TMVI: Difference between revisions

From Bay Area Structural Heart Wiki
← Older editNewer edit →
VisualWikitext
Warneh (talk | contribs)
422 edits
No edit summary
No edit summary
Line 1: Line 1:
{{Warn|This page needs revision!}}<BR>
 
{{Protip|Need Alcohol in lab for this procedure!}}
{{Protip|Need Alcohol in lab for this procedure!}}


'''TransCatheter Mitral Valve Repair/Replacement'''
'''TransCatheter Mitral Valve Insertion'''


Per Rosalie:
Per Rosalie:


TAVR/TMVI
TMVI


#Edwards Sapien 3 Ultra (20, 23 & 26mm) and Sapien 3 (29mm) – scan the valve barcode (box) in McKesson for documentation and charges.  Bundle includes valve, delivery system, crimper, e sheath intro set, balloon cath & locking syringe.  With the new inventory system (POU) space is limited in entering item full description.   If pre dilatation Edwards balloon is necessary free text the balloon used in procedure notes (McKesson).
#Edwards Sapien 3 Ultra (20, 23 & 26mm) and Sapien 3 (29mm) – scan the valve barcode (box) in McKesson for documentation and charges.  Bundle includes valve, delivery system, crimper, e sheath intro set, balloon cath & locking syringe.  With the new inventory system (POU) space is limited in entering item full description.   If pre dilatation Edwards balloon is necessary, free text the balloon used in procedure notes (McKesson).
#Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).
#Medtronic Core Valve – all items are charged separately.  Scan all barcodes (delivery system, loading system and valve).


MITRAL CLIP (Mitral/Tricuspid):
MITRAL CLIP (Mitral/Tricuspid):
Line 43: Line 43:
|}
|}
==Open:==
==Open:==
===SHEATHS:===
===Sheaths:===
 
*Micropuncture
*Micropuncture
*8fr Pinnacle for Perclose
*8fr Pinnacle for Perclose
*Perclose (If Spies is primary, NO perclose if Daniles is primary.)
*Perclose (If Spies is primary, NO perclose if Daniels is primary.)
*8. 5F Agilis
*8.5F Agilis
*16F E sheath, '''always''', regardless of valve size.
*16F E sheath, '''always''', regardless of valve size.


=== WIRES: ===
=== Wires: ===
*150 J wire
*150 J wire
*Safari 2
*Safari 2


===* NEW - Baylis Transseptal===
===Baylis:===
 
* VersaCross system
* VersaCross system
* Grounding pad
* Grounding pad


===Bellow items on standby!===*SL1 sheath
=== Misc: ===
* Large curve Baylis needle
*Baylis cable
*0.32 x 260 J-wire
=== MISC: ===
*Naked 3 Port Manifold
*Naked 3 Port Manifold
*Alligator pacing cable
*Alligator pacing cable


=== CATHETERS: ===
=== Catheters: ===
*6fr. Straight Pig
 
=== Septal dilation: ===
*12X4X75 Mustang'''for 23mm and 26mm Sapien OR''' 14mm Armada '''for 29mm Sapien'''
*Presto indeflator
 


*6fr. Straight Pig


=== SEPTAL DILATION: ===
===Edwards valve:===
*12X4X75 MUSTANG '''for 23mm and 26mm Sapien OR''' 14mm Armada '''for 29mm Sapien'''
*PRESTO INDEFLATOR
===BIPOLAR PACING ON STANDBY:===
*8x35 Brite tip
*5F Josephson Pacing Cable
*EP Quad Cable
*Remington Pacing Cable
*(2) Pacer Boxes
===FOR EDWARDS VALVE:===
*Indeflator (Second Indeflator on standby)
*Indeflator (Second Indeflator on standby)
*Crimper
*Crimper
Line 86: Line 78:
*Delivery system (Second delivery on standby)
*Delivery system (Second delivery on standby)
*Valve
*Valve
==Standby==
==Standby==
*9X4X75 MUSTANG
 
