TMVI: Difference between revisions

From Bay Area Structural Heart Wiki
(pasted from JD's email)
 
No edit summary
 
(40 intermediate revisions by 4 users not shown)
Line 1: Line 1:
DANIELS
{{Warn|This page needs revision!}}<BR>
{{Protip|Need Alcohol in lab for this procedure!}}


Sapien M3
'''TransCatheter Mitral Valve Repair/Replacement'''


'''GENERAL ANESTHESIA, TEE, BIPLANE'''
Per Rosalie:


'''ACCESS 2 FEMORAL VEINS (ESHEATH AND PACER), 1 FEMORAL ARTERY'''
TAVR/TMVI


'''TRIPLE LUMEN AND RADIAL ARTERY ACCESS BY ANESTHESIA'''
#Edwards Sapien 3 Ultra (20, 23 & 26mm) and Sapien 3 (29mm) – scan the valve barcode (box) in McKesson for documentation and charges.  Bundle includes valve, delivery system, crimper, e sheath intro set, balloon cath & locking syringe.  With the new inventory system (POU) space is limited in entering item full description.   If pre dilatation Edwards balloon is necessary free text the balloon used in procedure notes (McKesson).
#Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).


'''STABILIZER PLACEMENT PRIOR TO DRAPING'''
MITRAL CLIP (Mitral/Tricuspid):


= SHEATHS: =
#Use the barcode on Mckesson screen in Lab 1 – Mitraclip (Abbott) bundle consists of (1) Steerable Guide Catheter, (2) NTR Clip Delivery System & (1) XTR Clip Delivery System.
{| class="wikitable"
|+
! colspan="4" |TMVR
|-
!Anesthesia
!Imaging
!Access
!Pre-Procedure
|-
|
* General Anesthesia


* (1) 5F MICROPUNCTURE KIT
* A-Line Always!
* (1) 6F 10CM SHEATH
|
* (1) 8F 10CM SHEATH
* Single Plane Fluoro
* (1) 8F 35CM BRITE TIP SHEATH
* (1) 9F 10CM SHEATH
* (1) 8.5F 63CM SL1 TRANSSEPTAL SHEATH


= WIRES: =
* TEE


== '''Open''' ==
* No Acist
* Unipolar pacing
|


* (2) .035 150CM J WIRE
* RVF pre-closed x 1
* (1) .035 260CM J WIRE
|
* (1) SAFARI 2 WIRE
* Type and Cross
* (1) AMPLATZ SUPER STIFF 1CM TIP


== '''Standby''' ==
* Aspirin Given
|}
==Open:==
===SHEATHS:===
*Micropuncture
*8fr Pinnacle for Perclose
*Perclose (If Spies is primary, NO perclose if Daniles is primary.)
*8. 5F Agilis
*16F E sheath, '''always''', regardless of valve size.


* Baylis ProTrack wire
=== WIRES: ===
*150 J wire
*Safari 2


= CATHETERS =
===* NEW - Baylis Transseptal===


== '''Open''' ==
* VersaCross system
* Grounding pad


* 6F STRAIGHT PIGTAIL 110CM
===Bellow items on standby!===*SL1 sheath
* 6F ANGLED PIGTAIL 110CM
* Large curve Baylis needle
* 5F MPA1
*Baylis cable
*0.32 x 260 J-wire
=== MISC: ===
*Naked 3 Port Manifold
*Alligator pacing cable


== '''Standby''' ==
=== CATHETERS: ===


* 6F MPA1 125cm
*6fr. Straight Pig


= PACING =
=== SEPTAL DILATION: ===
*12X4X75 MUSTANG '''for 23mm and 26mm Sapien OR''' 14mm Armada '''for 29mm Sapien'''
*PRESTO INDEFLATOR
===BIPOLAR PACING ON STANDBY:===
*8x35 Brite tip
*5F Josephson Pacing Cable
*EP Quad Cable
*Remington Pacing Cable
*(2) Pacer Boxes
===FOR EDWARDS VALVE:===
*Indeflator (Second Indeflator on standby)
*Crimper
*E-sheath (Second E-Sheath on standby)
*Delivery system (Second delivery on standby)
*Valve
==Standby==
*9X4X75 MUSTANG
*14, 16 XXL Balloons
*TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
*10MM, 14MM, 18MM SEPTAL OCCLUDER


* 5F JOSEPHSON PACING CATHETER
==MEDICATIONS==
* EP QUAD CABLE
* DUAL RED/BLACK REMINGTON PACING CABLE
* (2) PACER BOXES


= VALVE TABLE =
*BUPIVACAINE
*EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
*ROTAGLIDE 10ML (EDWARDS VALVE)


* (5) STERILE BOWLS (2- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
==PROCEDURE:==
* (1) 90 INCH DRAPE
* 1L NORMAL SALINE IRRIGATION
* 500ML HEPARINIZED SALINE
* (2) 60ML SYRINGE
* (1) HIGH PRESSURE STOPCOCK
* (1) 20ML SYRINGE
* 30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION)
* 12 INCH EXTENSION
* ROTO TUBING


