Watchman: Difference between revisions
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'''LEFT ATRIAL APPENDAGE CLOSURE''' | |||
=== Sheaths: === | |||
==== Open ==== | |||
* 8.5fr SL1 sheath | |||
* 8fr sheath (dilator used pre-Perclose) | |||
==== Standby ==== | |||
* 4 or 5fr Pinnacle for Arterial line | |||
* 12fr dilator | |||
=== Wires: === | |||
==== Open ==== | |||
* Amplatz Super Stiff .035x260 1cm tip | |||
* Cordis 150J | |||
==== Standby ==== | |||
* .032 J-wire (backup for SL1 wire) | |||
* 190 Supracore | |||
* Wholey / Versacore | |||
=== Baylis/TransSeptal: === | |||
==== Open ==== | |||
* Baylis generator from EP | |||
* Large curve C1 Baylis needle | |||
* Baylis cable | |||
* Grounding pad | |||
=== Misc Supplies: === | |||
==== Open ==== | |||
* Micropuncture | |||
* Probe cover | |||
* Closure | |||
** Perclose (Not Spies) | |||
** 0-Prolene or 0-PDS (Spies) | |||
* 6fr Straight Pigtail | |||
* 6fr MPA2 (Spies) | |||
* 3-port manifold | |||
* 12” extension tubing | |||
* 25g blue lido needle (Daniels) | |||
* 60cc syringe | |||
=== Watchman supplies: === | |||
* 14fr Watchman access sheath (Open as requested after TEE) | |||
* Watchman device (Size as requested after TEE) | |||
=== Pericardiocentesis: === | |||
{{Pericardiocentesis}} | |||
'''Procedure Case Log''' | '''Procedure Case Log''' | ||
| Line 7: | Line 65: | ||
TIPS FOR STAFF | TIPS FOR STAFF | ||
# Look up patient. Make sure Type & Screen completed prior to pickup. | #Look up patient. Make sure Type & Screen completed prior to pickup. | ||
# Cath Lab staff pick up patient | #Cath Lab staff pick up patient | ||
# Circulating RN initiate Anesthesia SIGN-IN/Time Out | #Circulating RN initiate Anesthesia SIGN-IN/Time Out | ||
# Anesthesia intubates patient & '''no longer''' '''placing arterial line'''. Give prophylaxis Ancef IV | #Anesthesia intubates patient & '''no longer''' '''placing arterial line'''. Give prophylaxis Ancef IV | ||
# TEE performed. Procedure '''aborted''' if '''clot''' | #TEE performed. Procedure '''aborted''' if '''clot''' | ||
# Prep patient & drape: Bilateral groin & bilateral clavicle to SUBZYPHOID | #Prep patient & drape: Bilateral groin & bilateral clavicle to SUBZYPHOID | ||
# Micropuncture ultrasound-guided RFV access | #Micropuncture ultrasound-guided RFV access | ||
# 5 Fr Micropuncture sheath | #5 Fr Micropuncture sheath | ||
# 150 cm J Wire | #150 cm J Wire | ||
# 6 Fr Perclose pre-close RFV | #6 Fr Perclose pre-close RFV | ||
# 8 Fr dilator | #8 Fr dilator | ||
# 8.5 Fr SL 1 Sheath | #8.5 Fr SL 1 Sheath | ||
# TEE & fluro guided transeptal access & images of Left Atrial Appendage | #TEE & fluro guided transeptal access & images of Left Atrial Appendage | ||
# Anesthesia gives Heparin IV. ACT GOAL >250-300 | #Anesthesia gives Heparin IV. ACT GOAL >250-300 | ||
# Transeptal puncture with Large Curve C1 71cm Baylis Needle | #Transeptal puncture with Large Curve C1 71cm Baylis Needle | ||
# Measure LA pressure | #Measure LA pressure | ||
# Straight 260cm Super Stiff Amplatz wire to LA | #Straight 260cm Super Stiff Amplatz wire to LA | ||
# SL1 exchanged out for 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve | #SL1 exchanged out for 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve | ||
# 6 Fr Str Pigtail to LAA. Angiogram of appendage | #6 Fr Str Pigtail to LAA. Angiogram of appendage | ||
# Measure and select size of Watchman device | #Measure and select size of Watchman device | ||
# Open and insert Watchman Device (Size: 21, 24, 27, 30, 33mm) | #Open and insert Watchman Device (Size: 21, 24, 27, 30, 33mm) | ||
# Deploy Device. Confirm placement to meet PASS criteria: '''P'''osition '''A'''nchor, '''S'''ize, '''S'''eal. Can be recaptured/reposition. Fully unscrew to deploy device. | #Deploy Device. Confirm placement to meet PASS criteria: '''P'''osition '''A'''nchor, '''S'''ize, '''S'''eal. Can be recaptured/reposition. Fully unscrew to deploy device. | ||
# Placement confirmed by LA angiogram | #Placement confirmed by LA angiogram | ||
# Pull out pigtail & delivery guidecatheter | #Pull out pigtail & delivery guidecatheter | ||
# Deploy Perclose Vein. SPIES: Hemostatic surgical suture. MD removes later. | #Deploy Perclose Vein. SPIES: Hemostatic surgical suture. MD removes later. | ||
# Patient disposition | #Patient disposition | ||
## If device deployed → PACU → ICU Stepdown. | ##If device deployed → PACU → ICU Stepdown. | ||
## If case cancelled →PACU → Post Op → Home | ##If case cancelled →PACU → Post Op → Home | ||
< | <br> | ||
[[Category:Procedures]] | [[Category:Procedures]] | ||
<HR> | <HR /> | ||
APPROVED: MD initials MM/YY | APPROVED: MD initials MM/YY | ||
Revision as of 17:33, 11 October 2019
LEFT ATRIAL APPENDAGE CLOSURE
Sheaths:
Open
- 8.5fr SL1 sheath
- 8fr sheath (dilator used pre-Perclose)
Standby
- 4 or 5fr Pinnacle for Arterial line
- 12fr dilator
Wires:
Open
- Amplatz Super Stiff .035x260 1cm tip
- Cordis 150J
Standby
- .032 J-wire (backup for SL1 wire)
- 190 Supracore
- Wholey / Versacore
Baylis/TransSeptal:
Open
- Baylis generator from EP
- Large curve C1 Baylis needle
- Baylis cable
- Grounding pad
Misc Supplies:
Open
- Micropuncture
- Probe cover
- Closure
- Perclose (Not Spies)
- 0-Prolene or 0-PDS (Spies)
- 6fr Straight Pigtail
- 6fr MPA2 (Spies)
- 3-port manifold
- 12” extension tubing
- 25g blue lido needle (Daniels)
- 60cc syringe
Watchman supplies:
- 14fr Watchman access sheath (Open as requested after TEE)
- Watchman device (Size as requested after TEE)
Pericardiocentesis:
Not DD or CS
Call Echo
- Micropuncture
- 75 Amplatz SS
- Pericardiocentesis tray
- Accordion drain bag
Spies
Call Echo
Supplies:
- Micro puncture
- 150cm J wire
- 4/5fr slender sheath
- 5fr straight pigtail diagnostic
- gravity drainage bag
- brown reservoir lab canister
- Two 50 or 60ml syringes
Daniels
Call Echo
Supplies
Open
Emergency Kit located in each lab containing the following items:
- Eye drape
- Skater introducer set
- Bard locking pigtail (6f or 8f)
- (3) 60ml luer lock syringe
- Amplatz super stiff .035 180cm wire
- Probe cover
- Stopcock
- Accordion drainage bag
Standby
- Chiba biopsy needle 10cm 18g
- Standard .035 150cm j wire
Procedure Case Log
TIPS FOR STAFF
- Look up patient. Make sure Type & Screen completed prior to pickup.
- Cath Lab staff pick up patient
- Circulating RN initiate Anesthesia SIGN-IN/Time Out
- Anesthesia intubates patient & no longer placing arterial line. Give prophylaxis Ancef IV
- TEE performed. Procedure aborted if clot
- Prep patient & drape: Bilateral groin & bilateral clavicle to SUBZYPHOID
- Micropuncture ultrasound-guided RFV access
- 5 Fr Micropuncture sheath
- 150 cm J Wire
- 6 Fr Perclose pre-close RFV
- 8 Fr dilator
- 8.5 Fr SL 1 Sheath
- TEE & fluro guided transeptal access & images of Left Atrial Appendage
- Anesthesia gives Heparin IV. ACT GOAL >250-300
- Transeptal puncture with Large Curve C1 71cm Baylis Needle
- Measure LA pressure
- Straight 260cm Super Stiff Amplatz wire to LA
- SL1 exchanged out for 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
- 6 Fr Str Pigtail to LAA. Angiogram of appendage
- Measure and select size of Watchman device
- Open and insert Watchman Device (Size: 21, 24, 27, 30, 33mm)
- Deploy Device. Confirm placement to meet PASS criteria: Position Anchor, Size, Seal. Can be recaptured/reposition. Fully unscrew to deploy device.
- Placement confirmed by LA angiogram
- Pull out pigtail & delivery guidecatheter
- Deploy Perclose Vein. SPIES: Hemostatic surgical suture. MD removes later.
- Patient disposition
- If device deployed → PACU → ICU Stepdown.
- If case cancelled →PACU → Post Op → Home
APPROVED: MD initials MM/YY
