TMVI - Encircle Sapien M3: Difference between revisions

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DANIELS
__NOTOC__
{{Protip|Need Alcohol in lab for this procedure!}}


Sapien M3
{{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. }}


'''GENERAL ANESTHESIA, TEE, BIPLANE'''
{{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. }}


'''ACCESS 2 FEMORAL VEINS (ESHEATH AND PACER), 1 FEMORAL ARTERY'''


'''TRIPLE LUMEN AND RADIAL ARTERY ACCESS BY ANESTHESIA'''
{| class="wikitable"
! colspan="6" |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 2
|
*Stabilizer placement prior to draping: brought by rep, 80cm from mid-sternum
|}


'''STABILIZER PLACEMENT PRIOR TO DRAPING'''
=SHEATHS:=


*(1) 5F MICROPUNCTURE KIT
*(1) 6F 10CM SHEATH
*(1) 8F 10CM SHEATH
*(1) 8F 35CM BRITE TIP SHEATH
*(1) 9F 10CM SHEATH
*(1) 8.5F 63CM SL1 TRANSSEPTAL SHEATH


=WIRES:=
==Open:==
=='''Open'''==
===Sheaths:===
*Micropuncture set (for woggle with Daniels, or Access and Woggle for Spies)
*8f Pinnacle
*(2) Perclose
*Dilator?
===Wires:===
*(1) .035 150cm J wire
*(1) .035 260cm J wire
*(1) Safari Wire
===Catheters:===
*6F Straight Pigtail
===Pacing:===
'''Unipolar pacing setup'''  


*(2) .035 150CM J WIRE
* Alligator cables
*(1) .035 260CM J WIRE
* Solopace Remote
*(1) SAFARI 2 WIRE
*(1) AMPLATZ SUPER STIFF 1CM TIP


=='''Standby'''==
'''Bipolar on standby'''


*Baylis ProTrack wire
* Alligator Pacing Cable (open)


=CATHETERS=
*5F Josephson Pacing Cable (Standby)
=='''Open'''==
*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)
*0-Prolene for woggle


*6F STRAIGHT PIGTAIL 110CM
=== * NEW - Baylis Transseptal source ===
*6F ANGLED PIGTAIL 110CM
*5F MPA1


=='''Standby'''==
* VersaCross system
 
* Grounding pad
*6F MPA1 125cm
 
=PACING=
 
*5F JOSEPHSON PACING CATHETER
*EP QUAD CABLE
*DUAL RED/BLACK REMINGTON PACING CABLE
*(2) PACER BOXES
 
=VALVE TABLE=
 
*(5) STERILE BOWLS (2- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
*(1) 90 INCH DRAPE
*1L NORMAL SALINE IRRIGATION
*500ML HEPARINIZED SALINE
*(2) 60ML SYRINGE
*(1) HIGH PRESSURE STOPCOCK
*(1) 20ML SYRINGE
*30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION)
*12 INCH EXTENSION
*ROTO TUBING
 
=='''VALVE- SUPPLIED BY EDWARDS'''==
 
*INDEFLATOR
*CRIMPER
*E SHEATH
*DELIVERY SYSTEM
*VALVE
 
=TRANS SEPTAL=
 
*BAYLIS NEEDLE LARGE CURVE C1
*BAYLIS MACHINE
*BAYLIS CABLE
*GROUNDING PAD
 
=SEPTAL DILATION=
=='''Open'''==
 
*14X4 ATLAS GOLD- 135 CM SHAFT PREFERRED


===Standby:===
*Baylis ProTrack wire
*6F ballon wedge
*2530 Edwards indeflator
*14X4  Armada Balloon
*PRESTO INDEFLATOR
*PRESTO INDEFLATOR
 
*TORQUEVUE 45 DEGREE DELIVERY SYSTEM (9F OR 10F)
=='''Standby'''==
 
*TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
*10MM, 14MM, 18MM SEPTAL OCCLUDER
*10MM, 14MM, 18MM SEPTAL OCCLUDER


=ADDITIONAL SUPPLIES=
==Nurse Notes:==
=='''Open'''==
*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
*Baylis machine
*(2) Pacer Boxes
*Patient prepped from '''navel to knees''' in sterile fashion.  
*(1) Plum pump