== '''VALVE- SUPPLIED BY EDWARDS''' ==
*Patient prepped from '''navel to knees''' in sterile fashion.  
*Access obtained with u/s
*Dilate with 8F dilator
*Preclose, Versacross pigtail wire advanced through perclose
*Versacross sheath inserted
*Transeptal puncture, then pigtail wire advanced
*Versacross sheath removed
*Agilis advanced and directed to mitral valve.
*Pigtail and Safari2 inserted through Agilis for valve crossing.
*Safari2 wire inserted to ventricle. Simultaneous LA/LV pressure recorded.
*Pigtail and Agilis removed.
*12mm/14mm balloon advanced for septostomy and possible BAV
*Balloon removed, valve delivery system advanced.
*When valve is in place, black alligator cable attached and pacing tested.
*Valve deployed. Septum evaluated with echo for shunting.
*Delivery removed and SL1 re-advanced.
*Pigtail advanced to LV, wire removed and simultaneous LA/LV pressures recorded (maybe).
*Pigtail and SL1 removed.
*Pacer removed.
*Preclosure completed and stitch to RFV
*Dermabond access site, no dressings needed.


* INDEFLATOR
* CRIMPER
* E SHEATH
* DELIVERY SYSTEM
* VALVE


= TRANS SEPTAL =
== STANDBY EMERGENCY ECMO SUPPLIES ==
 
* BAYLIS NEEDLE LARGE CURVE C1
* BAYLIS MACHINE
* BAYLIS CABLE
* GROUNDING PAD
 
= SEPTAL DILATION =
 
== '''Open''' ==
 
* 14X4 ATLAS GOLD- 135 CM SHAFT PREFERRED
 
* PRESTO INDEFLATOR
 
== '''Standby''' ==
 
* TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
* 10MM, 14MM, 18MM SEPTAL OCCLUDER
 
= ADDITIONAL SUPPLIES =
 
== '''Open''' ==
 
* (2) PERCLOSE
* 3 PORT MANIFOLD  
* ACIST- 70/30 MIX
* PROBE COVER
* DUMP BAG
* 25g 1½ INCH NEEDLE
* STAT LOCK WITH STRING SECUREMENT
* PROLENE 2-0
* TAVR INSTRUMENT TRAY
* CHLORAPREP AND PREP TRAY
* DERMABOND
* (2) FLUORO DRAPES (FOR LATERAL BASE AND ANESTHESIA POLE)
* 36X36 BANDBAG (FOR LATERAL DETECTOR)
* 1L HEP SALINE ON PRESSURE BAG HUNG FROM IVY POLE
 
= MEDICATIONS =
 
* BUPIVACAINE/LIDOCAINE MIX
* EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
* ROTAGLIDE 10ML (PRE VALVE)
 
= STANDBY EMERGENCY ECMO SUPPLIES =


* 16F ARTERIAL CANNULA
* 16F ARTERIAL CANNULA
* 21F VENOUS CANNULA
* (2) PERCLOSE
* ECMO INSTRUMENT TRAY
* AMPLATZ SUPER STIFF
= 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
= PROCEDURE: =
* Patient prepped from '''navel to knees''' in sterile fashion.  
* ISOCENTER XRAY
* Access obtained with u/s


Typical sites:
*21F VENOUS CANNULA
*(2) PERCLOSE
*ECMO INSTRUMENT TRAY
*AMPLATZ SUPER STIFF


*** 6F LFA for Pigtail
==STANDBY PERICARDIOCENTESIS SUPPLIES==
*** 8F 35cm LFV for transcutaneous pacing
*** 20F RFV E-sheath for valve delivery
**** Dilate with 8F
**** Preclose
* Pigtail advanced through 6F sheath and LVgram performed
* Mitral annulus denoted on live monitor screen in A plane
* SL1 inserted over .032 kit wire
* Baylis needle inserted through SL1 and atrial septum puncture performed.
* Needle removed
* 5F MPA and standard J wire advanced to pulmonary vein
* 1cm Amplatz Super Stiff advanced and MPA and SL1 removed
* Edwards Guide Sheath (GS) advanced
* Dock Delivery System (DDS) advanced through GS
* Dock deployed in a timely fashion ;)
* DDS removed and MPA inserted over exchange  J for valve crossing
* J wire exchanged for Safari 2 and MPA removed
* 14mm balloon advanced for septostomy
* Balloon and GS removed
* Valve delivery system advanced
* When valve is in place, temp pacer inserted and tested.
* Valve deployed. Septum evaluated with echo for shunting and PVL.
* Delivery system removed and MPA inserted for LA pressure measurement.
* All equipment removed
* Preclosure closed and stitch to RFV
* Perclose LFA
* 8F vein exchanged for 9F 10cm sheath
* Secure sheath with Statlock. Tegaderm both sides.


