Left Subclavian IABP: Difference between revisions
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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= | |||
*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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[[category:procedures]] | |||
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Approved: md initials mm/yy | |||
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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
