TMVI - Encircle Sapien M3: Difference between revisions

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{| class="wikitable"
{| class="wikitable"
!colspan="6"|Short Procedure Name
! colspan="6" |Short Procedure Name
|-
|-
!Anesthesia
!Anesthesia
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*Possible Swan
*Possible Swan
|
|
*Biplane Fluoro  
*Biplane Fluoro
*TEE
*TEE
|
|
*Femoral Vein x2  
*Femoral Vein x2
*Radial Artery x1
*Radial Artery x1
|
|
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==Sheaths:==
==Sheaths:==
===Open:===
===Open:===
*Micropuncture set
*Micropuncture set
*5/6 Slender Daniels sheath
*5/6 Slender Daniels sheath
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*(2) 6F STRAIGHT PIGTAIL 110CM
*(2) 6F STRAIGHT PIGTAIL 110CM
*5F MPA1
*5F MPA1
*6F ballon wedge


=='''Standby'''==
=='''Standby'''==
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*PROBE COVER
*PROBE COVER
*STAT LOCK WITH STRING SECUREMENT
*STAT LOCK WITH STRING SECUREMENT
*0-Prolene
*(2)0-Prolene
*CHLORAPREP AND PREP TRAY
*CHLORAPREP AND PREP TRAY
*DERMABOND
*(2) FLUORO DRAPES (FOR LATERAL BASE AND IVY POLE ONCE IT IS MOVED TO THE END OF THE FIELD)
*(2) FLUORO DRAPES (FOR LATERAL BASE AND IVY POLE ONCE IT IS MOVED TO THE END OF THE FIELD)
*36X36 BANDBAG (FOR LATERAL DETECTOR)
*36X36 BANDBAG (FOR LATERAL DETECTOR)
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****Dilate with 8F
****Dilate with 8F
****Preclose
****Preclose
*Pigtail advanced through 6F sheath and LVgram performed
*Mitral annulus denoted on live monitor screen in A plane
*SL1 inserted over .032 kit wire
*SL1 inserted over .032 kit wire
*Baylis needle inserted through SL1 and atrial septum puncture performed.
*Baylis needle inserted through SL1 and atrial septum puncture performed.
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*1cm Amplatz Super Stiff advanced and MPA and SL1 removed
*1cm Amplatz Super Stiff advanced and MPA and SL1 removed
*Edwards Guide Sheath (GS) advanced
*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
*DDS prepped
**1L Hep. Saline (2U/2ml) bags with pressure bags spiked with heparin tubing, flushed, and attached to pump
**1L Hep. Saline (2U/2ml) bags with pressure bags spiked with heparin tubing, flushed, and attached to pump
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**After hookup and flush, Swiftlink cover can be slid over heparin tubing for additional slack on the table.
**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 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 ;)
*Dock deployed in a timely fashion ;)
*Temp pacer inserted and tested.
*DDS removed and Pigtail inserted over exchange  J for valve crossing
*DDS removed and Pigtail inserted over exchange  J for valve crossing
*J wire exchanged for Safari 2 and Pigtail removed
*J wire exchanged for Safari 2  
*Pigtail and GS removed
*14mm balloon advanced for septostomy
*14mm balloon advanced for septostomy
*Balloon and GS removed
*Balloon removed  
*Valve delivery system advanced
*Valve delivery system advanced
*When valve is in place, temp pacer inserted and tested.
*Valve deployed. Septum evaluated with echo for shunting and PVL.
*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.
*Delivery system removed and MPA inserted for LA pressure measurement.
*RHC performed with 6F swan to evaluate ASD
*All equipment removed
*All equipment removed
*Preclosure closed and stitch to RFV
*Preclosure closed and stitch to RFV, manual pressure LFV
*8F vein exchanged for 9F 10cm sheath
*
*Secure sheath with Statlock. Tegaderm both sides.
*Tegaderm both sides.


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Revision as of 05:06, 19 June 2020

DANIELS

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


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 2 WIRE
  • (1) AMPLATZ SUPER STIFF 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 CATHETER
  • EP QUAD CABLE
  • DUAL RED/BLACK 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 HEPARINIZED SALINE
  • (2) 60ML SYRINGE
  • (2) 20ML SYRINGE
  • (1) HIGH PRESSURE STOPCOCK
  • 30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION)

VALVE- SUPPLIED BY EDWARDS

  • INDEFLATOR
  • CRIMPER
  • E SHEATH
  • DELIVERY SYSTEM
  • VALVE

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

  • (1) PERCLOSE
  • 3 PORT MANIFOLD  
  • ACIST- 100% CONTRAST
  • PROBE COVER
  • STAT LOCK WITH STRING SECUREMENT
  • (2)0-Prolene
  • CHLORAPREP AND PREP TRAY
  • (2) FLUORO DRAPES (FOR LATERAL BASE AND IVY POLE ONCE IT IS MOVED TO THE END OF THE FIELD)
  • 36X36 BANDBAG (FOR LATERAL DETECTOR)
  • 2L HEP SALINE ON ALARIS PUMP
  • That's right, I said IVY pole.
  • (2) Alaris pump
  • (2) Heparin tubing
  • (2) 72” pressure tubing
  • Swiftlink cover

MEDICATIONS

  • BUPIVACAINE/LIDOCAINE MIX
  • EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
  • ROTAGLIDE 10ML (PRE VALVE)

STANDBY EMERGENCY ECMO SUPPLIES

  • 16F ARTERIAL CANNULA
  • 21F VENOUS CANNULA
  • (2) PERCLOSE
  • ECMO INSTRUMENT TRAY
  • AMPLATZ SUPER STIFF

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/2ml) 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
  • Tegaderm both sides.


APPROVED: MD initials MM/YY

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