Left Subclavian IABP: Difference between revisions

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(Created page with " ROMICK LEFT SUBCLAVIAN IABP '''IF LEFT SUBCLAVIAN IS OCCLUDED OR OTHERWISE INACCESSIBLE PROCEDURE IS ABORTED. IABP SHOULD NOT BE INSERTED THROUGH RIGHT SUBCLAVIAN PER CT...")
 
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#REDIRECT[[Impella#Axillary_Impella.2FIABP_-_DRAFT]]
'''If left subclavian is occluded or otherwise inaccessible procedure is aborted. IABP should not be inserted through right subclavian per CT surgery.'''


=Equipment=


ROMICK
*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


LEFT SUBCLAVIAN IABP
=Procedure=


'''IF LEFT SUBCLAVIAN IS OCCLUDED OR OTHERWISE INACCESSIBLE PROCEDURE IS ABORTED. IABP SHOULD NOT BE INSERTED THROUGH RIGHT SUBCLAVIAN PER CT SURGERY.'''
*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.


= EQUIPMENT =
*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.


* MICROPUNCTURE
<br>
* (2) 4/5F SLENDER RADIAL SHEATH
[[category:procedures]]
* AMPLATZ EXTRA STIFF 260CM WIRE
<hr />
* .035 150CM JWIRE
Approved: md initials mm/yy
* 5F PIGTAIL CATHETER
* 5F JR4 DIAGNOSTIC CATHETER
* IABP KIT
* 8F 23CM SAFESHEATH (EP)
* PERCLOSE
* TR BAND
 
= 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 SAFE SHEATH ADVANCED.
* IABP INSERTED
* SHEATH PEELED AWAY
* IABP SECURED WITH SUTURE AND SITE DRESSED.
* RADIAL SHEATH REMOVED AND TR BAND APPLIED

Latest revision as of 15:37, 11 October 2019

Redirect to:

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.


Approved: md initials mm/yy

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