Left Subclavian IABP

If left subclavian is occluded or otherwise inaccessible procedure is aborted. IABP should not be inserted through right subclavian per CT surgery.

Equipment

• Micropuncture
• (2) 4/5f slender radial sheath
• Amplatz extra stiff 260cm wire
• .035 150cm Jwire
• 5f pigtail catheter
• 5f JR4 diagnostic catheter
• IABP kit
• 8f 23cm safesheath (ep)(Romick) / 8fr x 23 brite-tip sheath (Spies)
• Perclose
• TR band
• Biopatch
• 0-Ethibond suture

Procedure

• Prep left side neck and chest (ear to nipple and shoulder to midline).
  • Note: The access site is not an absolute (may become axillary or subclavicular) hence the large site prep.

• Prep left radial.
• Left radial accessed and 4/5f slender sheath inserted.
• Pigtail advanced and angiogram performed. Pigtail left in place and used as reference for subclavian access.
• Subclavian accessed with ultrasound and fluoro guidance using micropuncture kit and radial sheath inserted.
• Pigtail catheter removed.
• J wire and JR4 inserted and directed to descending aorta.
• Catheter and sheath removed, 8f dilator inserted, and perclose advanced for pre-closure.
• Amplatz wire advanced, perclose removed, 8f sheath advanced.
• IABP inserted.
• Sheath peeled away. (Romick)
• IABP secured with suture and site dressed.
• Radial sheath removed and TR band applied.

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Approved: md initials mm/yy