TMVI - Encircle Sapien M3: Difference between revisions

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DANIELS
__NOTOC__
{{Protip|Need Alcohol in lab for this procedure!}}
 
{{Warn|<BR>THIS IS A RESEARCH PROCEDURE.  ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM.<BR> DO NOT THROW AWAY ANY BOXES. DOCUMENTATION NOTES IN RESEARCH HELPER IN CUPID. }}
 
{{Warn|If broadcasting case:<BR>DO NOT PUT PATIENT INFO INTO XRAY. PHI CANNOT BE STREAMED. <BR>CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE. PLEASE DO NOT SUBMIT CHARGES, ROSALIE WILL DO THEM. }}


Sapien M3


{| class="wikitable"
{| class="wikitable"
!colspan="6"|Short Procedure Name
! colspan="6" |Sapien M3
|-
|-
!Anesthesia
!Anesthesia
Line 13: Line 17:
|
|
*General Anesthesia
*General Anesthesia
*A-line
*A-line (per protocol)
*Possible Swan
*Possible Swan
|
|
*Biplane Fluoro
*Single plane fluoro
*Rampart ? (depends on deployment angle)
*100% contrast in ACIST
*Naked manifold for possible RHC
*TEE
*TEE
|
|
*Femoral Vein x2
* 28 F RFV pre-closed x 1
*Radial Artery x1
|
|
*Stabilizer placement prior to draping
*Stabilizer placement prior to draping: brought by rep, 80cm from mid-sternum
|}
|}




==Sheaths:==
 
===Open:===
==Open:==
*Micropuncture set
===Sheaths:===
*5/6 Slender Daniels sheath
*Micropuncture set (for woggle with Daniels, or Access and Woggle for Spies)
*8f Pinnacle
*8f Pinnacle
*8fr x 35cm Brite-Tip
===Wires:===
*8.5fr SL1 transseptal sheath
*(1) .035 150cm J wire
*(1) .035 260cm J wire
*(1) Safari Wire
===Catheters:===
*6F Straight Pigtail
===Pacing:===
'''Unipolar pacing setup'''


==Wires:==
* Alligator cables
===Open:===


*(2) .035 150CM J WIRE
'''Bipolar on standby'''
*(1) .035 260CM J WIRE
*(1) .032 260CM J WIRE
*(1) SAFARI 2 WIRE
*(1) AMPLATZ SUPER STIFF 1CM TIP


=='''Standby'''==
* Alligator Pacing Cable (open)


*Baylis ProTrack wire
*5F Josephson Pacing Cable (Standby)
*EP Quad Cable (Standby)
*Remington Pacing Cable (Standby)
*8F 35cm BriteTip Sheath (Standby)
===Misc:===
*Back table needs 5 bowls total. Use TAVR pack, and drop 2 extra small bowls. (3 of 0.9% Saline, 1 large bowl hep-saline, 1 contrast mix 15%)
*(2) 60ml Syringe
*(4) High Pressure stopcock
*(1) 84" tubing to connect with pump off table (same as A-line anesthesia tubing)
*3 port manifold (For a gradient at the end)
*(1) Perclose (If Spies is primary, NO perclose if Daniles is primary.)
*0-Prolene for woggle


=CATHETERS=
=== * NEW - Baylis Transseptal source ===
=='''Open'''==


*(2) 6F STRAIGHT PIGTAIL 110CM
* VersaCross system
*5F MPA1
* Grounding pad


=='''Standby'''==
=== Bellow items on standby! ===


*6F MPA1 125cm
* SL1 sheath
 
* Large curve Baylis needle
=PACING=
* Baylis cable
 
* (1) 0.32 260 J-wire
*5F JOSEPHSON PACING CATHETER
* 5F MPA
*EP QUAD CABLE
* (1) Amplatz SS 260cm 1cm Tip
*DUAL RED/BLACK REMINGTON PACING CABLE
*(2) PACER BOXES
 
=VALVE TABLE=
 
*(5) STERILE BOWLS (3- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
*(1) 90 INCH DRAPE
*1.5L NORMAL SALINE
*500ML HEPARINIZED SALINE
*(2) 60ML SYRINGE
*(2) 20ML SYRINGE
*(1) HIGH PRESSURE STOPCOCK
*30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION)
 
