TTVR: Difference between revisions

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(Created page with "Sheaths:[edit | edit source] 8Fr x 10 cm sheath (Dilator used only) Wires[edit | edit source] Cordis 260J 1 cm Tip Amplatz Extra Stiff 260cm Catheters:[edit | edit source]...")
 
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Sheaths:[edit | edit source]
<br />


8Fr x 10 cm sheath (Dilator used only)
=== '''Sheaths:'''[edit | edit source] ===


Wires[edit | edit source]
* 5Fr Micropuncture  Kit  
Cordis 260J
* 8Fr x 10 cm sheath (Dilator used only)
1 cm Tip Amplatz Extra Stiff 260cm


Catheters:[edit | edit source]
=== '''Wires'''[edit | edit source] ===
6Fr Ang Pigtail


Medications on table:[edit | edit source]
* (1) Cordis 150J
Lido/Bupivicaine 50/50
* 1 cm Amplatz Extra Stiff 260cm
Epinephrine 10mcg/ml in red medallion syringe (From anesthesia)
10 ml Rotaglide


Miscellaneous Supplies[edit | edit source]
=== '''Catheters:'''[edit | edit source] ===
(4) Sterile Bowls
Back table cover
High Pressure stopcock
60ml syringe
20 ml syringe
(1) Perclose
Fluoro cover


Transvenous pacemaker supplies[edit | edit source]
* 6Fr Ang Pigtail
5Fr Josephson Pacing catheter
Dual Red/Black Pacing Remington cables
EP Quad Cable


Standby ECMO & Pericardial Effusion supplies[edit | edit source]


Procedure[edit | edit source]
'''Medications on table:'''[edit | edit source]


SEE BELOW FOR STEPS SPECIFIC TO SPIES
* Lido/Bupivicaine 50/50


* Epinephrine 10mcg/ml in red medallion syringe (From anesthesia)
* 10 ml Rotaglide


Patient on defib pads. IF PATIENT HAS ICD: DEVICE DISABLED FOR PROCEDURE, COMPANY REP PRESENT IF POSSIBLE.
=== '''Miscellaneous Supplies'''[edit | edit source] ===


Leg strap secured above knees. Wrists restrained.
* (4) Sterile Bowls
* Back table cover
* High Pressure stopcock
* 60ml syringe
* 20 ml syringe
* (1) Perclose
* Fluoro cover
* (3) hemostats


Patient prepped from naval to mid thigh using chlorahexidine soap followed by chloraprep with 3 minute dry time.
=== '''Transvenous pacemaker supplies'''[edit | edit source] ===


Towel off site. Extend Femoral drape all the way to chin.
* Medtronic alligator pacing cables
* MYO/WIRE Temporary Cardiac Pacing Wire (Suture)


Fluoro cover used to drape anesthesia's IV pole/x-ray shield.


Extension tubing for anesthesia flushed and secured on respecitve sides of the groin .


Dual pressure lines primed and zeroed prior to case start.
'''Standby ECMO & Pericardial Effusion supplies'''[edit | edit source]


== Procedure[edit | edit source] ==


FRONT TABLE


50/50 Lido and Bupivicaine mix used for local anesthetic. Have extra available on front table.  
Patient on defib pads. IF PATIENT HAS ICD: DEVICE DISABLED FOR PROCEDURE, COMPANY REP PRESENT IF POSSIBLE. IF PATIENT HAS A PPM/ICD RAPID PACING WILL BE PERFORMED VIA PROGRAMER.  


100% contrast available on table. (May need for hand injection or for peripheral balloon prep)
Leg strap secured above knees. Wrists restrained.


10ml of Rotoglide on table (for E sheath just prior to valve insertion)
Patient prepped from naval to mid thigh using chlorhexidine soap followed by chloraprep with 3 minute dry time.


10ml syringe of 10mcg/ml taped on table.  
Towel off site. Extend Femoral drape all the way to chin.


U/S guidance for groin access
Fluoro cover used to drape anesthesia's IV pole/x-ray shield.


No venous or arterial lines for anestesia.


BACK TABLE- valve prep
Ultrasound guided access for Dr.Spies only.




4 Bowls: (2) Normal Saline (1) Hep Saline (1) 30ml contrast, 170ml Hep Saline mix (15%)
'''FRONT TABLE'''


60ml Syringe with contrast mixture for balloon prep
50/50 Lido and Bupivacaine mix used for local anesthetic. Have extra available on front table.


