Impella: Difference between revisions

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==Daniels single access Impella - DRAFT==
__TOC__
{{Note|Good article on Single access and sheaths:  [https://citoday.com/articles/2020-mar-apr/single-access-technique-for-impella-assisted-high-risk-pci Impella Single Access]}}
 
==Daniels single access Impella/PCI  ==


===Equipment===
===Equipment===


*16F Dryseal
*7F Destination
*8fr guide
*2 Percloses
*6fr Shuttle 90cm
*Micropuncture
*18G Cook need to stick Impella diaphragm for Destination advancement 
 
==Hui single access Impella - DRAFT==


==Hybrid OR Impella via Subclavian conduit==
====Double stick Impella sheath====


===Equipment===
===Equipment===
*Micropuncture
*6/7 Short slender sheath
*7fr. Guide


*Pack*
==Hybrid OR 5.5 Impella via Subclavian conduit==
*JR4
 
*Angled Pigtail
{{Note|Change location of supplies to Cath Lab 1!}}
*.025 exchange for BP removal
===Equipment===
*Perclose
===Open===
*Pack
*Cath Lab to-go cart
*ECMO cart
*.025 exchange - if removing IABP
*Perclose - if removing IABP/ECMO
*500ml bag heparinized saline
*D5W 1000ml (with 12,500 U of heparin and/or bicarb, confirm with surgeon)
===Standby===
*JR4
*6F *Cordis* Angled Pigtail
*AL1
*.035 exchange
*.035 exchange
*6-8.5 statlock
*Straight stiff glide
*18” cover for foot pedal*
 
*500ml bag heparinized saline
===Sheridan===
*Open
**6F Angled Pig
**6F 260 J
*Standby
**6F AL1
**6F JR4
**Glide Advantage
**Straight stiff glidewire
 
*Spies -
**6F JR4 with .035 J


:<nowiki>*</nowiki>Trust me on this...
*Romick -
**6F JR4 with .035 J
**Pigtail with .035 J


===Procedure===
*Daniels -
**AL1 with .035 J
**AL1 with Straight Stiff Glide


=== Room Setup and Procedure ===
*Enter an order for CCL in EPIC
*Enter an order for CCL in EPIC
*Open x-ray and McKesson using entered order.
*Open x-ray using entered order.
*Procedure in McKesson is “(33990)INSERT VAD ARTERY ACCESS”
*DO NOT CHARGE FOR THE PROCEDURE.  This is OR's procedure.
*Free-Text note that McKesson is open for billing and equipment only, not procedural charting. See Anesthesia and OR nurses notes.
*CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!
*Put input 4in1 B on V-integration 2 for TTE on the fluoro screen.
*Put input 4in1 B on V-integration 2 for TTE on the fluoro screen.
*Open and cut femoral drape across entire width at the level of the femoral fenestrations.
*Always prep for femoral access in the event of emergent ECMO.  
*Place over legs after surgical draping using remaining adhesive area to secure.
*Place drape over legs after surgical draping to cover abdomen.
*Put OR light camera in place to see the surgical site to monitor progress from control room.
*Put OR light camera in place to see the surgical site to monitor progress from control room.
*Tuck surgical drapes under mattress to expose controls.
*Ask OR for 1 pack Ray-Tec sponges for wipes.
*Ask OR for 1 pack Ray-Tec sponges for wipes.
*Do the thing (Insert 5.0 Impella)
*Do the thing (Insert 5.0 Impella)
**Pass off sheath and clamps to surgeon. Once sheath is inserted in the conduit, JR4 and J wire advanced for valve crossing.  IMPELLA wire retained in LV. Impella advanced under fluoro and echo guidance. Save image. Surgeon/ Interventionist discuss whether to removed additional support or leave in place. Surgeon closes.
*Remove the other thing (ECMO / Balloon pump / Impella)
*Remove the other thing (ECMO / Balloon pump / Impella)
*Statlock is for the chest/abdomen loop of the Impella similar to Leave in swan.
*Document times and doses in Cupid and log book.
*Document times and doses in McKesson - Write down for book.
*Reminder:::  CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!
*Save 2 stickers
*Close x-ray and archive to ACUTE
*Close x-ray and archive to EMIM_CATH
*Capture charges for Cupid
*Capture charges for McKesson
*Sticker goes in room 14 log book for tracking OR lab 1 log book, NEVER both.
*Generate and sign McKesson, then print device list in CCL.
*Sticker goes in room 6 book for tracking, second sticker is for device list
*Bill device list in Epic




== Axillary Impella/IABP - DRAFT ==
==Axillary Impella/IABP - DRAFT==




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*Micropuncture
*Micropuncture
*(2) 4/5f slender radial sheath
*Probe Cover
*Amplatz extra stiff 260cm wire
*4/5F slender radial sheath
*.035 150cm Jwire
*Amplatz extra stiff 260cm wire (on standby for Spies)
*5f pigtail catheter
*.035 150cm J wire
*5f JR4 diagnostic catheter
*5Fr pigtail catheter
*5Fr JR4 diagnostic catheter (on standby for Spies)
*IABP kit
*IABP kit
*8f 23cm safesheath (ep)(Romick) / 8fr x 23 brite-tip sheath (Spies)
*8Fr 23cm safesheath (ep)(Romick) / 8fr x 23 brite-tip sheath (Spies)
*Perclose
*Perclose
*TR band
*TR band
*Biopatch
*Biopatch
*0-Ethibond suture
*0-Ethibond suture
*Tournaquick (carrot top)
*3 Port Manifold


