TMVI - Encircle Sapien M3: Difference between revisions

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{{Protip|Need Alcohol in lab for this procedure!}}
{{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.}}
{{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|<BR>DO NOT PUT PATIENT INFO INTO MCKESSON OR XRAY. PHI CANNOT BE STREAMED. <BR>CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE.}}
{{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. }}




{| class="wikitable"
{| class="wikitable"
! colspan="6" |Short Procedure Name
! colspan="6" |Sapien M3
|-
|-
!Anesthesia
!Anesthesia
Line 17: 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
|}
|}


'''2/19 We used single plane with angles stored instead of biplane. Maybe new standard??ane'''
==Sheaths:==
===Open:===


*Micropuncture set
 
*5/6 Slender Daniels sheath
==Open:==
===Sheaths:===
*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
 
==Wires:==
===Open:===
 
*(2) .035 150cm J wire
*(1) .035 260cm J wire
*(1) .035 260cm J wire
*(1) .032 260cm J wire
*(1) Safari Wire
*(1) Safari Wire
*(1) Amplatz SS 260cm 1cm Tip
===Catheters:===
*6F Straight Pigtail
===Pacing:===
'''Unipolar pacing setup'''


=='''Standby'''==
* Alligator cables


*Baylis ProTrack wire
'''Bipolar on standby'''


=CATHETERS=
* Alligator Pacing Cable (open)
=='''Open'''==


*(2) 6F Straight Pigtail 110cm
*5F Josephson Pacing Cable (Standby)
*5F MPA1
*EP Quad Cable (Standby)
*6F ballon wedge
*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


=='''Standby'''==
=== * NEW - Baylis Transseptal source ===


*6F MPA1 125cm
* VersaCross system
* Grounding pad


=PACING=
=== Bellow items on standby! ===


*5F Josephson Pacing Cable
* SL1 sheath
*EP Quad Cable
* Large curve Baylis needle
*Remington Pacing Cable
* Baylis cable
*(2) Pacer Boxes
* (1) 0.32 260 J-wire
 
* 5F MPA
=VALVE TABLE=
* (1) Amplatz SS 260cm 1cm Tip
 
*(5) Sterile Bowls (3- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
*(1) 90 inch drape
*1.5L Normal Saline
*500ml Heparanized Saline
*(3) 60ml Syringe
*(3) 20ml Syringe
*(2) High Pressure stopcock
*30mL Contrast (mixed with 170ml Hep Saline for 15% concentration)
 
*
 
=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'''==
 
*(2) Perclose  
*ACIST- '''100% CONTRAST'''
*ACIST- '''100% CONTRAST'''
*(2)0-Prolene
*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]]
*2L Hep Saline on - [[Alaris Pump Pressure|Click this link to see pressure adjustment process]]
*Grounding pad
*That's right, I said IVY pole.
*Baylis machine
*(2) Alaris pump
*(2) Pacer Boxes
*(2) Heparin tubing
*Patient prepped from '''navel to knees''' in sterile fashion.  
*(2) 72” pressure tubing
*(1) Plum pump
*Swiftlink cover
 
=MEDICATIONS=


===MEDICATIONS===
*Bupivicaine/Lidocaine Mixed 10mL each
*Bupivicaine/Lidocaine Mixed 10mL each
*Epinephrine 10mcg/mL in red syringe on back table
*Epinephrine 10mcg/mL in red syringe on back table
*Rotaglide 10mL for sheath before valve is inserted


=STANDBY EMERGENCY ECMO SUPPLIES=
== 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
*16F Arterial Cannula
*21F Venous Cannula
*21F Venous Cannula
Line 129: Line 152:
*Amplatz SS 7cm tip  
*Amplatz SS 7cm tip  


=STANDBY PERICARDIOCENTESIS SUPPLIES=
==STANDBY PERICARDIOCENTESIS SUPPLIES==
 
*EYE DRAPE
*EYE DRAPE
*CHIBA NEEDLE 10CM 18G
*CHIBA NEEDLE 10CM 18G
Line 139: 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
*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
*Pigtail advanced through 6F sheath and LVgram @ 15/45 performed
**Change ACIST to 5/5 after lvgram
*Mitral annulus denoted on live monitor screen in A plane
*DDS prepped
**1L Hep. Saline (2U/ml) 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
**Change fluoro to 4fps once DDS is in place and dock deployment begins.
*Dock deployed in a timely fashion ;)
*Temp pacer inserted and tested.
*DDS removed and Pigtail inserted over exchange  J for valve crossing
*J wire exchanged for Safari 2
*Pigtail and GS removed
*14mm balloon advanced for septostomy
*Balloon 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
*All equipment removed
*Preclosure closed and stitch to RFV, manual pressure LFV
*
*Woggle vs Dermabond depending on Protamine


<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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