Watchman: Difference between revisions
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*Probe cover | *Probe cover | ||
*Closure | *Closure | ||
**Perclose | **Perclose | ||
**0-Prolene or 0-PDS (Spies) | **0-Prolene or 0-PDS (Spies) | ||
*5fr Straight Pigtail | *5fr Straight Pigtail | ||
*5fr MPA2 (Spies) | *5fr MPA2 (Spies) | ||
*3-port manifold | *3-port manifold | ||
*60cc syringe | *60cc syringe | ||
| Line 85: | Line 83: | ||
#Measure and select size of Watchman device | #Measure and select size of Watchman device | ||
#Open and prep Watchman Device - Device prep - Open touhy, exercise delivery, leave touhy open and attach to manifold with pressurized saline open to device to flush, close touhy (Size: 21, 24, 27, 30, 33mm) | #Open and prep Watchman Device - Device prep - Open touhy, exercise delivery, leave touhy open and attach to manifold with pressurized saline open to device to flush, close touhy (Size: 21, 24, 27, 30, 33mm) | ||
#Insert delivery with a wet-to-wet connection (leaving pressurized saline on) | #Insert delivery with a wet-to-wet connection (leaving pressurized saline on) | ||
#Deploy Device. Confirm placement to meet PASS criteria: '''P'''osition '''A'''nchor, '''S'''ize, '''S'''eal. Can be recaptured/reposition. Fully unscrew to deploy device. | #Deploy Device. Confirm placement to meet PASS criteria: '''P'''osition '''A'''nchor, '''S'''ize, '''S'''eal. Can be recaptured/reposition. Fully unscrew to deploy device. | ||
#Placement confirmed by LA angiogram | #Placement confirmed by LA angiogram | ||
Revision as of 16:37, 11 December 2019
LEFT ATRIAL APPENDAGE CLOSURE
Sheaths:
Open
- 8.5fr SL1 sheath
- 8fr sheath (dilator used pre-Perclose)
Standby
- 4 or 5fr Pinnacle for Arterial line
- 12fr dilator
Wires:
Open
- Amplatz Super Stiff .035x260 1cm tip
- Cordis 150J
Standby
- .032 J-wire (backup for SL1 wire)
- 190 Supracore
- Wholey / Versacore
Baylis/TransSeptal:
Open
- Baylis generator from EP
- Large curve C1 Baylis needle
- Baylis cable
- Grounding pad
Misc Supplies:
Open
- Micropuncture
- Probe cover
- Closure
- Perclose
- 0-Prolene or 0-PDS (Spies)
- 5fr Straight Pigtail
- 5fr MPA2 (Spies)
- 3-port manifold
- 60cc syringe
Watchman supplies:
- 14fr Watchman access sheath (Open as requested after TEE)
- Watchman device (Size as requested after TEE)
Pericardiocentesis
Not DD or CS
Call Echo
- Micropuncture
- 75 Amplatz SS
- Pericardiocentesis tray
- Accordion drain bag
Spies
Call Echo
Supplies:
- Micro puncture
- 150cm J wire
- 4/5fr slender sheath
- 5fr straight pigtail diagnostic
- gravity drainage bag
- brown reservoir lab canister
- Two 50 or 60ml syringes
Daniels
Call Echo
Supplies
Open
Emergency Kit located in each lab containing the following items:
- Eye drape
- Skater introducer set
- Bard locking pigtail (6f or 8f)
- (3) 60ml luer lock syringe
- Amplatz super stiff .035 180cm wire
- Probe cover
- Stopcock
- Accordion drainage bag
Standby
- Chiba biopsy needle 10cm 18g
- Standard .035 150cm j wire
Procedure Case Log
TIPS FOR STAFF
- Look up patient. Make sure Type & Screen completed prior to pickup.
- Cath Lab staff pick up patient
- Circulating RN initiate Anesthesia SIGN-IN/Time Out
- Anesthesia intubates patient & no longer placing arterial line. Give prophylaxis Ancef IV
- TEE performed. Procedure aborted if clot
- Prep patient & drape: Bilateral groin & bilateral clavicle to SUBZYPHOID
- Micropuncture ultrasound-guided RFV access
- 5 Fr Micropuncture sheath
- 150 cm J Wire
- 6 Fr Perclose pre-close RFV
- 8 Fr dilator
- 8.5 Fr SL 1 Sheath
- TEE & fluoro guided transeptal access & images of Left Atrial Appendage
- Anesthesia gives Heparin IV. ACT GOAL >250-300
- Transeptal puncture with Large Curve C1 71cm Baylis Needle
- Measure LA pressure
- Straight 260cm Super Stiff Amplatz wire to LA
- SL1 exchanged out for 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
- 5 Fr Str Pigtail to LAA. Angiogram of appendage
- Measure and select size of Watchman device
- Open and prep Watchman Device - Device prep - Open touhy, exercise delivery, leave touhy open and attach to manifold with pressurized saline open to device to flush, close touhy (Size: 21, 24, 27, 30, 33mm)
- Insert delivery with a wet-to-wet connection (leaving pressurized saline on)
- Deploy Device. Confirm placement to meet PASS criteria: Position Anchor, Size, Seal. Can be recaptured/reposition. Fully unscrew to deploy device.
- Placement confirmed by LA angiogram
- Pull out pigtail & delivery guidecatheter
- Deploy Perclose Vein. SPIES: Hemostatic surgical suture. MD removes later.
- Patient disposition
- If device deployed → PACU → ICU Stepdown.
- If case cancelled →PACU → Post Op → Home
APPROVED: MD initials MM/YY
