Intrepid valve: Difference between revisions

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{{Note|CALL MILENA AS SOON AS PATIENT IS IN THE ROOM!! 415-368-3094}}</BR>[[File:Intrepid_supply_list.pdf|thumb|page=1|right|Supply list from Medtronic]]  
{{Note|CALL MILENA AS SOON AS PATIENT IS IN THE ROOM!! 415-368-3094}}</BR>
 
<BR>[[File:Intrepid_supply_list.pdf|thumb|page=1|right|Supply list from Medtronic]]  
[[File:IntrepidTable1.jpg|thumb|150px|right|Intrepid table Setup]]
[[File:IntrepidTable1.jpg|thumb|150px|right|Intrepid table Setup]]
[[File:IntrepidTable2.jpg|thumb|150px|right|Intrepid table Setup]]
[[File:IntrepidTable2.jpg|thumb|150px|right|Intrepid table Setup]]
[[File:IntrepidTable3.jpg|thumb|150px|right|Intrepid table Setup]]
[[File:IntrepidTable3.jpg|thumb|150px|right|Intrepid table Setup]]
{{Note|TIMEOUT - Be sure that any temporary catheter across the tricuspid valve is removed prior to deployment }}
__NOINDEX__
__NOINDEX__
===Setup Notes===
===Setup Notes===
*Reps prep - ~ 1 hour!
*Reps prep - ~ 1 hour! (Make sure reps are prepping valve WAYYY before we prep the patient)
**6 liters cold saline
**(6) liters cold saline
**Pressure bags x2 for device drips
**(2) Pressure bags with NS for device drips
**Open 1 extra pickups (suture removal kit)
**(3) bowls with 500ml NS in each
**Mitra-clip plate and stool provided by reps
**(1) 60 cc with 30ml of Hep Saline the other two are for Saline.
*Use Coban to attach long table to short table end-to-end to make extra long table(drape first).
**Pickups for back table
*Surgical access
**Neptune and Bovie
**OR setup like carotid
**Cut-down with plegeted purse-string


*A/V access on opposite side
*Mitra-clip plate and stool provided by reps (Stool edge is 100cm from mid-sternum)
*Monopolar pacing in LV via arterial access with Safari and apical pacing patch
 
*Stool edge is 100cm from mid-sternum  
*Use Coban to attach long table to short table end-to-end to make extra long table
*LV pacing


===Open===
===Open===
*TAVR pack
*TAVR pack
*Back table cover
*Back table cover
*Micropuncture
*6fr. Pinnacle
*6fr. Pinnacle
*8fr. Pinnacle
*8fr. Pinnacle
*Micropuncture
*Safari
*0.035x150 J-wire
*0.035 x150 J-wire
*5fr. JR4 diagnostic catheter
*Lunderquist DC 260cm
*Lunderquist J-wire 260cm
*Rampart Drape
*Watchdog (10/6/22 DD tested RV pacing, may not need don't drop)
*5Fr JR4 diagnostic catheter
*Alligator clip pacing cable (Black clip stays on table; pass off red and plug to circ.)
*5Fr angled pigtail
*Perclose
*Alligator clip pacing cable
*2 Roto-tubing(for back table)
* (3) Perclose
*2 60ml syringes (for back table)
* 2 Roto-tubing(for back table)
* 2 60ml syringes (for back table)
*2 20ml syringes (for back table)
*2 20ml syringes (for back table)
*Acist setup with 100% contrast for RV or LV gram
*Acist setup with 100% contrast for RV or LV gram


===Procedure===
=== Procedure===
#Surgical cutdown to RFV
#6Fr Sheath RFA with micropuncture
#LFA access with micropuncture -> 6fr. Sheath
#8Fr Sheath RFV with 18 gauge entry needle access
#18 gauge entry needle access -> 8fr. Sheath to RFV
# RFV Pre-closed x 2
#Maybe Pigtail advanced for RV-gram (Reference image. Lunderquist advanced thru pigtail if used.)
#150 J loaded into perclose and 8Fr sheath in RFV
#150 J loaded in JR4 inserted
#JR4 advanced to SVC for wire exchange.
#J-wire removed for Lunderquist
#J-wire removed for Lunderquist.
#40Fr Dilator in and out.
#Intrepid sheath inserted over Lunderquist
#Intrepid sheath inserted over Lunderquist
#Manipulate valve to pre-deployment position
#Manipulate valve to pre-deployment position
#150J loaded in JR4 -> LFA to cross Aortic valve
#150J loaded in Pigtail -> LFA to cross Aortic valve
#J-wire out for Safari
#J-wire out for Safari
#Safari positioned in LV and alligator clip attached (black to back)
#Safari positioned in LV and alligator clip attached (black to back)
#Pacing threshold tested
#Pacing threshold tested
#Final positioning of valve and deployed while pacing.
#Final positioning of valve and deployed while pacing.
#Safari and JR4 removed
#Safari and pigtail
#Intrepid sheath removed and surgically closed
#Intrepid sheath removed and perclose completed. May need a 2-0 prolene for mattress stitch.
#Perclose to LFA
#Perclose to RFA
 


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

Latest revision as of 21:51, 24 September 2024

Note Note: CALL MILENA AS SOON AS PATIENT IS IN THE ROOM!! 415-368-3094


File:Intrepid supply list.pdf

Intrepid table Setup
Intrepid table Setup
Intrepid table Setup

Note Note: TIMEOUT - Be sure that any temporary catheter across the tricuspid valve is removed prior to deployment

Setup Notes

  • Reps prep - ~ 1 hour! (Make sure reps are prepping valve WAYYY before we prep the patient)
    • (6) liters cold saline
    • (2) Pressure bags with NS for device drips
    • (3) bowls with 500ml NS in each
    • (1) 60 cc with 30ml of Hep Saline the other two are for Saline.
    • Pickups for back table
  • Mitra-clip plate and stool provided by reps (Stool edge is 100cm from mid-sternum)
  • Use Coban to attach long table to short table end-to-end to make extra long table
  • LV pacing

Open

  • TAVR pack
  • Back table cover
  • Micropuncture
  • 6fr. Pinnacle
  • 8fr. Pinnacle
  • Safari
  • 0.035 x150 J-wire
  • Lunderquist DC 260cm
  • Rampart Drape
  • 5Fr JR4 diagnostic catheter
  • 5Fr angled pigtail
  • Alligator clip pacing cable
  • (3) Perclose
  • 2 Roto-tubing(for back table)
  • 2 60ml syringes (for back table)
  • 2 20ml syringes (for back table)
  • Acist setup with 100% contrast for RV or LV gram

Procedure

  1. 6Fr Sheath RFA with micropuncture
  2. 8Fr Sheath RFV with 18 gauge entry needle access
  3. RFV Pre-closed x 2
  4. 150 J loaded into perclose and 8Fr sheath in RFV
  5. JR4 advanced to SVC for wire exchange.
  6. J-wire removed for Lunderquist.
  7. 40Fr Dilator in and out.
  8. Intrepid sheath inserted over Lunderquist
  9. Manipulate valve to pre-deployment position
  10. 150J loaded in Pigtail -> LFA to cross Aortic valve
  11. J-wire out for Safari
  12. Safari positioned in LV and alligator clip attached (black to back)
  13. Pacing threshold tested
  14. Final positioning of valve and deployed while pacing.
  15. Safari and pigtail
  16. Intrepid sheath removed and perclose completed. May need a 2-0 prolene for mattress stitch.
  17. Perclose to RFA
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