WatchmanEPmisc: Difference between revisions

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last updated 11/16/23 zr/ac  
last updated 10/18/24 zr   


While the [[Watchman|Cath Lab's Watchman Page]] provides the majority of what you need, this page has some additional info.   
See [[Watchman|Cath Lab's Watchman Page]] for additional info.   


''---temp workflow change 4/1/24---''
''(ICE/VERISIGHT IS ON HOLD as of 10/1/24. Start with TEE.''  


2 x RFV access. Please make sure to separate the wires by 10mm 
<big>'''''Set fluoro to 10p/s, Card Alt.'''''</big>
   


8F RFV ---> pre close Perclose ----> 16F 33cm Dryseal sheath ---> advance 230cm Baylis Versa Cross through 16F


10F 30cm Check-Flo for Philips VeriSight Pro ICE Catheter. Locate a catheter, ICE display connection cable+adapter (DP-DVI), and the cardboard box in the watchman cart for noninvasive prior to case




<big>'''RN:'''</big>


<big>'''RN:'''</big> 
-Large bottle of visipaque (ex, 500mL if 4 cases) + contrast spike  
 
-Large bottle of visipaque + contrast spike  


-3x 500cc bags of normal saline with 5000 units of heparin per bag (2 for table, 1 for transducer)   
-3x 500cc bags of normal saline with 5000 units of heparin per bag (2 for table, 1 for transducer)   
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'''<big>Pull list</big>'''
'''<big>Pull list</big>'''


''--temporary/new 4/1/24: --''
-standby (spies): 16f Gore DrySeal, Silk + Needle Driver
 
-6fr Straight Pig
 
-Contrast Spike
 
-3 Port Manifold (TAVR leftover kit if possible, if not, drop a simple kit + the below 5 items) (<s>ref 63160612</s>) 
 
-12" Extension 


''--16f dryseal, 10f 30cm checkflo--''  
-Morse Syringe  


-6fr Straight Pig  
-Pressure transducer kit  


-Contrast Spike (ref 90400039)
-Rotoblator Tubing 


-3 Port Manifold (ref 63160612)  
-Contrast tubing kit with large squeeze chamber/green float ball  


'''-'''Long Versacross kit (230cm) (ref VXSK0032)
'''-'''Long Versacross kit (230cm) (ref VXSK0032)


'''-'''Perclose  
'''-'''Perclose


-3cc syringe for ACT  
-3cc syringe for ACT  
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-Ultrasound Cover  
-Ultrasound Cover  
-Pressure Transducer w/Tubing


-RadPad  
-RadPad  
-Rampart Cover


-Light Handle Cover
-Light Handle Cover
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-The CCL Watchman Page mentions use of a 150 J Cordis - but Dr. Woods has been loading the 5fr pigtail over the 230cm versacross pigtailwire directly as of 4/2023.
-The CCL Watchman Page mentions use of a 150 J Cordis - but Dr. Woods has been loading the 5fr pigtail over the 230cm versacross pigtailwire directly as of 4/2023.


-exofin on standby
-Exofin


-Ioban
-Ioban


-Ground pad, defib, dots, sp02, bp cuff
-Ground pad, defib, dots, sp02, bp cuff
NOTES FOR ICE/VERISIGHT (not being used as of 10/1/24)
<s>2 x RFV access. Please make sure to separate the wires by 10mm.</s>
<s>If DrySeal: 8F RFV, preclose, upsize to Dryseal, 230cm VersaCross thru Dryseal, upsize VersaCross to fixed Watchman sheath</s>
<s>If TrueSteer: 8F RFV, preclose, upsize to 230cm VersaCross, cross septum, upsize to TrueSteer</s>
<s>Either way, drop 10F 30cm Check-Flo for Philips VeriSight Pro ICE Catheter. As of 9/5/24 we're working on attaching a 10F Mullins or SL0/SL1 to VNC which we'd upsize to from Check-Flo for a second transeptal puncture for ICE. Locate a catheter in the store room in the hallway.</s> 
''<s>--check with MD whether to drop16f DrySeal OR TrueSteer (dropped by rep - deflectable watchman delivery sheath),</s>''
''<s>--10f 30cm checkflo, Verisight ICE, ice sleeve, a second perclose for the ice sheath (postclose)</s>''
<s>--0.0 silk + needle driver only if using DrySeal</s> 
<s>''0.035" 260cm J''</s> 
<s>''14f checkflo''</s> 
<s>''10.5F SL1''</s>   
<s>Caudal - 10.5F RFV --> Verisight</s> 
<s>Cranial - 8f RFV</s> 
<s>preclose, upsize to 16f Dryseal</s> 
<s>versacross into Dryseal, transeptal access</s> 
<s>upsize to watchman sheath</s> 
<s>leave pigtailwire across LA</s> 
<s>add 0.035" 260cm J, remove pigtailwire</s>   
<s>-Decision: 5 min timer to get ICE thru transeptal hole</s> 
<s>if successful, proceed as normal</s> 
<s>if unsuccessful, put ice through the watchman sheath alongside 0.035" J, withdraw watchman sheath to RA and leave ICE in RA to guide second transeptal</s> 
<s>upsize 10.5f to 14F checkflo</s> 
<s>VC through 14F checkflo</s> 
<s>Second transeptal, remove VC sheath and leave pigtailwire, upsize to 10.5F SL1 in LA</s> 
<s>Remove ICE from watchman sheath, advance through SL1 into LA</s> 
<s>6f straight pig/Watchman delivery through watchman sheath as normal.</s>

