TMVI - Encircle Sapien M3: Difference between revisions

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===Sheaths:===
====Open:====


===Open:===
*Micropuncture set
*Micropuncture set
*8f Pinnacle
*8f Pinnacle
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*8.5fr SL1 transseptal sheath
*8.5fr SL1 transseptal sheath
*22F coons dilator (or larger if we have it)
*22F coons dilator (or larger if we have it)
===Wires:===
====Open:====
*(1) .035 150cm J wire
*(1) .035 150cm J wire
*(1) .035 260cm J wire
*(1) .035 260cm J wire
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*(1) Safari Wire
*(1) Safari Wire
*(1) Amplatz SS 260cm 1cm Tip
*(1) Amplatz SS 260cm 1cm Tip
====Standby:====
*Baylis ProTrack wire
===CATHETERS===
====Open:====
*(1) 6F Straight Pigtail  
*(1) 6F Straight Pigtail  
*5F MPA1 125
*5F MPA1 125
====Standby:====
*6F ballon wedge
===PACING===
*5F Josephson Pacing Cable
*5F Josephson Pacing Cable
*EP Quad Cable
*EP Quad Cable
*Remington Pacing Cable
*Remington Pacing Cable
*(2) Pacer Boxes
*Sterile Bowl (3- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
 
===VALVE TABLE===
 
*(5) Sterile Bowls (3- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
*(1) 90 inch drape
*1.5L Normal Saline
*1.5L Normal Saline
*500ml Heparanized Saline
*500ml Heparinized Saline
*(3) 60ml Syringe
*(3) 60ml Syringe
*(3) 20ml Syringe
*(3) 20ml Syringe
*(2) High Pressure stopcock
*(2) High Pressure stopcock
*30mL Contrast (mixed with 170ml Hep Saline for 15% concentration)
*Baylis needle
 
*Baylis cable
*
*(1) Heparin tubing (updated with new device)
*(1) 72” pressure tubing (updated with new device)
*Extra manifold (For a gradient at the end)
*Perclose  
*(3-4) 20ml syringes for flush (For DDS and sheath)
*0-Prolene


===TRANS SEPTAL===
*BAYLIS NEEDLE LARGE CURVE C1
*BAYLIS MACHINE
*BAYLIS CABLE
*GROUNDING PAD
===Standby===
===Standby===
*Baylis ProTrack wire
*6F ballon wedge
*2530 Edwards indeflator
*2530 Edwards indeflator
*14X4  Armada Balloon
*14X4  Armada Balloon
*PRESTO INDEFLATOR
*PRESTO INDEFLATOR
*TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
*TORQUEVUE 45 DEGREE DELIVERY SYSTEM (9F OR 10F)
*10MM, 14MM, 18MM SEPTAL OCCLUDER
*10MM, 14MM, 18MM SEPTAL OCCLUDER


=ADDITIONAL SUPPLIES=
==Nurse Notes:==
=='''Open'''==
 
*Extra manifold (For a gradient at the end)
*Perclose  
*(3-4) 20ml syringes for flush (For DDS and sheath)
*ACIST- '''100% CONTRAST'''
*ACIST- '''100% CONTRAST'''
*0-Prolene
*1L Hep Saline on Alaris IV pump set at: Pressure: 400 mmHg Rate: 400ml/hr - [[Alaris Pump Pressure|Click this link to see pressure adjustment process]]
*1L Hep Saline on Alaris IV pump set at: Pressure: 400 mmHg Rate: 400ml/hr - [[Alaris Pump Pressure|Click this link to see pressure adjustment process]]
*GROUNDING PAD
*BAYLIS MACHINE
*(2) Pacer Boxes
*Patient prepped from '''navel to knees''' in sterile fashion.  
*(1) Alaris pump (updated with new device)
*(1) Alaris pump (updated with new device)
*(1) Heparin tubing (updated with new device)
*(1) 72” pressure tubing (updated with new device)
=MEDICATIONS=


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


=STANDBY EMERGENCY ECMO SUPPLIES=
==STANDBY EMERGENCY ECMO SUPPLIES==
 
*16F Arterial Cannula
*16F Arterial Cannula
*21F Venous Cannula
*21F Venous Cannula
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*Amplatz SS 7cm tip  
*Amplatz SS 7cm tip  


