Carotid TAVI: Difference between revisions

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Procedure to be performed in Hybrid OR 14 in conjunction with the OR team.
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{| class="wikitable"
!colspan="3"|Carotid TAVR
|-
!Anesthesia
!Imaging
!Access
|-
|General
|Fluoro and TEE
|
*Carotid cutdown
*Right Radial
|-
 
! colspan="3" |Pre-Procedure Watchouts
|-
|colspan="3" |
*'''Transcutaneous O2 Sat'''
*'''MAP above 100'''
|-
|}
 


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==Equipment==
==Equipment==
In addition to standard TAVR equipment the OR team will need:


*Micropuncture
*Micropuncture (for Sheridan)
*6F 10cm Pinnacle Sheath
*6F 10cm Pinnacle Sheath (for Sheridan)
*5/6 Slender
*.035 x 150 J wire
*.035 x 260 J wire
*Straight stiff glide wire
*5F AL1
*5F Angled Pigtail
*Alligator pacing cable
*Safari wire - if using commander delivery system


<br />
*180 Amplatz SS 4cm tip  - if using certitude delivery system, in the TAVR cart
 
* Safari wire instead of Amplatz ES
* Can get away with 1 short J wire




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*Anesthesia to get left sided A line
*Anesthesia to get left sided A line
*Table at 30 degrees
*Table at '''50''' degrees
*Bring C arm in perpendicular to table
*Bring C arm in perpendicular to table
*Echo at head of bed (TEE)
*Echo at head of bed (TEE)
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*CT surgeon on right side with scrub RN
*CT surgeon on right side with scrub RN
*Cath Lab will have standard 2 tables plus high table for valve delivery.   
*Cath Lab will have standard 2 tables plus high table for valve delivery.   
**consider using mayo stand to bridge the gap between valve table and access site
**mayo stand to bridge the gap between valve table and access site
* Cover Fluoro Pedal and Base of C-arm
*Cover Fluoro Pedal and Base of C-arm
* 2 venous extensions needed for Anesthesia  
*2 venous extensions needed for Anesthesia (if doing bi=polar pacing)
* Leave large boom to the side of the room. Use Monitors 3 &4 for pigtail and pacer.  
*Leave large boom to the side of the room. Use Monitors 3 &4 for pigtail and pacer.  
** 3 Live and 4 McKesson
**3 Live and 4 McKesson
* When DD moves to the head to assist with valve crossing bring in monitors 3 &4
*When DD moves to the head to assist with valve crossing bring in monitors 3 &4
** 3- echo 4-Mckesson 1- Live 2- Anesthesia Vitals
**3- echo 4-Mckesson 1- Live 2- Anesthesia Vitals
** Right wall monitor with quad view
**Right wall monitor with quad view
** boom with standard tavr display
**boom with standard tavr display


<br />
<br />


== Procedure- Right Sided ==
==Procedure- Right Sided==
 
* Sheridan will start with cutdown.
* DD will obtain radial access for pigtail and femoral venous for Pacer
* AOgram per usual
* CTS inserts 6F sheath
* One CL tech stays at foot of bed for injections and pigtail pull
* Preloaded AL1 and Stiff glide inserted
* stiff glide exchanged for SAFARI
* E sheath inserted
* Valve delivered
* Venous sheath removed and figure 8 with prolene
* TR Band applied


*Sheridan will start with cutdown.
*DD will obtain radial access for pigtail (and femoral venous for Pacer if using certitude delivery)
*AO gram per usual
*CTS inserts 6F sheath
*One CL tech stays at foot of bed for injections and pigtail pull
*Preloaded AL1 and Stiff glide inserted
*stiff glide exchanged for SAFARI
*E sheath inserted
*Valve delivered
*Venous sheath removed and figure 8 with prolene
*TR Band applied after OR finished closing.


[[Category:Procedures]]
[[Category:Procedures]]

Latest revision as of 21:38, 10 September 2024


Carotid TAVR
Anesthesia Imaging Access
General Fluoro and TEE
  • Carotid cutdown
  • Right Radial
Pre-Procedure Watchouts
  • Transcutaneous O2 Sat
  • MAP above 100


Equipment

  • Micropuncture (for Sheridan)
  • 6F 10cm Pinnacle Sheath (for Sheridan)
  • 5/6 Slender
  • .035 x 150 J wire
  • .035 x 260 J wire
  • Straight stiff glide wire
  • 5F AL1
  • 5F Angled Pigtail
  • Alligator pacing cable
  • Safari wire - if using commander delivery system
  • 180 Amplatz SS 4cm tip - if using certitude delivery system, in the TAVR cart


Setup- Right Sided Carotid

  • Anesthesia to get left sided A line
  • Table at 50 degrees
  • Bring C arm in perpendicular to table
  • Echo at head of bed (TEE)
  • OR will do prep. (Include groins and right wrist)
  • First assist to stand at head of bed on the left
  • CT surgeon on right side with scrub RN
  • Cath Lab will have standard 2 tables plus high table for valve delivery.
    • mayo stand to bridge the gap between valve table and access site
  • Cover Fluoro Pedal and Base of C-arm
  • 2 venous extensions needed for Anesthesia (if doing bi=polar pacing)
  • Leave large boom to the side of the room. Use Monitors 3 &4 for pigtail and pacer.
    • 3 Live and 4 McKesson
  • When DD moves to the head to assist with valve crossing bring in monitors 3 &4
    • 3- echo 4-Mckesson 1- Live 2- Anesthesia Vitals
    • Right wall monitor with quad view
    • boom with standard tavr display


Procedure- Right Sided

  • Sheridan will start with cutdown.
  • DD will obtain radial access for pigtail (and femoral venous for Pacer if using certitude delivery)
  • AO gram per usual
  • CTS inserts 6F sheath
  • One CL tech stays at foot of bed for injections and pigtail pull
  • Preloaded AL1 and Stiff glide inserted
  • stiff glide exchanged for SAFARI
  • E sheath inserted
  • Valve delivered
  • Venous sheath removed and figure 8 with prolene
  • TR Band applied after OR finished closing.
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