=='''VALVE- SUPPLIED BY EDWARDS'''==
 
*INDEFLATOR
*CRIMPER
*E SHEATH
*DELIVERY SYSTEM
*VALVE
 
=TRANS SEPTAL=
 
*BAYLIS NEEDLE LARGE CURVE C1
*BAYLIS MACHINE
*BAYLIS CABLE
*GROUNDING PAD
 
=SEPTAL DILATION=
=='''Open'''==
 
*14X4 ARMADA BALLOON- prepped


===Standby:===
*Baylis ProTrack wire
*6F ballon wedge
*2530 Edwards indeflator
*14X4  Armada Balloon
*PRESTO INDEFLATOR
*PRESTO INDEFLATOR
 
*TORQUEVUE 45 DEGREE DELIVERY SYSTEM (9F OR 10F)
=='''Standby'''==
 
*TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
*10MM, 14MM, 18MM SEPTAL OCCLUDER
*10MM, 14MM, 18MM SEPTAL OCCLUDER


=ADDITIONAL SUPPLIES=
==Nurse Notes:==
=='''Open'''==
 
*(1) PERCLOSE
*3 PORT MANIFOLD  
*ACIST- '''100% CONTRAST'''
*ACIST- '''100% CONTRAST'''
*PROBE COVER
*1L Hep Saline on PLUM IV pump set at: Pressure: 400 mmHg Rate: 400ml/hr - [[Alaris Pump Pressure|Click this link to see pressure adjustment process]]
*STAT LOCK WITH STRING SECUREMENT
*Grounding pad
*0-Prolene
*Baylis machine
*CHLORAPREP AND PREP TRAY
*(2) Pacer Boxes
*DERMABOND
*Patient prepped from '''navel to knees''' in sterile fashion.  
*(2) FLUORO DRAPES (FOR LATERAL BASE AND IVY POLE ONCE IT IS MOVED TO THE END OF THE FIELD)
*(1) Plum pump
*36X36 BANDBAG (FOR LATERAL DETECTOR)
*2L HEP SALINE ON ALARIS PUMP
*That's right, I said IVY pole.
*(2) Alaris pump
*(2) Heparin tubing
*(2) 72” pressure tubing
*Swiftlink cover


=MEDICATIONS=
===MEDICATIONS===
*Bupivicaine/Lidocaine Mixed 10mL each
*Epinephrine 10mcg/mL in red syringe on back table


*BUPIVACAINE/LIDOCAINE MIX
== Back Table Set Up ==
*EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
*ROTAGLIDE 10ML (PRE VALVE)


=STANDBY EMERGENCY ECMO SUPPLIES=
* (3) bowls with 500 ml of NS
* (1) large bowl with 1000 ml of hep saline
* (4) HP stock cocks
* (1) 84" tubing
* (1) bowl with 15 ml of contrast (not 30!)
* (2) 60 ml syringes
* (1) 10 ml syringe
* (1) forcep/kelly
* (1) blade or scissor
* (1) tegaderm (pop tart size)


*16F ARTERIAL CANNULA
==PROCEDURE==
*21F VENOUS CANNULA
*Access obtained with u/s
*(2) PERCLOSE
*Need 20 and 60 cc flush on front table for the delivery system.
*ECMO INSTRUMENT TRAY
*(Possible) 8F 35cm LFV for transcutaneous pacing
*AMPLATZ SUPER STIFF
*RFV Access
*Dilate with 8F
*Preclose
*Versacross Sheath inserted
*Versacross pigtail wire inserted
*Transeptal puncture, pigtail wire advanced
*Versacros sheath exchanged for 29F Delivery sheath over pigtail wire
*Pigtail advanced across the mitral valve and LV gram @ 15/45 performed
*Mitral annulus denoted on live monitor screen by Rep.
*DDS prepped
**1L Hep. Saline (2U/ml) bag with pressure bag spiked with heparin tubing, flushed, and attached to pump
**Alaris settings 400ml/hr occlusion pressure limit 400mm Hg
**Pressure tubing attached to stopcock and DDS
*Dock Delivery System (DDS) advanced through GS
*Dock deployed in a timely fashion ;)
*DDS removed and Pigtail inserted over exchange  J for valve crossing
*J wire exchanged for Safari 2
*Pigtail and GS removed
*Valve delivery system advanced
*Valve deployed. Septum evaluated with echo for shunting and PVL.
**remind MD to lower FIO2*** Delivery system removed and MPA inserted for LA pressure measurement.
*(RHC performed with 6F swan to evaluate ASD)
*Safari retained across septum until shunt is evaluated
*All equipment removed
*Preclosure closed and stitch to RFV, manual pressure LFV if accessed
*Woggle vs Dermabond depending on Protamine


