Mitral Clip: Difference between revisions

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*(5) High Pressure Stopcock
*(5) High Pressure Stopcock
*8F Sheath for dilator - (also used as a backup sheath)
*8F Sheath for dilator - (also used as a backup sheath)
*Perclose  
*Perclose
*0 Prolene suture on a CT-1 needle (Spies)
*0 Prolene suture on a CT-1 needle (Spies)
*60cc syringe
*60cc syringe
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==Procedure==
==Procedure==


* Anesthesia will obtain radial art line prior to draping.  
*Anesthesia will obtain radial art line prior to draping.
* Pre procedure TEE imaging performed  
*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 mid-sternum to leading edge of stool. Make sure there is direct contact between stool and plate.  
*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 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.  
*Prep patient and drape per usual. Drape anesthesia pole and or xray shield.
* Obtain RFV access, dilate with 8F, Preclose. Hand MD .032wire loaded into micropuncture after perclose deployment.  
*Obtain RFV access, dilate with 8F, Preclose. Hand MD .032wire loaded into micropuncture after perclose deployment.
* SL1 introduced over .032 wire.  
*SL1 introduced over .032 wire.
* Baylis needle inserted and echo imaging performed. Septostomy performed.  
*Baylis needle inserted and echo imaging performed. Septostomy performed.
* Baylis needle removed. .032wire inserted. Wire and dilator removed.  
*Baylis needle removed. .032wire inserted. Wire and dilator removed.
* MPA and Jwire inserted to pulmonary vein. Give MD Amplatz SS to shape.  
*MPA and Jwire inserted to pulmonary vein. LA pressure measured. Give MD Amplatz SS to shape.
* Jwire removed and Amplatz SS advanced.  
*Jwire removed and Amplatz SS advanced.
* MPA removed.  
*MPA removed.
* SL1 removed  
*SL1 removed
* 20F dilator inserted and removed  
*20F dilator inserted and removed
* MitraClip Guide inserted.
*MitraClip Guide inserted.
* Setup stabilizer and silicone sheet. Hand MD 60ml syringe with short extension tubing for aspiration.  
*Setup stabilizer and silicone sheet. Hand MD 60ml syringe with short extension tubing for aspiration.
* Amplatz wire and dilator removed. Clip inserted.  
*Amplatz wire and dilator removed. Clip inserted.
* Drips should be maintained at 1drip every 4seconds.  If bubbles are seen on echo, turn drips down.  
*Drips should be maintained at 1drip every 4seconds.  If bubbles are seen on echo, turn drips down.
* When clip is being deployed turn room lights up and drips up.  
*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.
*LA pressure measured. Set up for subsequent clips if needed.
*Prolene used for groin closure.




*Bullet list of typical procedure steps
BACK TABLE SETUP
*More steps
 
* 108" Tubing spikes handed off to circulator, keep rollers on sterile field.
* Follow Rep instructions for device prep.
 
<br />
 
*
 


  Inset alternative steps
  Inset alternative steps
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        [[Category:Procedures]]
          [[Category:Procedures]]


APPROVED: MD initials MM/YY
APPROVED: MD initials MM/YY

Revision as of 21:36, 23 October 2019

DRAFT

Mitral Clip
Anesthesia Imaging Access Pre-Procedure
General Fluoro, TEE, and ICE

Femoral Vein

Big Equipment:

Open

  • Cath pack
  • Lift / Footstool / Support base
  • Clear Plexiglass base support
  • Sterile System Stabilizer
  • Baylis generator (Mitral only)
  • ICE 8fr. and SwiftLink cover (Tricuspid only)
    • 9fr x 23cm Pinnacle for ICE

Baylis/transseptal:

Not used for Tricuspid clipping

Open

  • SL1 TransSeptal sheath
  • Large curve Baylis needle
  • Baylis cable
  • Grounding pad

Standby

  • BRK1 transseptal needle (Rarely used)

Wires:

Open

  • Cordis 260J
  • Cordis 150J
  • Amplatz SuperStiff 1cm Tip

Standby

  • .032 X 260 “J” wire
  • .014 X 190 BMW wire

Catheters:

Open

  • 5F MPA2

Misc supplies:

Open

  • (2) 108cm High pressure IV Lines
  • (5) High Pressure Stopcock
  • 8F Sheath for dilator - (also used as a backup sheath)
  • Perclose
  • 0 Prolene suture on a CT-1 needle (Spies)
  • 60cc syringe
  • 12” extension (Keep stickers to label flush tubing)
  • (2) Sterile towel packs for back table
  • 3 port manifold to measure LA pressure only
  • Fluoro cover to anesthesia IV pole or moving xray shield
  • 20F Dilator
  • Needle driver
  • Micropuncture
  • U/S probe cover
  • dump bag

Standby

  • Additional Perclose
  • Pericardiocentesis supplies

Non-Sterile Supplies

  • (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 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 RFV access, dilate with 8F, Preclose. Hand MD .032wire loaded into micropuncture after perclose deployment.
  • SL1 introduced over .032 wire.
  • Baylis needle inserted and echo imaging performed. Septostomy performed.
  • Baylis needle removed. .032wire inserted. Wire and dilator removed.
  • MPA and Jwire inserted to pulmonary vein. LA pressure measured. Give MD Amplatz SS to shape.
  • Jwire removed and Amplatz SS advanced.
  • MPA removed.
  • SL1 removed
  • 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 1drip every 4seconds. 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.
  • LA pressure measured. Set up for subsequent clips if needed.
  • Prolene used for groin closure.


BACK TABLE SETUP

  • 108" Tubing spikes handed off to circulator, keep rollers on sterile field.
  • Follow Rep instructions for device prep.



Inset alternative steps
or notes
Start line with a space
     More spaces inset more

APPROVED: MD initials MM/YY

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