*(2) PERCLOSE
===MEDICATIONS===
*3 PORT MANIFOLD  
*Bupivicaine/Lidocaine Mixed 10mL each
*ACIST- 70/30 MIX
*Epinephrine 10mcg/mL in red syringe on back table
*PROBE COVER
*DUMP BAG
*25g 1½ INCH NEEDLE
*STAT LOCK WITH STRING SECUREMENT
*PROLENE 2-0
*TAVR INSTRUMENT TRAY
*CHLORAPREP AND PREP TRAY
*DERMABOND
*(2) FLUORO DRAPES (FOR LATERAL BASE AND ANESTHESIA POLE)
*36X36 BANDBAG (FOR LATERAL DETECTOR)
*1L HEP SALINE ON PRESSURE BAG HUNG FROM IVY POLE
*That's right, I said IVY pole.


=MEDICATIONS=
== Back Table Set Up ==


*BUPIVACAINE/LIDOCAINE MIX
* (3) bowls with 500 ml of NS
*EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
* (1) large bowl with 1000 ml of hep saline
*ROTAGLIDE 10ML (PRE VALVE)
* (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)


=STANDBY EMERGENCY ECMO SUPPLIES=
==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


*16F ARTERIAL CANNULA
==STANDBY EMERGENCY ECMO SUPPLIES==
*21F VENOUS CANNULA
*16F Arterial Cannula
*(2) PERCLOSE
*21F Venous Cannula
*ECMO INSTRUMENT TRAY
*(2) Perclose
*AMPLATZ SUPER STIFF
*ECMO Instrument Tray
 
*Amplatz SS 7cm tip
=STANDBY PERICARDIOCENTESIS SUPPLIES=


==STANDBY PERICARDIOCENTESIS SUPPLIES==
*EYE DRAPE
*EYE DRAPE
*CHIBA NEEDLE 10CM 18G
*CHIBA NEEDLE 10CM 18G
Line 132: Line 154:
*AMPLATZ SUPER STIFF 180CM
*AMPLATZ SUPER STIFF 180CM


=STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES=
==STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES==
'''SEE MITRAL PARAVALVULAR LEAK REPAIR'''
[[Paravalvular leak- Mitral|SEE MITRAL PARAVALVULAR LEAK REPAIR]]
 
*AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE
*AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE
=PROCEDURE:=
*Patient prepped from '''navel to knees''' in sterile fashion.  
*ISOCENTER XRAY
*Access obtained with u/s
Typical sites:
***6F LFA for Pigtail
***8F 35cm LFV for transcutaneous pacing
***20F RFV E-sheath for valve delivery
****Dilate with 8F
****Preclose
*Pigtail advanced through 6F sheath and LVgram performed
*Mitral annulus denoted on live monitor screen in A plane
*SL1 inserted over .032 kit wire
*Baylis needle inserted through SL1 and atrial septum puncture performed.
*Needle removed
*5F MPA and standard J wire advanced to pulmonary vein
*1cm Amplatz Super Stiff advanced and MPA and SL1 removed
*Edwards Guide Sheath (GS) advanced
*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 and Pigtail removed
*14mm balloon advanced for septostomy
*Balloon and GS removed
*Valve delivery system advanced
*When valve is in place, temp pacer inserted and tested.
*Valve deployed. Septum evaluated with echo for shunting and PVL.
*Delivery system removed and MPA inserted for LA pressure measurement.
*All equipment removed
*Preclosure closed and stitch to RFV
*Perclose LFA
*8F vein exchanged for 9F 10cm sheath
*Secure sheath with Statlock. Tegaderm both sides.


<br />
<br />
[[Category:Procedures]]
<HR />
APPROVED: MD initials MM/YY

Latest revision as of 14:35, 18 April 2025

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 2
  • 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
  • (2) Perclose
  • Dilator?

Wires:

  • (1) .035 150cm J wire
  • (1) .035 260cm J wire
  • (1) Safari Wire

Catheters:

  • 6F Straight Pigtail

Pacing:

Unipolar pacing setup

  • Alligator cables
  • Solopace Remote

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)
  • 0-Prolene for woggle

* NEW - Baylis Transseptal source

  • VersaCross system
  • Grounding pad

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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