===Septal procedure:===
*9X4X75 Mustang
*14, 16 XXL Balloons
*14, 16 XXL Balloons
*TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
*Torqueview 45DEGREE delivery system (9fr. or 10fr.)
*10MM, 14MM, 18MM SEPTAL OCCLUDER
*10mm, 14mm, 18mm septal occluder
 
===Baylis Standby===
*SL1 sheath
*Large curve Baylis needle
*Baylis cable
*0.32 x 260 J-wire
 
===Bipolar pacing standby:===
*8x35 Brite tip
*5F Josephson Pacing Cable
*EP Quad Cable
*Remington Pacing Cable
*(2) Pacer Boxes


==MEDICATIONS==


*BUPIVACAINE
==Medications for table==
*EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
*ROTAGLIDE 10ML (EDWARDS VALVE)


==PROCEDURE:==
*Bupivacaine/Lidocaine
*Epinephrine 10mcg/ml in red syringe on back table secured with steri-strip
*Rotaglide 10 ml (Edwards valve only!)
 
==Procedure:==


*Patient prepped from '''navel to knees''' in sterile fashion.  
*Patient prepped from '''navel to knees''' in sterile fashion.  
*Access obtained with u/s
*Access obtained with u/s
*Dilate with 8F dilator
*Dilate with 8F dilator
*Preclose, Versacross pigtail wire advanced through perclose
*Pre-close, Versacross pigtail wire advanced through Perclose
*Versacross sheath inserted
*Versacross sheath inserted
*Transeptal puncture, then pigtail wire advanced
*Transeptal puncture, then pigtail wire advanced
Line 119: Line 128:
*Pigtail and SL1 removed.
*Pigtail and SL1 removed.
*Pacer removed.  
*Pacer removed.  
*Preclosure completed and stitch to RFV
*Perclose completed and stitch to RFV
*Dermabond access site, no dressings needed.
*Dermabond access site, no dressings needed.




== STANDBY EMERGENCY ECMO SUPPLIES ==
==ECMO Standby:==
*16fr. vented arterial cannula
*21fr. venous cannula
*Perclose x 2
*ECMO instrument tray
*180 Amplatz Super Stiff wire


* 16F ARTERIAL CANNULA
==Pericardiocentesis standby==
*Eye drape
*18g. x 10 cm. Chiba needle
*Skater introducer set
*Bard locking pigtail 6fr. or 8fr.
*60ml syringe x 3
*Stopcock
*180 Amplatz Super Stiff wire


*21F VENOUS CANNULA
*(2) PERCLOSE
*ECMO INSTRUMENT TRAY
*AMPLATZ SUPER STIFF


==STANDBY PERICARDIOCENTESIS SUPPLIES==
[[Category:Procedures]]


*EYE DRAPE
*CHIBA NEEDLE 10CM 18G
*SKATER INTRODUCER SET
*BARD LOCKING PIGTAIL 6F OR 8F
*(3) 60ML SYRINGES
*STOPCOCK
*AMPLATZ SUPER STIFF 180CM
<br>
[[Category:Procedures]]
[[Category:NeedsWork]]
<HR />
<HR />
APPROVED: MD initials MM/YY
APPROVED: MD initials MM/YY

Revision as of 16:01, 7 January 2025

Note Protip: Need Alcohol in lab for this procedure!

TransCatheter Mitral Valve Insertion

Per Rosalie:

TMVI

  1. Edwards Sapien 3 Ultra (20, 23 & 26mm) and Sapien 3 (29mm) – scan the valve barcode (box) in McKesson for documentation and charges.  Bundle includes valve, delivery system, crimper, e sheath intro set, balloon cath & locking syringe.  With the new inventory system (POU) space is limited in entering item full description.   If pre dilatation Edwards balloon is necessary, free text the balloon used in procedure notes (McKesson).
  2. Medtronic Core Valve – all items are charged separately.  Scan all barcodes (delivery system, loading system and valve).

