Watchman: Difference between revisions

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{| class="wikitable"
! colspan="4" |Watchman - Left Atrial appendage closure
|-
!Anesthesia
!Imaging
!Access
!ACIST/manifold
|-
|General
|Fluoro and TEE
|
*14F RFV


'''LEFT ATRIAL APPENDAGE CLOSURE'''
|One manifold with contrast
|-


===Sheaths:===
! colspan="4" |Pre-Procedure Watchouts
|-
| colspan="4" |
PRE PROCEDURE: Type and Screen
|-
|}
 
Type and Screen


====Open====
====Open====


*8.5fr SL1 sheath
*Micropuncture
*8fr sheath (dilator used pre-Perclose)
*8fr sheath (dilator used pre-Perclose)
*Probe cover
*1 Perclose
**0-Prolene or 0-PDS (Spies will add a suture after perclose if site is oozing. If no ooze Exofin.)
* Cordis 150J
*5fr Straight Pigtail
*3-port manifold
*Baylis VersaCross Access System (purple box in structural cart)
*Grounding pad
*(Spies - Lido with EPI)


====Standby====
====Standby====


*4 or 5fr Pinnacle for Arterial line
*4 or 5fr Pinnacle for Arterial line
*12fr dilator


===Wires:===
====Open====
*Amplatz Super Stiff .035x260 1cm tip
*Cordis 150J
====Standby====
*.032 J-wire (backup for SL1 wire)
*190 Supracore
*190 Supracore
*Wholey / Versacore
*Wholey / Versacore
===Baylis/TransSeptal:===
====Open====
*Baylis generator from EP
*Large curve C1 Baylis needle
*Baylis cable
*Grounding pad
===Misc Supplies:===
====Open====
*Micropuncture
*Probe cover
*Closure
**Perclose (Not Spies)
**0-Prolene or 0-PDS (Spies)
*5fr Straight Pigtail
*5fr MPA2 (Spies)
*3-port manifold
*12” extension tubing
*25g blue lido needle (Daniels)
*60cc syringe


===Watchman supplies:===
===Watchman supplies:===
Line 57: Line 52:
*Watchman device (Size as requested after TEE)
*Watchman device (Size as requested after TEE)


===PROCEDURE===


 
#Basic table set up ONLY until it is determined by TEE that case will proceed.
'''Procedure Case Log'''
 
TIPS FOR STAFF
 
#Look up patient. Make sure Type & Screen completed prior to pickup.
#Cath Lab staff pick up patient
#Circulating RN initiate Anesthesia SIGN-IN/Time Out
#Anesthesia intubates patient & '''no longer''' '''placing arterial line'''. Give prophylaxis Ancef IV
#TEE performed. Procedure '''aborted''' if '''clot'''
#TEE performed. Procedure '''aborted''' if '''clot'''
#Prep patient & drape: Bilateral groin & bilateral clavicle to SUBZYPHOID
#Prep bilateral groins and drape once probe has been inserted.
#Micropuncture ultrasound-guided RFV access
#Micropuncture ultrasound-guided RFV access
#5 Fr Micropuncture sheath
#5 Fr Micropuncture sheath  
#150 cm J Wire
#Baby J wire from sheath
#6 Fr Perclose pre-close RFV
#8 Fr dilator
#8 Fr dilator
#8.5 Fr SL 1 Sheath
#6 Fr Perclose pre-close RFV.  .032 wire inserted after preclosure deployment.
#TEE & fluro guided transeptal access & images of Left Atrial Appendage
#.035 J wire from versacross system advanced thru perclose for Baylis sheath advancement.
#.035 J wire removed, VersaCross RF pigtail wire advanced for transeptal puncture.  
#TEE & fluoro guided transeptal access & images of Left Atrial Appendage
#Anesthesia gives Heparin IV. ACT GOAL >250-300
#Anesthesia gives Heparin IV. ACT GOAL >250-300
#Transeptal puncture with Large Curve C1 71cm Baylis Needle
#Transeptal puncture, ACT drawn from LA.
#Measure LA pressure
#Measure LA pressure
#Straight 260cm Super Stiff Amplatz wire to LA
#15 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
#SL1 exchanged out for 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
#Backloaded 5 Fr Str Pigtail advanced to the LAA
#6 Fr Str Pigtail to LAA. Angiogram of appendage
#Hook pigtail up to manifold for angiogram of LAA
#Measure and select size of Watchman device
#Measure and select size of Watchman device
#Open and insert Watchman Device (Size: 21, 24, 27, 30, 33mm)
#Open and prep Watchman Device -
#*Open touhy
#*Exercise delivery
#*Advance feet of device to just inside of marker
#*Leave touhy open and attach to manifold with pressurized hep saline open, close touhy and flush to device. Tap through delivery system while flushing. (Size: 21, 24, 27, 30, 33mm)
#Pigtail removed just prior to delivery system insertion.
#Insert delivery with a wet-to-wet connection (leaving pressurized saline on)
#Once inserted, begin filling delivery system with contrast.  Delivery system takes 20ml to fill.
#Deploy Device. Confirm placement to meet PASS criteria: '''P'''osition '''A'''nchor, '''S'''ize, '''S'''eal. Can be recaptured/reposition. Fully unscrew to deploy device.
#Deploy Device. Confirm placement to meet PASS criteria: '''P'''osition '''A'''nchor, '''S'''ize, '''S'''eal. Can be recaptured/reposition. Fully unscrew to deploy device.
#Placement confirmed by LA angiogram
#Placement confirmed by LA angiogram
#Pull out pigtail & delivery guidecatheter
#Delivery system removed as MD tamps perclose knot.  
#Deploy Perclose Vein. SPIES: Hemostatic surgical suture. MD removes later.
#If access is clean, Dermabond. If bleeding, [[woggle]].
#Patient disposition
##If device deployed → PACU → ICU Stepdown.
##If case cancelled →PACU → Post Op → Home


