TMVI: Difference between revisions
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'''TransCatheter Mitral Valve Repair/Replacement''' | |||
Per Rosalie: | |||
TAVR/TMVI | |||
# Edwards Sapien 3 Ultra (20, 23 & 26mm) and Sapien 3 (29mm) – scan the valve barcode (box) in McKesson for documentation and charges. Bundle includes valve, delivery system, crimper, e sheath intro set, balloon cath & locking syringe. With the new inventory system (POU) space is limited in entering item full description. If pre dilatation Edwards balloon is necessary free text the balloon used in procedure notes (McKesson). | |||
# Medtronic Core Valve – all items are charge separately. Scan all barcodes (delivery system, loading system and valve). | |||
MITRAL CLIP (Mitral/Tricuspid): | |||
# Use the barcode on Mckesson screen in Lab 1 – Mitraclip (Abbott) bundle consists of (1) Steerable Guide Catheter, (2) NTR Clip Delivery System & (1) XTR Clip Delivery System. | |||
'''GENERAL ANESTHESIA AND TEE IMAGING''' | '''GENERAL ANESTHESIA AND TEE IMAGING''' | ||
| Line 9: | Line 19: | ||
'''PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN''' | '''PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN''' | ||
= SHEATHS: = | =SHEATHS:= | ||
* (1) 5F MICROPUNCTURE KIT | *(1) 5F MICROPUNCTURE KIT | ||
* (1) 5F 10CM SHEATH | *(1) 5F 10CM SHEATH | ||
*** '''OR''' 6F IF CORONARY IMAGING NECESSARY | ***'''OR''' 6F IF CORONARY IMAGING NECESSARY | ||
* (1) 8F 10CM SHEATH | *(1) 8F 10CM SHEATH | ||
* (1) 8F 35CM BRITE TIP SHEATH | *(1) 8F 35CM BRITE TIP SHEATH | ||
* (1) 9F 10CM SHEATH | *(1) 9F 10CM SHEATH | ||
* (1) 8.5F 63CM SL1 TRANSSEPTAL SHEATH | *(1) 8.5F 63CM SL1 TRANSSEPTAL SHEATH | ||
* (1) 8.5F AGILIS SMALL CURL | *(1) 8.5F AGILIS SMALL CURL | ||
= WIRES: = | =WIRES:= | ||
== '''Open''' == | =='''Open'''== | ||
* (2) .035 150CM J WIRE | *(2) .035 150CM J WIRE | ||
* (1) SAFARI 2 WIRE | *(1) SAFARI 2 WIRE | ||
== '''Standby''' == | =='''Standby'''== | ||
* .035 260CM J WIRE | *.035 260CM J WIRE | ||
* AMPLATZ SUPER STIFF 1CM TIP | *AMPLATZ SUPER STIFF 1CM TIP | ||
* SUPRACORE 190CM | *SUPRACORE 190CM | ||
= CATHETERS = | =CATHETERS= | ||
== '''Open''' == | =='''Open'''== | ||
* 6F STRAIGHT PIGTAIL 110CM | *6F STRAIGHT PIGTAIL 110CM | ||
== '''Standby''' == | =='''Standby'''== | ||
* 6F LANGSTON | *6F LANGSTON | ||
* 5.2F ANGLED PIGTAIL | *5.2F ANGLED PIGTAIL | ||
* 5F MPA | *5F MPA | ||
* 5F JL4 AND JR4 (FOR CORONARIES) | *5F JL4 AND JR4 (FOR CORONARIES) | ||
= PACING = | =PACING= | ||
* 5F JOSEPHSON PACING CATHETER | *5F JOSEPHSON PACING CATHETER | ||
* EP QUAD CABLE | *EP QUAD CABLE | ||
* DUAL RED/BLACK REMINGTON PACING CABLE | *DUAL RED/BLACK REMINGTON PACING CABLE | ||
* (2) PACER BOXES | *(2) PACER BOXES | ||
= VALVE TABLE = | =VALVE TABLE= | ||
* (4) STERILE BOWLS (2- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX) | *(4) STERILE BOWLS (2- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX) | ||
* (1) 90 INCH DRAPE (OR) | *(1) 90 INCH DRAPE (OR) | ||
* 1L NORMAL SALINE IRRIGATION | *1L NORMAL SALINE IRRIGATION | ||
* 500ML HEPARINIZED SALINE | *500ML HEPARINIZED SALINE | ||
* (1) 60ML SYRINGE | *(1) 60ML SYRINGE | ||
* (1) HIGH PRESSURE STOPCOCK | *(1) HIGH PRESSURE STOPCOCK | ||