Did you notice we wrote IVY pole instead of IV? Delirious.
*EYE DRAPE
*CHIBA NEEDLE 10CM 18G
*SKATER INTRODUCER SET
*BARD LOCKING PIGTAIL 6F OR 8F
*(3) 60ML SYRINGES
*STOPCOCK
*AMPLATZ SUPER STIFF 180CM


The End.
<br>
[[Category:Procedures]]
[[Category:NeedsWork]]
<HR />
APPROVED: MD initials MM/YY

Latest revision as of 22:13, 9 May 2024

Note Warning: This page needs revision!
Note Protip: Need Alcohol in lab for this procedure!

TransCatheter Mitral Valve Repair/Replacement

Per Rosalie:

TAVR/TMVI

  1. Edwards Sapien 3 Ultra (20, 23 & 26mm) and Sapien 3 (29mm) – scan the valve barcode (box) in McKesson for documentation and charges.  Bundle includes valve, delivery system, crimper, e sheath intro set, balloon cath & locking syringe.  With the new inventory system (POU) space is limited in entering item full description.   If pre dilatation Edwards balloon is necessary free text the balloon used in procedure notes (McKesson).
  2. Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).

MITRAL CLIP (Mitral/Tricuspid):

  1. Use the barcode on Mckesson screen in Lab 1 – Mitraclip (Abbott) bundle consists of (1) Steerable Guide Catheter, (2) NTR Clip Delivery System & (1) XTR Clip Delivery System.
TMVR
Anesthesia Imaging Access Pre-Procedure
  • General Anesthesia
  • A-Line Always!
  • Single Plane Fluoro
  • TEE
  • No Acist
  • Unipolar pacing
  • RVF pre-closed x 1
  • Type and Cross
  • Aspirin Given

Open:

SHEATHS:

  • Micropuncture
  • 8fr Pinnacle for Perclose
  • Perclose (If Spies is primary, NO perclose if Daniles is primary.)
  • 8. 5F Agilis
  • 16F E sheath, always, regardless of valve size.

WIRES:

  • 150 J wire
  • Safari 2

* NEW - Baylis Transseptal

  • VersaCross system
  • Grounding pad

===Bellow items on standby!===*SL1 sheath

  • Large curve Baylis needle
  • Baylis cable
  • 0.32 x 260 J-wire

MISC:

  • Naked 3 Port Manifold
  • Alligator pacing cable

CATHETERS:

  • 6fr. Straight Pig

SEPTAL DILATION:

  • 12X4X75 MUSTANG for 23mm and 26mm Sapien OR 14mm Armada for 29mm Sapien
  • PRESTO INDEFLATOR

BIPOLAR PACING ON STANDBY:

  • 8x35 Brite tip
  • 5F Josephson Pacing Cable
  • EP Quad Cable
  • Remington Pacing Cable
  • (2) Pacer Boxes

FOR EDWARDS VALVE:

  • Indeflator (Second Indeflator on standby)
  • Crimper
  • E-sheath (Second E-Sheath on standby)
  • Delivery system (Second delivery on standby)
  • Valve

Standby

  • 9X4X75 MUSTANG
  • 14, 16 XXL Balloons
  • TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
  • 10MM, 14MM, 18MM SEPTAL OCCLUDER

MEDICATIONS

  • BUPIVACAINE
  • EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
  • ROTAGLIDE 10ML (EDWARDS VALVE)

PROCEDURE:

  • Patient prepped from navel to knees in sterile fashion.  
  • Access obtained with u/s
  • Dilate with 8F dilator
  • Preclose, Versacross pigtail wire advanced through perclose
  • Versacross sheath inserted
  • Transeptal puncture, then pigtail wire advanced
  • Versacross sheath removed
  • Agilis advanced and directed to mitral valve.
  • Pigtail and Safari2 inserted through Agilis for valve crossing.
  • Safari2 wire inserted to ventricle. Simultaneous LA/LV pressure recorded.
  • Pigtail and Agilis removed.
  • 12mm/14mm balloon advanced for septostomy and possible BAV
  • Balloon removed, valve delivery system advanced.
  • When valve is in place, black alligator cable attached and pacing tested.
  • Valve deployed. Septum evaluated with echo for shunting.
  • Delivery removed and SL1 re-advanced.
  • Pigtail advanced to LV, wire removed and simultaneous LA/LV pressures recorded (maybe).
  • Pigtail and SL1 removed.
  • Pacer removed.
  • Preclosure completed and stitch to RFV
  • Dermabond access site, no dressings needed.


STANDBY EMERGENCY ECMO SUPPLIES

  • 16F ARTERIAL CANNULA
  • 21F VENOUS CANNULA
  • (2) PERCLOSE
  • ECMO INSTRUMENT TRAY
  • AMPLATZ SUPER STIFF

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


APPROVED: MD initials MM/YY

Retrieved from "https://wiki.bayareastructuralheart.com/index.php?title=TMVI&oldid=2262"