=Procedure=
=Procedure=
Line 77: Line 113:
*Subclavian accessed with ultrasound and fluoro guidance using micropuncture kit and radial sheath inserted.
*Subclavian accessed with ultrasound and fluoro guidance using micropuncture kit and radial sheath inserted.
*Pigtail catheter removed.
*Pigtail catheter removed.
*J wire and JR4 inserted and directed to descending aorta.
*J wire and JR4 inserted and directed to descending aorta if unable to be directed to abdominal aorta
*Catheter and sheath removed, 8f dilator inserted, and perclose advanced for pre-closure.
*Catheter and sheath removed, 8f dilator inserted, and perclose advanced for pre-closure.
*Amplatz wire advanced, perclose removed, 8f sheath advanced.
*Amplatz wire advanced, perclose removed, 8f sheath advanced.
Line 84: Line 120:
*IABP secured with suture and site dressed.
*IABP secured with suture and site dressed.
*Radial sheath removed and TR band applied.
*Radial sheath removed and TR band applied.
[[Category:Procedures]]

Latest revision as of 19:49, 30 September 2024

Note Note: Good article on Single access and sheaths: Impella Single Access

Daniels single access Impella/PCI

Equipment

  • 7F Destination
  • 2 Percloses
  • Micropuncture
  • 18G Cook need to stick Impella diaphragm for Destination advancement

Hui single access Impella - DRAFT

Double stick Impella sheath

Equipment

  • Micropuncture
  • 6/7 Short slender sheath
  • 7fr. Guide

Hybrid OR 5.5 Impella via Subclavian conduit

Note Note: Change location of supplies to Cath Lab 1!

Equipment

Open

  • Pack
  • Cath Lab to-go cart
  • ECMO cart
  • .025 exchange - if removing IABP
  • Perclose - if removing IABP/ECMO
  • 500ml bag heparinized saline
  • D5W 1000ml (with 12,500 U of heparin and/or bicarb, confirm with surgeon)

Standby

  • JR4
  • 6F *Cordis* Angled Pigtail
  • AL1
  • .035 exchange
  • Straight stiff glide

Sheridan

  • Open
    • 6F Angled Pig
    • 6F 260 J
  • Standby
    • 6F AL1
    • 6F JR4
    • Glide Advantage
    • Straight stiff glidewire
  • Spies -
    • 6F JR4 with .035 J
  • Romick -
    • 6F JR4 with .035 J
    • Pigtail with .035 J
  • Daniels -
    • AL1 with .035 J
    • AL1 with Straight Stiff Glide

Room Setup and Procedure

  • Enter an order for CCL in EPIC
  • Open x-ray using entered order.
  • DO NOT CHARGE FOR THE PROCEDURE. This is OR's procedure.
  • CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!
  • Put input 4in1 B on V-integration 2 for TTE on the fluoro screen.
  • Always prep for femoral access in the event of emergent ECMO.
  • Place drape over legs after surgical draping to cover abdomen.
  • Put OR light camera in place to see the surgical site to monitor progress from control room.
  • Ask OR for 1 pack Ray-Tec sponges for wipes.
  • Do the thing (Insert 5.0 Impella)
    • Pass off sheath and clamps to surgeon. Once sheath is inserted in the conduit, JR4 and J wire advanced for valve crossing. IMPELLA wire retained in LV. Impella advanced under fluoro and echo guidance. Save image. Surgeon/ Interventionist discuss whether to removed additional support or leave in place. Surgeon closes.
  • Remove the other thing (ECMO / Balloon pump / Impella)
  • Document times and doses in Cupid and log book.
  • Reminder::: CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!
  • Close x-ray and archive to ACUTE
  • Capture charges for Cupid
  • Sticker goes in room 14 log book for tracking OR lab 1 log book, NEVER both.


Axillary Impella/IABP - DRAFT

If left subclavian is occluded or otherwise inaccessible procedure is aborted. IABP should not be inserted through right subclavian per CT surgery.

Equipment

  • Micropuncture
  • Probe Cover
  • 4/5F slender radial sheath
  • Amplatz extra stiff 260cm wire (on standby for Spies)
  • .035 150cm J wire
  • 5Fr pigtail catheter
  • 5Fr JR4 diagnostic catheter (on standby for Spies)
  • IABP kit
  • 8Fr 23cm safesheath (ep)(Romick) / 8fr x 23 brite-tip sheath (Spies)
  • Perclose
  • TR band
  • Biopatch
  • 0-Ethibond suture
  • Tournaquick (carrot top)
  • 3 Port Manifold

Procedure

  • Prep left side neck and chest (ear to nipple and shoulder to midline).
    • Note: The access site is not an absolute (may become axillary or subclavicular) hence the large site prep.
  • Prep left radial.
  • Left radial accessed and 4/5f slender sheath inserted.
  • Pigtail advanced and angiogram performed. Pigtail left in place and used as reference for subclavian access.
  • Subclavian accessed with ultrasound and fluoro guidance using micropuncture kit and radial sheath inserted.
  • Pigtail catheter removed.
  • J wire and JR4 inserted and directed to descending aorta if unable to be directed to abdominal aorta
  • Catheter and sheath removed, 8f dilator inserted, and perclose advanced for pre-closure.
  • Amplatz wire advanced, perclose removed, 8f sheath advanced.
  • IABP inserted.
  • Sheath peeled away. (Romick)
  • IABP secured with suture and site dressed.
  • Radial sheath removed and TR band applied.
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