* (1) 20ML SYRINGE | *(1) 20ML SYRINGE | ||
* 30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION) | *30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION) | ||
== '''FOR EDWARDS VALVE''' == | =='''FOR EDWARDS VALVE'''== | ||
* INDEFLATOR | *INDEFLATOR | ||
* CRIMPER | *CRIMPER | ||
* E SHEATH | *E SHEATH | ||
* DELIVERY SYSTEM | *DELIVERY SYSTEM | ||
* VALVE | *VALVE | ||
= TRANS SEPTAL = | =TRANS SEPTAL= | ||
* BAYLIS NEEDLE LARGE CURVE C1 | *BAYLIS NEEDLE LARGE CURVE C1 | ||
* BAYLIS MACHINE | *BAYLIS MACHINE | ||
* BAYLIS CABLE | *BAYLIS CABLE | ||
* GROUNDING PAD | *GROUNDING PAD | ||
= SEPTAL DILATION = | =SEPTAL DILATION= | ||
== '''Open''' == | =='''Open'''== | ||
* 12X4X75 MUSTANG '''OR''' 14X4 XXL BALLOON (FROM IR) | *12X4X75 MUSTANG '''OR''' 14X4 XXL BALLOON (FROM IR) | ||
''SIZE DEPENDENT ON VALVE- CHECK WITH DANIELS BEFORE OPENING'' | ''SIZE DEPENDENT ON VALVE- CHECK WITH DANIELS BEFORE OPENING'' | ||
* PRESTO INDEFLATOR | *PRESTO INDEFLATOR | ||
== '''Standby''' == | =='''Standby'''== | ||
* 9X4X135 MUSTANG | *9X4X135 MUSTANG | ||
* TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F) | *TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F) | ||
* 10MM, 14MM, 18MM SEPTAL OCCLUDER | *10MM, 14MM, 18MM SEPTAL OCCLUDER | ||
= ADDITIONAL SUPPLIES = | =ADDITIONAL SUPPLIES= | ||
== '''Open''' == | =='''Open'''== | ||
* (2) PERCLOSE | *(2) PERCLOSE | ||
* 3 PORT MANIFOLD | *3 PORT MANIFOLD | ||
* ACIST- FULL STRENGTH CONTRAST OK | *ACIST- FULL STRENGTH CONTRAST OK | ||
* PROBE COVER | *PROBE COVER | ||
* DUMP BAG | *DUMP BAG | ||
* 25g 1½ INCH NEEDLE | *25g 1½ INCH NEEDLE | ||
* STAT LOCK WITH STRING SECUREMENT | *STAT LOCK WITH STRING SECUREMENT | ||
* PROLENE 2-0 | *PROLENE 2-0 | ||
* TAVR INSTRUMENT TRAY | *TAVR INSTRUMENT TRAY | ||
* CHLORAPREP AND PREP TRAY | *CHLORAPREP AND PREP TRAY | ||
* A LINE TUBING AND VENOUS EXTENSION FOR ANESTHESIA | *A LINE TUBING AND VENOUS EXTENSION FOR ANESTHESIA | ||
* DERMABOND | *DERMABOND | ||
== '''Standby''' == | =='''Standby'''== | ||
* 150ML CONTRAST (FOR CORONARIES) | *150ML CONTRAST (FOR CORONARIES) | ||
* BIOPATCH | *BIOPATCH | ||
* FLUORO DRAPE | *FLUORO DRAPE | ||
* 8F ANGIOSEAL | *8F ANGIOSEAL | ||
* 0 SILK SUTURE | *0 SILK SUTURE | ||
* EXTRA PERCLOSE | *EXTRA PERCLOSE | ||
= MEDICATIONS = | =MEDICATIONS= | ||
* BUPIVACAINE | *BUPIVACAINE | ||
* EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE | *EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE | ||
* ROTAGLIDE 10ML (EDWARDS VALVE) | *ROTAGLIDE 10ML (EDWARDS VALVE) | ||
= STANDBY EMERGENCY ECMO SUPPLIES = | =STANDBY EMERGENCY ECMO SUPPLIES= | ||
* 16F ARTERIAL CANNULA | *16F ARTERIAL CANNULA | ||
* 21F VENOUS CANNULA | *21F VENOUS CANNULA | ||
* (2) PERCLOSE | *(2) PERCLOSE | ||
* ECMO INSTRUMENT TRAY | *ECMO INSTRUMENT TRAY | ||
* AMPLATZ SUPER STIFF | *AMPLATZ SUPER STIFF | ||
= STANDBY PERICARDIOCENTESIS SUPPLIES = | =STANDBY PERICARDIOCENTESIS SUPPLIES= | ||
* EYE DRAPE | *EYE DRAPE | ||
* CHIBA NEEDLE 10CM 18G | *CHIBA NEEDLE 10CM 18G | ||
* SKATER INTRODUCER SET | *SKATER INTRODUCER SET | ||
* BARD LOCKING PIGTAIL 6F OR 8F | *BARD LOCKING PIGTAIL 6F OR 8F | ||
* (3) 60ML SYRINGES | *(3) 60ML SYRINGES | ||
