TMVI: Difference between revisions
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* 8F vein exchanged for 9F 10cm sheath | * 8F vein exchanged for 9F 10cm sheath | ||
* Secure sheath with Statlock. Tegaderm both sides. | * Secure sheath with Statlock. Tegaderm both sides. | ||
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[[Category:Procedures]] | |||
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APPROVED: MD initials MM/YY |
Revision as of 15:49, 10 October 2019
Daniels
Transcather Mitral Valve Replacement
GENERAL ANESTHESIA AND TEE IMAGING
ACCESS 2 FEMORAL VEINS (TAVR AND PACER), 1 FEMORAL ARTERY (ANESTESIA)
PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN
SHEATHS:
- (1) 5F MICROPUNCTURE KIT
- (1) 5F 10CM SHEATH
- OR 6F IF CORONARY IMAGING NECESSARY
- (1) 8F 10CM SHEATH
- (1) 8F 35CM BRITE TIP SHEATH
- (1) 9F 10CM SHEATH
- (1) 8.5F 63CM SL1 TRANSSEPTAL SHEATH
- (1) 8.5F AGILIS SMALL CURL
WIRES:
Open
- (2) .035 150CM J WIRE
- (1) SAFARI 2 WIRE
Standby
- .035 260CM J WIRE
- AMPLATZ SUPER STIFF 1CM TIP
- SUPRACORE 190CM
CATHETERS
Open
- 6F STRAIGHT PIGTAIL 110CM
Standby
- 6F LANGSTON
- 5.2F ANGLED PIGTAIL
- 5F MPA
- 5F JL4 AND JR4 (FOR CORONARIES)
PACING
- 5F JOSEPHSON PACING CATHETER
- EP QUAD CABLE
- DUAL RED/BLACK REMINGTON PACING CABLE
- (2) PACER BOXES
VALVE TABLE
- (4) STERILE BOWLS (2- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
- (1) 90 INCH DRAPE (OR)
- 1L NORMAL SALINE IRRIGATION
- 500ML HEPARINIZED SALINE
- (1) 60ML SYRINGE
- (1) HIGH PRESSURE STOPCOCK
- (1) 20ML SYRINGE
- 30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION)
FOR EDWARDS VALVE
- INDEFLATOR
- CRIMPER
- E SHEATH
- DELIVERY SYSTEM
- VALVE
TRANS SEPTAL
- BAYLIS NEEDLE LARGE CURVE C1
- BAYLIS MACHINE
- BAYLIS CABLE
- GROUNDING PAD
SEPTAL DILATION
Open
- 12X4X75 MUSTANG OR 14X4 XXL BALLOON (FROM IR)
SIZE DEPENDENT ON VALVE- CHECK WITH DANIELS BEFORE OPENING
- PRESTO INDEFLATOR
Standby
- 9X4X135 MUSTANG
- TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
- 10MM, 14MM, 18MM SEPTAL OCCLUDER
ADDITIONAL SUPPLIES
Open
- (2) PERCLOSE
- 3 PORT MANIFOLD
- ACIST- FULL STRENGTH CONTRAST OK
- PROBE COVER
- DUMP BAG
- 25g 1½ INCH NEEDLE
- STAT LOCK WITH STRING SECUREMENT
- PROLENE 2-0
- TAVR INSTRUMENT TRAY
- CHLORAPREP AND PREP TRAY
- A LINE TUBING AND VENOUS EXTENSION FOR ANESTHESIA
- DERMABOND
Standby
- 150ML CONTRAST (FOR CORONARIES)
- BIOPATCH
- FLUORO DRAPE
- 8F ANGIOSEAL
- 0 SILK SUTURE
- EXTRA PERCLOSE
MEDICATIONS
- BUPIVACAINE
- EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
- ROTAGLIDE 10ML (EDWARDS VALVE)
STANDBY EMERGENCY ECMO SUPPLIES
- 16F ARTERIAL CANNULA
- 21F VENOUS CANNULA
- (2) PERCLOSE
- ECMO INSTRUMENT TRAY
- AMPLATZ SUPER STIFF
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
PROCEDURE:
- Patient prepped from navel to knees in sterile fashion.
- Access obtained with u/s
Typical sites:
- 5F LFA for anesthesia monitoring
- 8F 35cm LFV for transcutaneous pacing
- 14F OR 16F RFV E-sheath for valve delivery
- Dilate with 8F
- Preclose
- SL1 inserted over .032 kit wire
- Baylis needle inserted through SL1 and atrial septum puncture performed.
- Needle removed, .032 wire advanced to pulmonary vein
- Agilis advanced and directed to mitral valve
- Pigtail inserted through agilis for valve crossing.
- Safari2 wire inserted to ventricle.
- Pigtail and agilis removed.
- 12mm/14mm balloon advanced for septostomy and possible BAV
- Balloon removed, valve delivery system advanced.
- When valve is in place, temp pacer inserted and tested.
- Valve deployed. Septum evaluated with echo for shunting.
- Pacer removed. Delivery system removed.
- Preclosure closed and stitch to RFV
- Perclose LFA
- 8F vein exchanged for 9F 10cm sheath
- Secure sheath with Statlock. Tegaderm both sides.
APPROVED: MD initials MM/YY