Watchman

WATCHMAN : LEFT ATRIAL APPENDAGE CLOSURE

Procedure Case Log

TIPS FOR STAFF

1. Look up patient. Make sure Type & Screen completed prior to pickup.
2. Cath Lab staff pick up patient
3. Circulating RN initiate Anesthesia SIGN-IN/Time Out
4. Anesthesia intubates patient & no longer placing arterial line. Give prophylaxis Ancef IV
5. TEE performed. Procedure aborted if clot
6. Prep patient & drape: Bilateral groin & bilateral clavicle to SUBZYPHOID
7. Micropuncture ultrasound-guided RFV access
8. 5 Fr Micropuncture sheath
9. 150 cm J Wire
10. 6 Fr Perclose pre-close RFV
11. 8 Fr dilator
12. 8.5 Fr SL 1 Sheath
13. TEE & fluro guided transeptal access & images of Left Atrial Appendage
14. Anesthesia gives Heparin IV. ACT GOAL >250-300
15. Transeptal puncture with Large Curve C1 71cm Baylis Needle
16. Measure LA pressure
17. Straight 260cm Super Stiff Amplatz wire to LA
18. SL1 exchanged out for 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
19. 6 Fr Str Pigtail to LAA. Angiogram of appendage
20. Measure and select size of Watchman device
21. Open and insert Watchman Device (Size: 21, 24, 27, 30, 33mm)
22. Deploy Device. Confirm placement to meet PASS criteria: Position Anchor, Size, Seal. Can be recaptured/reposition. Fully unscrew to deploy device.
23. Placement confirmed by LA angiogram
24. Pull out pigtail & delivery guidecatheter
25. Deploy Perclose Vein. SPIES: Hemostatic surgical suture. MD removes later.
26. Patient disposition
    1. If device deployed → PACU → ICU Stepdown.
    2. If case cancelled →PACU → Post Op → Home

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APPROVED: MD initials MM/YY