* STOPCOCK | *STOPCOCK | ||
* AMPLATZ SUPER STIFF 180CM | *AMPLATZ SUPER STIFF 180CM | ||
= PROCEDURE: = | =PROCEDURE:= | ||
* Patient prepped from '''navel to knees''' in sterile fashion. | *Patient prepped from '''navel to knees''' in sterile fashion. | ||
* Access obtained with u/s | *Access obtained with u/s | ||
Typical sites: | Typical sites: | ||
*** 5F LFA for anesthesia monitoring | ***5F LFA for anesthesia monitoring | ||
*** 8F 35cm LFV for transcutaneous pacing | ***8F 35cm LFV for transcutaneous pacing | ||
*** 14F OR 16F RFV E-sheath for valve delivery | ***14F OR 16F RFV E-sheath for valve delivery | ||
**** Dilate with 8F | ****Dilate with 8F | ||
**** Preclose | ****Preclose | ||
* SL1 inserted over .032 kit wire | *SL1 inserted over .032 kit wire | ||
* Baylis needle inserted through SL1 and atrial septum puncture performed. | *Baylis needle inserted through SL1 and atrial septum puncture performed. | ||
* Needle removed, .032 wire advanced to pulmonary vein | *Needle removed, .032 wire advanced to pulmonary vein | ||
* Agilis advanced and directed to mitral valve | *Agilis advanced and directed to mitral valve | ||
* Pigtail inserted through agilis for valve crossing. | *Pigtail inserted through agilis for valve crossing. | ||
* Safari2 wire inserted to ventricle. | *Safari2 wire inserted to ventricle. | ||
* Pigtail and agilis removed. | *Pigtail and agilis removed. | ||
* 12mm/14mm balloon advanced for septostomy and possible BAV | *12mm/14mm balloon advanced for septostomy and possible BAV | ||
* Balloon removed, valve delivery system advanced. | *Balloon removed, valve delivery system advanced. | ||
* When valve is in place, temp pacer inserted and tested. | *When valve is in place, temp pacer inserted and tested. | ||
* Valve deployed. Septum evaluated with echo for shunting. | *Valve deployed. Septum evaluated with echo for shunting. | ||
* Pacer removed. Delivery system removed. | *Pacer removed. Delivery system removed. | ||
* Preclosure closed and stitch to RFV | *Preclosure closed and stitch to RFV | ||
* Perclose LFA | *Perclose LFA | ||
* 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. | ||
< | <br> | ||
[[Category:Procedures]] | [[Category:Procedures]] | ||
<HR> | <HR /> | ||
APPROVED: MD initials MM/YY | APPROVED: MD initials MM/YY | ||
Revision as of 15:59, 25 November 2019
TransCatheter Mitral Valve Repair/Replacement
Per Rosalie:
TAVR/TMVI
- Edwards Sapien 3 Ultra (20, 23 & 26mm) and Sapien 3 (29mm) – scan the valve barcode (box) in McKesson for documentation and charges. Bundle includes valve, delivery system, crimper, e sheath intro set, balloon cath & locking syringe. With the new inventory system (POU) space is limited in entering item full description. If pre dilatation Edwards balloon is necessary free text the balloon used in procedure notes (McKesson).
- Medtronic Core Valve – all items are charge separately. Scan all barcodes (delivery system, loading system and valve).
MITRAL CLIP (Mitral/Tricuspid):
- Use the barcode on Mckesson screen in Lab 1 – Mitraclip (Abbott) bundle consists of (1) Steerable Guide Catheter, (2) NTR Clip Delivery System & (1) XTR Clip Delivery System.
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
