Carotid TAVI: Difference between revisions
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!colspan="3"|Carotid TAVR | |||
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!Anesthesia | |||
!Imaging | |||
!Access | |||
|- | |||
|General | |||
|Fluoro and TEE | |||
| | |||
*Carotid cutdown | |||
*Right Radial | |||
|- | |||
! colspan="3" |Pre-Procedure Watchouts | |||
|- | |||
|colspan="3" | | |||
*'''Transcutaneous O2 Sat''' | |||
*'''MAP above 100''' | |||
|- | |||
|} | |||
==Equipment== | ==Equipment== | ||
*Micropuncture | *Micropuncture (for Sheridan) | ||
*6F 10cm Pinnacle Sheath | *6F 10cm Pinnacle Sheath (for Sheridan) | ||
*5/6 Slender | |||
*.035 x 150 J wire | |||
*.035 x 260 J wire | |||
*Straight stiff glide wire | |||
*5F AL1 | |||
*5F Angled Pigtail | |||
*Alligator pacing cable | |||
*Safari wire - if using commander delivery system | |||
* | *180 Amplatz SS 4cm tip - if using certitude delivery system, in the TAVR cart | ||
| Line 23: | Line 43: | ||
*Anesthesia to get left sided A line | *Anesthesia to get left sided A line | ||
*Table at | *Table at '''50''' degrees | ||
*Bring C arm in perpendicular to table | *Bring C arm in perpendicular to table | ||
*Echo at head of bed (TEE) | *Echo at head of bed (TEE) | ||
| Line 32: | Line 52: | ||
**mayo stand to bridge the gap between valve table and access site | **mayo stand to bridge the gap between valve table and access site | ||
*Cover Fluoro Pedal and Base of C-arm | *Cover Fluoro Pedal and Base of C-arm | ||
*2 venous extensions needed for Anesthesia | *2 venous extensions needed for Anesthesia (if doing bi=polar pacing) | ||
*Leave large boom to the side of the room. Use Monitors 3 &4 for pigtail and pacer. | *Leave large boom to the side of the room. Use Monitors 3 &4 for pigtail and pacer. | ||
**3 Live and 4 McKesson | **3 Live and 4 McKesson | ||
| Line 45: | Line 65: | ||
*Sheridan will start with cutdown. | *Sheridan will start with cutdown. | ||
*DD will obtain radial access for pigtail and femoral venous for Pacer | *DD will obtain radial access for pigtail (and femoral venous for Pacer if using certitude delivery) | ||
* | *AO gram per usual | ||
*CTS inserts 6F sheath | *CTS inserts 6F sheath | ||
*One CL tech stays at foot of bed for injections and pigtail pull | *One CL tech stays at foot of bed for injections and pigtail pull | ||
Latest revision as of 21:38, 10 September 2024
| Carotid TAVR | ||
|---|---|---|
| Anesthesia | Imaging | Access |
| General | Fluoro and TEE |
|
| Pre-Procedure Watchouts | ||
| ||
Equipment
- Micropuncture (for Sheridan)
- 6F 10cm Pinnacle Sheath (for Sheridan)
- 5/6 Slender
- .035 x 150 J wire
- .035 x 260 J wire
- Straight stiff glide wire
- 5F AL1
- 5F Angled Pigtail
- Alligator pacing cable
- Safari wire - if using commander delivery system
- 180 Amplatz SS 4cm tip - if using certitude delivery system, in the TAVR cart
Setup- Right Sided Carotid
- Anesthesia to get left sided A line
- Table at 50 degrees
- Bring C arm in perpendicular to table
- Echo at head of bed (TEE)
- OR will do prep. (Include groins and right wrist)
- First assist to stand at head of bed on the left
- CT surgeon on right side with scrub RN
- Cath Lab will have standard 2 tables plus high table for valve delivery.
- mayo stand to bridge the gap between valve table and access site
- Cover Fluoro Pedal and Base of C-arm
- 2 venous extensions needed for Anesthesia (if doing bi=polar pacing)
- Leave large boom to the side of the room. Use Monitors 3 &4 for pigtail and pacer.
- 3 Live and 4 McKesson
- When DD moves to the head to assist with valve crossing bring in monitors 3 &4
- 3- echo 4-Mckesson 1- Live 2- Anesthesia Vitals
- Right wall monitor with quad view
- boom with standard tavr display
Procedure- Right Sided
- Sheridan will start with cutdown.
- DD will obtain radial access for pigtail (and femoral venous for Pacer if using certitude delivery)
- AO gram per usual
- CTS inserts 6F sheath
- One CL tech stays at foot of bed for injections and pigtail pull
- Preloaded AL1 and Stiff glide inserted
- stiff glide exchanged for SAFARI
- E sheath inserted
- Valve delivered
- Venous sheath removed and figure 8 with prolene
- TR Band applied after OR finished closing.
