TMVI - Encircle Sapien M3: Difference between revisions

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{{Warn|<BR>THIS IS A RESEARCH PROCEDURE.  ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM.<BR> DO NOT THROW AWAY ANY BOXES.}}
{{Warn|<BR>THIS IS A RESEARCH PROCEDURE.  ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM.<BR> DO NOT THROW AWAY ANY BOXES.}}


{{Warn|<BR>If broadcasting case:<BR>DO NOT PUT PATIENT INFO INTO MCKESSON OR XRAY. PHI CANNOT BE STREAMED. <BR>CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE.}}
{{Warn|If broadcasting case:<BR>DO NOT PUT PATIENT INFO INTO MCKESSON OR XRAY. PHI CANNOT BE STREAMED. <BR>CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE.}}




Revision as of 16:52, 12 August 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
  • 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 Wire
  • (1) Amplatz SS 260cm 1cm Tip

Standby

  • Baylis ProTrack wire

CATHETERS

Open

  • (1) 6F Straight Pigtail 110cm
  • (1) 5F Straight Pigtail 110cm
  • 5F MPA1
  • 6F ballon wedge

Standby

  • 6F MPA1 125cm

PACING

  • 5F Josephson Pacing Cable
  • EP Quad Cable
  • 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 Heparanized Saline
  • (3) 60ml Syringe
  • (3) 20ml Syringe
  • (2) High Pressure stopcock
  • 30mL Contrast (mixed with 170ml Hep Saline for 15% concentration)

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

  • (2) Perclose  
  • (3-4) 20ml syringes for flush (For DDS and sheath)
  • ACIST- 100% CONTRAST
  • (2)0-Prolene
  • 2L Hep Saline on Alaris IV pump set at 425 mmHg - Click this link to see pressure adjustment process
  • (2) Alaris pump
  • (2) Heparin tubing
  • (2) 72” pressure tubing
  • Swiftlink cover

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

  • 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/ml) 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
  • Woggle vs Dermabond depending on Protamine


APPROVED: MD initials MM/YY

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