20ml Syringe for flushing delivery system
10ml of Rotaglide on table (for E sheath just prior to valve insertion)


Indelator: volume dependent upon valve size
10ml syringe of 10mcg/ml of Epinephrine taped on table.


Crimper


Hemostats and scissors for valve opening
'''BACK TABLE'''- valve prep


PROCEDURE STEPS
Contrlateral arterial access - 6fr. Sheath (normally LFA) using micropuncture. Verify wire position with fluoro and save an image.
Primary access - with micropuncture. Verify wire position with fluoro and save an image Leave micropuncture wire in while venous access is obtained
Once venous sheath is in place, dilate tract with 8F dilator
Double preclose. Each perclose suture secured with hemostat.
After second perclose Amplatz ES is inserted using micropuncture sheath as a cheater


Venous access- 8F 35cm brite tip over 150cm J wire. (Same side as TAVR sheath)
4 Bowls: (2) Normal Saline (1) Hep Saline (1) 30ml contrast, 170ml Hep Saline mix (15%)
Esheath sutured with 0-Ethibond
Pigtail -> LFA -> AO root injection Standard Injector settings (adjusted based on pt and root size) 10/10 20mm valve


60ml Syringe with contrast mixture for balloon prep


15/15 23mm and 26mm valve
20ml Syringe for flushing delivery system
20/20 29mm valve
Insert and test pacemaker Rapid pace 160, check for capture, 220 burst


AL1 advanced through E sheath over Amplatz ES
Indelator: volume dependent upon valve size
Amplatz ES removed and crossing wire advanced. Cross valve. Wire removed.
Measure gradient
Amplatz ES shaped by MD and advanced to LV. AL1 removed. 8fr. Dilator or micropuncture sheath on Amplatz ES as a cheater


Rotoglide in sheath.
Crimper
Insert valve delivery system
Multiple AO grams for positioning
Pace -> AO gram -> Pigtail pulled back -> Deploy valve Cine length set at 40 seconds or more


TTE
Hemostats and scissors for valve opening


if post dilation is needed...


Rep will come up and re-prep valve, adding desired amount of additional volume
'''PROCEDURE STEPS'''


If Amplatz ES was pulled back, recross wire will be needed (260cm straight stiff glide)
* RFV access obtained with cook needle. Verify wire position with fluoro and save an image.
Pigtail readvanced to AO for AO gram (15/30 standard injection)
* Dilate with 8F dilator than pre-close with perclose device. Perclose suture secured with hemostat.
Amplatz ES exchanged for 260 J
* After perclose Esheath is advanced with .035 exchange J wire.
Temp paver removed
* Pigtail advanced to cross tricuspid valve. Once pigtail is in RV the .035 exchange J wire is exchanged for the Amplatz ES wire.
Delivery system removed Have perclose tools and dilator ready
* Pigtail is removed.


Protamine given, Preclosures completed, manual pressure for 5ish minutes
* Pacing will be performed via pacing suture and alligator clip cables if patient doesn't have an existing PPM.
Pigtail pulled back to iliac bifurcation and subtracted iliac angio performed
* Rotoglide in sheath as delivery system advanced.
Pigtail removed
* Insert valve delivery system
Secondary access Perclosed
* Pace -> Deploy valve
Venous sheath exchanged for 9fr. Sheath 10cm sheath -> suture-locked
** Cine length set at 40 seconds or more
* TTE


''if post dilation is needed...''


EMERGENT PERICARDIOCENTESIS[edit | edit source]
Rep will come up and re-prep valve, adding desired amount of additional volume


Call Echo
If Amplatz ES was pulled back, recross wire will be needed (260cm straight stiff glide)


Supplies:[edit source]
* Pigtail readvanced to AO for AO gram (15/30 standard injection)
* Amplatz ES exchanged for 260 J
* Delivery system removed
** Have perclose tools and dilator ready
* Protamine given, Preclosure completed, manual pressure for 5ish minutes


Emergency Kit located in each lab containing the following items:  
<br />
Eye drape
 
Chiba biopsy needle 10cm 18g
=== '''EMERGENT PERICARDIOCENTESIS'''[edit | edit source] ===
Skater introducer set
'''Call Echo'''
Bard locking pigtail (6f or 8f)
 
(3) 60ml luer lock syringe
==== '''Supplies:'''[edit source] ====
Standard .035 150cm j wire
'''Emergency Kit located in each lab containing the following items:'''
Amplatz super stiff .035 180cm wire
 