Latest revision as of 02:07, 19 October 2024

last updated 10/18/24 zr

See Cath Lab's Watchman Page for additional info.

(ICE/VERISIGHT IS ON HOLD as of 10/1/24. Start with TEE.

Set fluoro to 10p/s, Card Alt.



RN:

-Large bottle of visipaque (ex, 500mL if 4 cases) + contrast spike

-3x 500cc bags of normal saline with 5000 units of heparin per bag (2 for table, 1 for transducer)

-1x 1L bag of saline with 2000 units of heparin, premade in pyxis (manifold saline - on 1L pressure bag)

-Lido w/ Epi

-Check with PACU for pre-op - NS 500cc bolus, 4 chewable aspirins, precedex

-Labs day of: PT-INR, Type & Screen

-Labs within 30 days: CBC, BMP, EKG

-Tell Anesthesia - Ancef + General Anesthesia

-Tell PACU - shave groins + subxiphoid

Pull list

-standby (spies): 16f Gore DrySeal, Silk + Needle Driver

-6fr Straight Pig

-Contrast Spike

-3 Port Manifold (TAVR leftover kit if possible, if not, drop a simple kit + the below 5 items) (ref 63160612)

-12" Extension

-Morse Syringe

-Pressure transducer kit

-Rotoblator Tubing

-Contrast tubing kit with large squeeze chamber/green float ball

-Long Versacross kit (230cm) (ref VXSK0032)

-Perclose

-3cc syringe for ACT

-EP Pack

-Micropuncture

-8F pinnacle (just for dilator)

-Ultrasound Cover

-RadPad

-Light Handle Cover

-The CCL Watchman Page mentions use of a 150 J Cordis - but Dr. Woods has been loading the 5fr pigtail over the 230cm versacross pigtailwire directly as of 4/2023.

-Exofin

-Ioban

-Ground pad, defib, dots, sp02, bp cuff




NOTES FOR ICE/VERISIGHT (not being used as of 10/1/24)

2 x RFV access. Please make sure to separate the wires by 10mm.

If DrySeal: 8F RFV, preclose, upsize to Dryseal, 230cm VersaCross thru Dryseal, upsize VersaCross to fixed Watchman sheath

If TrueSteer: 8F RFV, preclose, upsize to 230cm VersaCross, cross septum, upsize to TrueSteer

Either way, drop 10F 30cm Check-Flo for Philips VeriSight Pro ICE Catheter. As of 9/5/24 we're working on attaching a 10F Mullins or SL0/SL1 to VNC which we'd upsize to from Check-Flo for a second transeptal puncture for ICE. Locate a catheter in the store room in the hallway.

--check with MD whether to drop16f DrySeal OR TrueSteer (dropped by rep - deflectable watchman delivery sheath),

--10f 30cm checkflo, Verisight ICE, ice sleeve, a second perclose for the ice sheath (postclose)

--0.0 silk + needle driver only if using DrySeal

0.035" 260cm J

14f checkflo

10.5F SL1

Caudal - 10.5F RFV --> Verisight

Cranial - 8f RFV

preclose, upsize to 16f Dryseal

versacross into Dryseal, transeptal access

upsize to watchman sheath

leave pigtailwire across LA

add 0.035" 260cm J, remove pigtailwire

-Decision: 5 min timer to get ICE thru transeptal hole

if successful, proceed as normal

if unsuccessful, put ice through the watchman sheath alongside 0.035" J, withdraw watchman sheath to RA and leave ICE in RA to guide second transeptal

upsize 10.5f to 14F checkflo

VC through 14F checkflo

Second transeptal, remove VC sheath and leave pigtailwire, upsize to 10.5F SL1 in LA

Remove ICE from watchman sheath, advance through SL1 into LA

6f straight pig/Watchman delivery through watchman sheath as normal.

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