=STANDBY PERICARDIOCENTESIS SUPPLIES=
==STANDBY EMERGENCY ECMO SUPPLIES==
*16F Arterial Cannula
*21F Venous Cannula
*(2) Perclose
*ECMO Instrument Tray
*Amplatz SS 7cm tip


==STANDBY PERICARDIOCENTESIS SUPPLIES==
*EYE DRAPE
*EYE DRAPE
*CHIBA NEEDLE 10CM 18G
*CHIBA NEEDLE 10CM 18G
Line 146: Line 161:
*AMPLATZ SUPER STIFF 180CM
*AMPLATZ SUPER STIFF 180CM


=STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES=
==STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES==
'''[[Paravalvular leak- Mitral|SEE MITRAL PARAVALVULAR LEAK REPAIR]]'''
[[Paravalvular leak- Mitral|SEE MITRAL PARAVALVULAR LEAK REPAIR]]
 
*AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE
*AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE
=PROCEDURE=
*Patient prepped from '''navel to knees''' in sterile fashion.  
*ISOCENTER XRAY
*Access obtained with u/s
Typical sites:
***6F Right radial for Pigtail
***8F 35cm LFV for transcutaneous pacing
***20F RFV E-sheath for valve delivery
****Dilate with 8F
****Preclose
*Pigtail advanced through 6F sheath and LVgram performed
*Mitral annulus denoted on live monitor screen in A plane
*SL1 inserted over .032 kit wire
*Baylis needle inserted through SL1 and atrial septum puncture performed.
*Needle removed
*5F MPA advanced over .032 wire
*1cm Amplatz Super Stiff advanced and MPA and SL1 removed
*Edwards Guide Sheath (GS) advanced
*DDS prepped
**1L Hep. Saline (2U/2ml) bags with pressure bags spiked with heparin tubing, flushed, and attached to pump
**Alaris settings 200ml/hr occlusion pressure limit 300mm Hg
**Pressure tubing attached to stopcock and DDS
**Swiftlink cover installed over pressure tubing and secured ~18” from off-table end
**After hookup and flush, Swiftlink cover can be slid over heparin tubing for additional slack on the table.
*Dock Delivery System (DDS) advanced through GS
*Dock deployed in a timely fashion ;)
*DDS removed and Pigtail inserted over exchange  J for valve crossing
*J wire exchanged for Safari 2 and Pigtail removed
*14mm balloon advanced for septostomy
*Balloon and GS removed
*Valve delivery system advanced
*When valve is in place, temp pacer inserted and tested.
*Valve deployed. Septum evaluated with echo for shunting and PVL.
*Delivery system removed and MPA inserted for LA pressure measurement.
*All equipment removed
*Preclosure closed and stitch to RFV
*8F vein exchanged for 9F 10cm sheath
*Secure sheath with Statlock. Tegaderm both sides.


<br />
<br />

Latest revision as of 22:40, 27 August 2024

Note Protip: Need Alcohol in lab for this procedure!

Note Warning:
THIS IS A RESEARCH PROCEDURE. ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM.
DO NOT THROW AWAY ANY BOXES. DOCUMENTATION NOTES IN RESEARCH HELPER IN CUPID.

Note Warning: If broadcasting case:
DO NOT PUT PATIENT INFO INTO XRAY. PHI CANNOT BE STREAMED.
CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE. PLEASE DO NOT SUBMIT CHARGES, ROSALIE WILL DO THEM.


Sapien M3
Anesthesia Imaging Access Pre-Procedure
  • General Anesthesia
  • A-line (per protocol)
  • Possible Swan
  • Single plane fluoro
  • Rampart ? (depends on deployment angle)
  • 100% contrast in ACIST
  • Naked manifold for possible RHC
  • TEE
  • 28 F RFV pre-closed x 1
  • Stabilizer placement prior to draping: brought by rep, 80cm from mid-sternum


Open:

Sheaths:

  • Micropuncture set (for woggle with Daniels, or Access and Woggle for Spies)
  • 8f Pinnacle

Wires:

  • (1) .035 150cm J wire
  • (1) .035 260cm J wire
  • (1) Safari Wire

Catheters:

  • 6F Straight Pigtail

Pacing:

Unipolar pacing setup

  • Alligator cables

Bipolar on standby

  • Alligator Pacing Cable (open)
  • 5F Josephson Pacing Cable (Standby)
  • EP Quad Cable (Standby)
  • Remington Pacing Cable (Standby)
  • 8F 35cm BriteTip Sheath (Standby)

Misc:

  • Back table needs 5 bowls total. Use TAVR pack, and drop 2 extra small bowls. (3 of 0.9% Saline, 1 large bowl hep-saline, 1 contrast mix 15%)
  • (2) 60ml Syringe
  • (4) High Pressure stopcock
  • (1) 84" tubing to connect with pump off table (same as A-line anesthesia tubing)
  • 3 port manifold (For a gradient at the end)
  • (1) Perclose (If Spies is primary, NO perclose if Daniles is primary.)
  • 0-Prolene for woggle

* NEW - Baylis Transseptal source

  • VersaCross system
  • Grounding pad

Bellow items on standby!

  • SL1 sheath
  • Large curve Baylis needle
  • Baylis cable
  • (1) 0.32 260 J-wire
  • 5F MPA
  • (1) Amplatz SS 260cm 1cm Tip

Standby:

  • Baylis ProTrack wire
  • 6F ballon wedge
  • 2530 Edwards indeflator
  • 14X4 Armada Balloon
  • PRESTO INDEFLATOR
  • TORQUEVUE 45 DEGREE DELIVERY SYSTEM (9F OR 10F)
  • 10MM, 14MM, 18MM SEPTAL OCCLUDER

Nurse Notes:

  • ACIST- 100% CONTRAST
  • 1L Hep Saline on PLUM IV pump set at: Pressure: 400 mmHg Rate: 400ml/hr - Click this link to see pressure adjustment process
  • Grounding pad
  • Baylis machine
  • (2) Pacer Boxes
  • Patient prepped from navel to knees in sterile fashion.  
  • (1) Plum pump

MEDICATIONS

  • Bupivicaine/Lidocaine Mixed 10mL each
  • Epinephrine 10mcg/mL in red syringe on back table

Back Table Set Up

  • (3) bowls with 500 ml of NS
  • (1) large bowl with 1000 ml of hep saline
  • (4) HP stock cocks
  • (1) 84" tubing
  • (1) bowl with 15 ml of contrast (not 30!)
  • (2) 60 ml syringes
  • (1) 10 ml syringe
  • (1) forcep/kelly
  • (1) blade or scissor
  • (1) tegaderm (pop tart size)

PROCEDURE

  • Access obtained with u/s
  • Need 20 and 60 cc flush on front table for the delivery system.
  • (Possible) 8F 35cm LFV for transcutaneous pacing
  • RFV Access
  • Dilate with 8F
  • Preclose
  • Versacross Sheath inserted
  • Versacross pigtail wire inserted
  • Transeptal puncture, pigtail wire advanced
  • Versacros sheath exchanged for 29F Delivery sheath over pigtail wire
  • Pigtail advanced across the mitral valve and LV gram @ 15/45 performed
  • Mitral annulus denoted on live monitor screen by Rep.
  • DDS prepped
    • 1L Hep. Saline (2U/ml) bag with pressure bag spiked with heparin tubing, flushed, and attached to pump
    • Alaris settings 400ml/hr occlusion pressure limit 400mm Hg
    • Pressure tubing attached to stopcock and DDS
  • Dock Delivery System (DDS) advanced through GS
  • Dock deployed in a timely fashion ;)
  • DDS removed and Pigtail inserted over exchange  J for valve crossing
  • J wire exchanged for Safari 2
  • Pigtail and GS removed
  • Valve delivery system advanced
  • Valve deployed. Septum evaluated with echo for shunting and PVL.
    • remind MD to lower FIO2*** Delivery system removed and MPA inserted for LA pressure measurement.
  • (RHC performed with 6F swan to evaluate ASD)
  • Safari retained across septum until shunt is evaluated
  • All equipment removed
  • Preclosure closed and stitch to RFV, manual pressure LFV if accessed
  • Woggle vs Dermabond depending on Protamine

STANDBY EMERGENCY ECMO SUPPLIES

  • 16F Arterial Cannula
  • 21F Venous Cannula
  • (2) Perclose
  • ECMO Instrument Tray
  • Amplatz SS 7cm tip

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

STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES

SEE MITRAL PARAVALVULAR LEAK REPAIR

  • AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE


APPROVED: MD initials MM/YY

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