MITRAL CLIP (Mitral/Tricuspid):

  1. Use the barcode on Mckesson screen in Lab 1 – Mitraclip (Abbott) bundle consists of (1) Steerable Guide Catheter, (2) NTR Clip Delivery System & (1) XTR Clip Delivery System.
TMVR
Anesthesia Imaging Access Pre-Procedure
  • General Anesthesia
  • A-Line Always!
  • Single Plane Fluoro
  • TEE
  • No Acist
  • Unipolar pacing
  • RVF pre-closed x 1
  • Type and Cross
  • Aspirin Given

Open:

Sheaths:

  • Micropuncture
  • 8fr Pinnacle for Perclose
  • Perclose (If Spies is primary, NO perclose if Daniels is primary.)
  • 8.5F Agilis
  • 16F E sheath, always, regardless of valve size.

Wires:

  • 150 J wire
  • Safari 2

Baylis:

  • VersaCross system
  • Grounding pad

Misc:

  • Naked 3 Port Manifold
  • Alligator pacing cable

Catheters:

  • 6fr. Straight Pig

Septal dilation:

  • 12X4X75 Mustangfor 23mm and 26mm Sapien OR 14mm Armada for 29mm Sapien
  • Presto indeflator


Edwards valve:

  • Indeflator (Second Indeflator on standby)
  • Crimper
  • E-sheath (Second E-Sheath on standby)
  • Delivery system (Second delivery on standby)
  • Valve

Standby

Septal procedure:

  • 9X4X75 Mustang
  • 14, 16 XXL Balloons
  • Torqueview 45DEGREE delivery system (9fr. or 10fr.)
  • 10mm, 14mm, 18mm septal occluder

Baylis Standby

  • SL1 sheath
  • Large curve Baylis needle
  • Baylis cable
  • 0.32 x 260 J-wire

Bipolar pacing standby:

  • 8x35 Brite tip
  • 5F Josephson Pacing Cable
  • EP Quad Cable
  • Remington Pacing Cable
  • (2) Pacer Boxes


Medications for table

  • Bupivacaine/Lidocaine
  • Epinephrine 10mcg/ml in red syringe on back table secured with steri-strip
  • Rotaglide 10 ml (Edwards valve only!)

Procedure:

  • Patient prepped from navel to knees in sterile fashion.  
  • Access obtained with u/s
  • Dilate with 8F dilator
  • Pre-close, Versacross pigtail wire advanced through Perclose
  • Versacross sheath inserted
  • Transeptal puncture, then pigtail wire advanced
  • Versacross sheath removed
  • Agilis advanced and directed to mitral valve.
  • Pigtail and Safari2 inserted through Agilis for valve crossing.
  • Safari2 wire inserted to ventricle. Simultaneous LA/LV pressure recorded.
  • Pigtail and Agilis removed.
  • 12mm/14mm balloon advanced for septostomy and possible BAV
  • Balloon removed, valve delivery system advanced.
  • When valve is in place, black alligator cable attached and pacing tested.
  • Valve deployed. Septum evaluated with echo for shunting.
  • Delivery removed and SL1 re-advanced.
  • Pigtail advanced to LV, wire removed and simultaneous LA/LV pressures recorded (maybe).
  • Pigtail and SL1 removed.
  • Pacer removed.
  • Perclose completed and stitch to RFV
  • Dermabond access site, no dressings needed.


ECMO Standby:

  • 16fr. vented arterial cannula
  • 21fr. venous cannula
  • Perclose x 2
  • ECMO instrument tray
  • 180 Amplatz Super Stiff wire

Pericardiocentesis standby

  • Eye drape
  • 18g. x 10 cm. Chiba needle
  • Skater introducer set
  • Bard locking pigtail 6fr. or 8fr.
  • 60ml syringe x 3
  • Stopcock
  • 180 Amplatz Super Stiff wire

APPROVED: MD initials MM/YY

Retrieved from "https://wiki.bayareastructuralheart.com/index.php?title=TMVI&oldid=2607"