Tricuspid Clip

Anterior Septal imaging for Tricuspid clip

DRAFT

Tricuspid Clip
Anesthesia	Imaging	Access	Pre-Procedure
General	Fluoro TEE ICE on standby	Primary access is patient dependent 5F Venous sheath LFV for ACT's and potential ICE access	80 cm from sub-xyphoid, or 85 from mid-sternum for stool placement

• It is a good idea to have the Guide prepped around time-out since there is no transeptal; they need the guide much sooner than we're used to.
  

Big Equipment:

Open

• Cath pack
• Lift / Footstool / Support base
• Clear Plexiglass base support
• Sterile System Stabilizer

Standby

• ICE 8fr. and SwiftLink cover
• 9fr x 23cm Pinnacle for ICE
• 150cm J wire

Wires:

Open

• Amplatz SS 7cm x 260

Misc supplies:

Open

• (4) 108cm High pressure IV Lines
• (8) Stopcocks
• 8F Sheath for dilator - (also used as a backup sheath)
• (1) Perclose
• 5F MPA2
• 4-0 Vicryl/monocryl
• Pickups (Either from a suture removal kit or individual from SPD)
• (2) 60cc syringe
• (2) 12” extension (Keep stickers to label flush tubing)
  • One for 60cc syringe, one for 3-port manifold
• Sterile towel pack for back table
• Fluoro cover to anesthesia IV pole or moving xray shield
• 20F Dilator
• Micropuncture
• U/S probe cover
• 3 Port Manifold to record Pre/Post RA pressures

Standby

• Additional Perclose
• Pericardiocentesis supplies

Non-Sterile Supplies

• Set-up 2 IV poles to facilitate quick device changeover.
• (4) Liter bags of heparinized saline
• (4) Liter sized pressure bags

Procedure

• Anesthesia will obtain radial art line prior to draping.
• Pre procedure TEE imaging performed

• Prior to prepping patient, place MitraClip Plate (plexiglass board – hinge side up) under patient’s leg off center to the right. Place MitralClip Lift (step stool) over patients right leg, angled down towards the head. Measure 80cm from subxyphoid, or 85 from mid-sternum to leading edge of stool. Make sure there is direct contact between stool and plate.

• Prep patient and drape per usual. Drape anesthesia pole and/or xray shield.
• Obtain FV access, dilate with 8F, preclose. .035 wire inserted into perclose.
• Amplatz SS advanced through perclose to RV
• 20F dilator inserted and removed
• MitraClip Guide inserted.
• Setup stabilizer and silicone sheet. Hand MD 60ml syringe with short extension tubing for aspiration.
• Amplatz wire and dilator removed. Clip inserted.
• Drips should be maintained at 1 drip every 3 seconds. If bubbles are seen on echo, turn drips down.
• When clip is being deployed turn room lights up and drips up. Place bowl below to catch drips while deploying.
• Hand MD 60ml syringe with extension tubing for aspiration while delivery system is removed.
• Vicryl used for groin closure

Off Label Tricuspid Clip Notes

• Left femoral venous access (height and septal hugger)
• Guide upside down to start
• 180 degree mis key, blue line at 11 o clock
• Steer down with A "A is F"
• "Negative is L"
• Create a septal hugger by adding M
• Rotation of clip Counter clockwise to decrease septal hugger

BACK TABLE SETUP

• 108" Tubing spikes handed off to circulator, keep rollers on sterile field.

• Follow Rep instructions for device prep.

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APPROVED: MD initials MM/YY