TMVI - Encircle Sapien M3: Difference between revisions

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(updated from case 2/19)
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{{Protip|Need Alcohol in lab for this procedure!}}
{{Protip|Need Alcohol in lab for this procedure!}}


=== '''***THIS IS A RESEARCH PROCEDURE.  ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM. DO NOT THROW AWAY ANY BOXES.***''' ===
{{Warn|THIS IS A RESEARCH PROCEDURE.  ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM. DO NOT THROW AWAY ANY BOXES.}}


=== ***'''DO NOT PUT PATIENT INFO INTO MCKESSON OR XRAY. PHI CANNOT BE STREAMED. CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE.***''' ===
{{Warn|DO NOT PUT PATIENT INFO INTO MCKESSON OR XRAY. PHI CANNOT BE STREAMED. CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE.}}
Sapien M3
Sapien M3


Revision as of 15:11, 12 August 2021

Note Protip: Need Alcohol in lab for this procedure!

Note Warning: THIS IS A RESEARCH PROCEDURE. ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM. DO NOT THROW AWAY ANY BOXES.

Note Warning: DO NOT PUT PATIENT INFO INTO MCKESSON OR XRAY. PHI CANNOT BE STREAMED. CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE. Sapien M3

Short Procedure Name
Anesthesia Imaging Access Pre-Procedure
  • General Anesthesia
  • A-line
  • Possible Swan
  • Biplane Fluoro
  • TEE
  • Femoral Vein x2
  • Radial Artery x1
  • Stabilizer placement prior to draping

2/19 We used single plane with angles stored instead of biplane. Maybe new standard??ane

Sheaths:

Open:

  • Micropuncture set
  • 5/6 Slender Daniels sheath
  • 8f Pinnacle
  • 8fr x 35cm Brite-Tip
  • 8.5fr SL1 transseptal sheath

Wires:

Open:

  • (2) .035 150cm J wire
  • (1) .035 260cm J wire
  • (1) .032 260cm J wire
  • (1) Safari Wire
  • (1) Amplatz SS 260cm 1cm Tip

Standby

  • Baylis ProTrack wire

CATHETERS

Open

  • (2) 6F Straight Pigtail 110cm
  • 5F MPA1
  • 6F ballon wedge

Standby

  • 6F MPA1 125cm

PACING

  • 5F Josephson Pacing Cable
  • EP Quad Cable
  • Remington Pacing Cable
  • (2) Pacer Boxes

VALVE TABLE

  • (5) Sterile Bowls (3- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
  • (1) 90 inch drape
  • 1.5L Normal Saline
  • 500ml Heparanized Saline
  • (3) 60ml Syringe
  • (3) 20ml Syringe
  • (2) High Pressure stopcock
  • 30mL Contrast (mixed with 170ml Hep Saline for 15% concentration)

TRANS SEPTAL

  • BAYLIS NEEDLE LARGE CURVE C1
  • BAYLIS MACHINE
  • BAYLIS CABLE
  • GROUNDING PAD

SEPTAL DILATION

Open

  • 14X4 Armada Balloon- prepped
  • PRESTO INDEFLATOR

Standby

  • TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
  • 10MM, 14MM, 18MM SEPTAL OCCLUDER

ADDITIONAL SUPPLIES

Open

MEDICATIONS

  • Bupivicaine/Lidocaine Mixed 10mL each
  • Epinephrine 10mcg/mL in red syringe on back table
  • Rotaglide 10mL for sheath before valve is inserted

STANDBY EMERGENCY ECMO SUPPLIES

  • 16F Arterial Cannula
  • 21F Venous Cannula
  • (2) Perclose
  • ECMO Instrument Tray
  • Amplatz SS 7cm tip

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

      • 6F Right radial for Pigtail
      • 8F 35cm LFV for transcutaneous pacing
      • 20F RFV E-sheath for valve delivery
        • Dilate with 8F
        • Preclose
  • SL1 inserted over .032 kit wire
  • Baylis needle inserted through SL1 and atrial septum puncture performed.
  • Needle removed
  • 5F MPA advanced over .032 wire
  • 1cm Amplatz Super Stiff advanced and MPA and SL1 removed
  • Edwards Guide Sheath (GS) advanced
  • Pigtail advanced through 6F sheath and LVgram @ 15/45 performed
    • Change ACIST to 5/5 after lvgram
  • Mitral annulus denoted on live monitor screen in A plane
  • DDS prepped
    • 1L Hep. Saline (2U/ml) bags with pressure bags spiked with heparin tubing, flushed, and attached to pump
    • Alaris settings 200ml/hr occlusion pressure limit 300mm Hg
    • Pressure tubing attached to stopcock and DDS
    • Swiftlink cover installed over pressure tubing and secured ~18” from off-table end
    • After hookup and flush, Swiftlink cover can be slid over heparin tubing for additional slack on the table.
  • Dock Delivery System (DDS) advanced through GS
    • Change fluoro to 4fps once DDS is in place and dock deployment begins.
  • Dock deployed in a timely fashion ;)
  • Temp pacer inserted and tested.
  • DDS removed and Pigtail inserted over exchange  J for valve crossing
  • J wire exchanged for Safari 2
  • Pigtail and GS removed
  • 14mm balloon advanced for septostomy
  • Balloon removed
  • Valve delivery system advanced
  • Valve deployed. Septum evaluated with echo for shunting and PVL.
    • remind MD to lower FIO2*** Delivery system removed and MPA inserted for LA pressure measurement.
  • RHC performed with 6F swan to evaluate ASD
  • All equipment removed
  • Preclosure closed and stitch to RFV, manual pressure LFV
  • Woggle vs Dermabond depending on Protamine


APPROVED: MD initials MM/YY

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