<br>
<br>

Latest revision as of 19:32, 18 November 2022

Watchman - Left Atrial appendage closure
Anesthesia Imaging Access ACIST/manifold
General Fluoro and TEE
  • 14F RFV
 One manifold with contrast
Pre-Procedure Watchouts

PRE PROCEDURE: Type and Screen

Type and Screen

Open

  • Micropuncture
  • 8fr sheath (dilator used pre-Perclose)
  • Probe cover
  • 1 Perclose
    • 0-Prolene or 0-PDS (Spies will add a suture after perclose if site is oozing. If no ooze Exofin.)
  • Cordis 150J
  • 5fr Straight Pigtail
  • 3-port manifold
  • Baylis VersaCross Access System (purple box in structural cart)
  • Grounding pad
  • (Spies - Lido with EPI)

Standby

  • 4 or 5fr Pinnacle for Arterial line
  • 190 Supracore
  • Wholey / Versacore

Watchman supplies:

  • 14fr Watchman access sheath (Open as requested after TEE)
  • Watchman device (Size as requested after TEE)

PROCEDURE

  1. Basic table set up ONLY until it is determined by TEE that case will proceed.
  2. TEE performed. Procedure aborted if clot
  3. Prep bilateral groins and drape once probe has been inserted.
  4. Micropuncture ultrasound-guided RFV access
  5. 5 Fr Micropuncture sheath
  6. Baby J wire from sheath
  7. 8 Fr dilator
  8. 6 Fr Perclose pre-close RFV. .032 wire inserted after preclosure deployment.
  9. .035 J wire from versacross system advanced thru perclose for Baylis sheath advancement.
  10. .035 J wire removed, VersaCross RF pigtail wire advanced for transeptal puncture.
  11. TEE & fluoro guided transeptal access & images of Left Atrial Appendage
  12. Anesthesia gives Heparin IV. ACT GOAL >250-300
  13. Transeptal puncture, ACT drawn from LA.
  14. Measure LA pressure
  15. 15 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
  16. Backloaded 5 Fr Str Pigtail advanced to the LAA
  17. Hook pigtail up to manifold for angiogram of LAA
  18. Measure and select size of Watchman device
  19. Open and prep Watchman Device -
    • Open touhy
    • Exercise delivery
    • Advance feet of device to just inside of marker
    • Leave touhy open and attach to manifold with pressurized hep saline open, close touhy and flush to device. Tap through delivery system while flushing. (Size: 21, 24, 27, 30, 33mm)
  20. Pigtail removed just prior to delivery system insertion.
  21. Insert delivery with a wet-to-wet connection (leaving pressurized saline on)
  22. Once inserted, begin filling delivery system with contrast. Delivery system takes 20ml to fill.
  23. Deploy Device. Confirm placement to meet PASS criteria: Position Anchor, Size, Seal. Can be recaptured/reposition. Fully unscrew to deploy device.
  24. Placement confirmed by LA angiogram
  25. Delivery system removed as MD tamps perclose knot.
  26. If access is clean, Dermabond. If bleeding, woggle.


APPROVED: MD initials MM/YY

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