Probe cover
* Eye drape
Stopcock
* Chiba biopsy needle 10cm 18g
Accordion drainage bag
* Skater introducer set
* Bard locking pigtail (6f or 8f)
* (3) 60ml luer lock syringe
* Standard .035 150cm j wire
* Amplatz super stiff .035 180cm wire
* Probe cover
* Stopcock
* Accordion drainage bag

Latest revision as of 22:48, 15 January 2020


Sheaths:[edit | edit source]

  • 5Fr Micropuncture  Kit  
  • 8Fr x 10 cm sheath (Dilator used only)

Wires[edit | edit source]

  • (1) Cordis 150J
  • 1 cm Amplatz Extra Stiff 260cm

Catheters:[edit | edit source]

  • 6Fr Ang Pigtail


Medications on table:[edit | edit source]

  • Lido/Bupivicaine 50/50
  • Epinephrine 10mcg/ml in red medallion syringe (From anesthesia)
  • 10 ml Rotaglide

Miscellaneous Supplies[edit | edit source]

  • (4) Sterile Bowls
  • Back table cover
  • High Pressure stopcock
  • 60ml syringe
  • 20 ml syringe
  • (1) Perclose
  • Fluoro cover
  • (3) hemostats

Transvenous pacemaker supplies[edit | edit source]

  • Medtronic alligator pacing cables
  • MYO/WIRE Temporary Cardiac Pacing Wire (Suture)


Standby ECMO & Pericardial Effusion supplies[edit | edit source]

Procedure[edit | edit source]

Patient on defib pads. IF PATIENT HAS ICD: DEVICE DISABLED FOR PROCEDURE, COMPANY REP PRESENT IF POSSIBLE. IF PATIENT HAS A PPM/ICD RAPID PACING WILL BE PERFORMED VIA PROGRAMER.

Leg strap secured above knees. Wrists restrained.

Patient prepped from naval to mid thigh using chlorhexidine soap followed by chloraprep with 3 minute dry time.

Towel off site. Extend Femoral drape all the way to chin.

Fluoro cover used to drape anesthesia's IV pole/x-ray shield.

No venous or arterial lines for anestesia.

Ultrasound guided access for Dr.Spies only.


FRONT TABLE

50/50 Lido and Bupivacaine mix used for local anesthetic. Have extra available on front table.

10ml of Rotaglide on table (for E sheath just prior to valve insertion)

10ml syringe of 10mcg/ml of Epinephrine taped on table.


BACK TABLE- valve prep


4 Bowls: (2) Normal Saline (1) Hep Saline (1) 30ml contrast, 170ml Hep Saline mix (15%)

60ml Syringe with contrast mixture for balloon prep

20ml Syringe for flushing delivery system

Indelator: volume dependent upon valve size

Crimper

Hemostats and scissors for valve opening


PROCEDURE STEPS

  • RFV access obtained with cook needle. Verify wire position with fluoro and save an image.
  • Dilate with 8F dilator than pre-close with perclose device. Perclose suture secured with hemostat.
  • After perclose Esheath is advanced with .035 exchange J wire.
  • Pigtail advanced to cross tricuspid valve. Once pigtail is in RV the .035 exchange J wire is exchanged for the Amplatz ES wire.
  • Pigtail is removed.
  • Pacing will be performed via pacing suture and alligator clip cables if patient doesn't have an existing PPM.
  • Rotoglide in sheath as delivery system advanced.
  • Insert valve delivery system
  • Pace -> Deploy valve
    • Cine length set at 40 seconds or more
  • TTE

if post dilation is needed...

Rep will come up and re-prep valve, adding desired amount of additional volume

If Amplatz ES was pulled back, recross wire will be needed (260cm straight stiff glide)

  • Pigtail readvanced to AO for AO gram (15/30 standard injection)
  • Amplatz ES exchanged for 260 J
  • Delivery system removed
    • Have perclose tools and dilator ready
  • Protamine given, Preclosure completed, manual pressure for 5ish minutes


EMERGENT PERICARDIOCENTESIS[edit | edit source]

Call Echo

Supplies:[edit source]

Emergency Kit located in each lab containing the following items:

  • Eye drape
  • Chiba biopsy needle 10cm 18g
  • Skater introducer set
  • Bard locking pigtail (6f or 8f)
  • (3) 60ml luer lock syringe
  • Standard .035 150cm j wire
  • Amplatz super stiff .035 180cm wire
  • Probe cover
  • Stopcock
  • Accordion drainage bag
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