LVgram @ 15/45 performed
*Mitral annulus denoted on live monitor screen in A plane
*DDS prepped
*DDS prepped
**1L Hep. Saline (2U/ml) bag with pressure bag spiked with heparin tubing, flushed, and attached to pump
**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
**Alaris settings 400ml/hr occlusion pressure limit 400mm Hg
**Pressure tubing attached to stopcock and DDS
**Pressure tubing attached to stopcock and DDS
**Swiftlink cover installed over pressure tubing and secured ~18” from off-table end
**After hookup and flush, Swiftlink cover can be slid over heparin tubing for additional slack on the table.
*Dock Delivery System (DDS) advanced through GS
*Dock Delivery System (DDS) advanced through GS
*Dock deployed in a timely fashion ;)
*Dock deployed in a timely fashion ;)
*Temp pacer inserted and tested.
*DDS removed and Pigtail inserted over exchange  J for valve crossing
*DDS removed and Pigtail inserted over exchange  J for valve crossing
*J wire exchanged for Safari 2  
*J wire exchanged for Safari 2
*Pigtail and GS removed
*Pigtail and GS removed
*Balloon removed
*Valve delivery system advanced
*Valve delivery system advanced
*Valve deployed. Septum evaluated with echo for shunting and PVL.
*Valve deployed. Septum evaluated with echo for shunting and PVL.
Line 140: Line 142:
*Safari retained across septum until shunt is evaluated
*Safari retained across septum until shunt is evaluated
*All equipment removed
*All equipment removed
*Preclosure closed and stitch to RFV, manual pressure LFV
*Preclosure closed and stitch to RFV, manual pressure LFV if accessed
*Woggle vs Dermabond depending on Protamine
*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==
[[Paravalvular leak- Mitral|SEE MITRAL PARAVALVULAR LEAK REPAIR]]
*AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE


<br />
<br />

Latest revision as of 22:40, 27 August 2024

Note Protip: Need Alcohol in lab for this procedure!

Note 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.

Note 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
  • General Anesthesia
  • A-line (per protocol)
  • Possible Swan
  • Single plane fluoro
  • Rampart ? (depends on deployment angle)
  • 100% contrast in ACIST
  • Naked manifold for possible RHC
  • TEE
  • 28 F RFV pre-closed x 1
  • Stabilizer placement prior to draping: brought by rep, 80cm from mid-sternum


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

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