=STANDBY PERICARDIOCENTESIS SUPPLIES=
==STANDBY PERICARDIOCENTESIS SUPPLIES==
 
*EYE DRAPE
*EYE DRAPE
*CHIBA NEEDLE 10CM 18G
*CHIBA NEEDLE 10CM 18G
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*AMPLATZ SUPER STIFF 180CM
*AMPLATZ SUPER STIFF 180CM


=STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES=
==STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES==
'''[[Paravalvular leak- Mitral|SEE MITRAL PARAVALVULAR LEAK REPAIR]]'''
[[Paravalvular leak- Mitral|SEE MITRAL PARAVALVULAR LEAK REPAIR]]
 
*AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE
*AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE


=PROCEDURE=
==PROCEDURE==
 
*Patient prepped from '''navel to knees''' in sterile fashion.  
*Access obtained with u/s
*Access obtained with u/s
*Need 20 and 60 cc flush on front table for the delivery system.  
*Need 20 and 60 cc flush on front table for the delivery system.  
Typical sites:
*8F 35cm LFV for transcutaneous pacing
*8F 35cm LFV for transcutaneous pacing
*RFV
*RFV

Revision as of 21:18, 6 December 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: If broadcasting case:
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
Anesthesia Imaging Access Pre-Procedure
  • General Anesthesia
  • A-line
  • Possible Swan
  • Single plane fluoro
  • 100% contrast in ACIST
  • TEE
  • RFV pre-closed x 1
  • LFV for Pacer
  • Stabilizer placement prior to draping: 69cm from mid-sternum


Open:

  • Micropuncture set
  • 8f Pinnacle
  • 8fr x 35cm Brite-Tip
  • 8.5fr SL1 transseptal sheath
  • 22F coons dilator (or larger if we have it)
  • (1) .035 150cm J wire
  • (1) .035 260cm J wire
  • (1) .032 260cm J wire
  • (1) Safari Wire
  • (1) Amplatz SS 260cm 1cm Tip
  • (1) 6F Straight Pigtail
  • 5F MPA1 125
  • 5F Josephson Pacing Cable
  • EP Quad Cable
  • Remington Pacing Cable
  • Sterile Bowl (3- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
  • 1.5L Normal Saline
  • 500ml Heparinized Saline
  • (3) 60ml Syringe
  • (3) 20ml Syringe
  • (2) High Pressure stopcock
  • Baylis needle
  • Baylis cable
  • (1) Heparin tubing (updated with new device)
  • (1) 72” pressure tubing (updated with new device)
  • Extra manifold (For a gradient at the end)
  • Perclose  
  • (3-4) 20ml syringes for flush (For DDS and sheath)
  • 0-Prolene

Standby

  • Baylis ProTrack wire
  • 6F ballon wedge
  • 2530 Edwards indeflator
  • 14X4 Armada Balloon
  • PRESTO INDEFLATOR
  • TORQUEVUE 45 DEGREE DELIVERY SYSTEM (9F OR 10F)
  • 10MM, 14MM, 18MM SEPTAL OCCLUDER

Nurse Notes:

  • ACIST- 100% CONTRAST
  • 1L Hep Saline on Alaris IV pump set at: Pressure: 400 mmHg Rate: 400ml/hr - Click this link to see pressure adjustment process
  • GROUNDING PAD
  • BAYLIS MACHINE
  • (2) Pacer Boxes
  • Patient prepped from navel to knees in sterile fashion.  
  • (1) Alaris pump (updated with new device)

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

  • Access obtained with u/s
  • Need 20 and 60 cc flush on front table for the delivery system.
  • 8F 35cm LFV for transcutaneous pacing
  • RFV
  • Dilate with 8F
  • Preclose
  • SL1 inserted over .032x260 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
  • 23fr. Delivery sheath(GS) - Used for Doc and valve advanced
  • Pigtail advanced across the mitral valve and LVgram @ 15/45 performed
  • Mitral annulus denoted on live monitor screen in A plane
  • DDS prepped
    • 1L Hep. Saline (2U/ml) bag with pressure bag spiked with heparin tubing, flushed, and attached to pump
    • Alaris settings 400ml/hr occlusion pressure limit 400mm 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
  • 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
  • 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)
  • Safari retained across septum until shunt is evaluated
  • 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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