Watchman: Difference between revisions

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'''LEFT ATRIAL APPENDAGE CLOSURE'''
'''LEFT ATRIAL APPENDAGE CLOSURE'''
Anesthesia/TEE/Type and Screen


===Sheaths:===
===Sheaths:===
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*5fr MPA2 (Spies)
*5fr MPA2 (Spies)
*3-port manifold
*3-port manifold
*60cc syringe


===Watchman supplies:===
===Watchman supplies:===
Line 55: Line 56:
*Watchman device (Size as requested after TEE)
*Watchman device (Size as requested after TEE)


===Pericardiocentesis===
===PROCEDURE===
{{Pericardiocentesis}}
 
==Procedure Case Log==
 
===TIPS FOR STAFF===


#Look up patient. Make sure Type & Screen completed prior to pickup.
#Basic table set up ONLY until it is determined by TEE that case will proceed.
#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'''
#TEE performed. Procedure '''aborted''' if '''clot'''
#Prep patient & drape: Bilateral groin & bilateral clavicle to SUBZYPHOID
#Prep bilateral groins and drape once probe has been inserted.
#Micropuncture ultrasound-guided RFV access
#Micropuncture ultrasound-guided RFV access
#5 Fr Micropuncture sheath
#5 Fr Micropuncture sheath  
#150 cm J Wire
#Baby J wire from sheath
#6 Fr Perclose pre-close RFV
#8 Fr dilator
#8 Fr dilator
#6 Fr Perclose pre-close RFV.  .032 wire inserted after preclosure deployment.
#8.5 Fr SL 1 Sheath
#8.5 Fr SL 1 Sheath
#Baylis needle inserted
#TEE & fluoro guided transeptal access & images of Left Atrial Appendage
#TEE & fluoro 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
#Needle removed and .032 wire inserted to advance SL1 into LA
#Measure LA pressure
#Measure LA pressure
#Straight 260cm Super Stiff Amplatz wire to LA
#MPA preloaded with J wire inserted through SL1
#SL1 exchanged out for 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
#J wire removed and 260cm SS Amplatz advanced to LA (preshaped by MD)
#5 Fr Str Pigtail to LAA. Angiogram of appendage
#Straight 260cm Super Stiff Amplatz wire to LUPV
#MPA and SL1 removed
#14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
#5 Fr Str Pigtail advanced over ''back loaded'' J wire to the LAA
#Hook pigtail up to manifold for angiogram of LAA
#Measure and select size of Watchman device
#Measure and select size of Watchman device
#Open and prep Watchman Device - Device prep - Open touhy, exercise delivery, leave touhy open and attach to manifold with pressurized saline open to device to flush, close touhy (Size: 21, 24, 27, 30, 33mm)
#Open and prep Watchman Device -  
#*Open touhy
#*Exercise delivery  
#*Advance feet of device to just inside of marker
#*Leave touhy open and attach to manifold with pressurized hep saline open, close touhy and flush to device. Tap through delivery system while flushing. (Size: 21, 24, 27, 30, 33mm)
#Pigtail removed just prior to delivery system insertion.
#Insert delivery with a wet-to-wet connection (leaving pressurized saline on)
#Insert delivery with a wet-to-wet connection (leaving pressurized saline on)
#Once inserted, begin filling delivery system with contrast.  Delivery system takes 20ml to fill.
#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
#Delivery system removed as MD tamps perclose knot.
#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


<br>
<br>

Revision as of 00:19, 12 December 2019

LEFT ATRIAL APPENDAGE CLOSURE

Anesthesia/TEE/Type and Screen

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
    • 0-Prolene or 0-PDS (Spies)
  • 5fr Straight Pigtail
  • 5fr MPA2 (Spies)
  • 3-port manifold

Watchman supplies:

  • 14fr Watchman access sheath (Open as requested after TEE)
  • Watchman device (Size as requested after TEE)

PROCEDURE

  1. Basic table set up ONLY until it is determined by TEE that case will proceed.
  2. TEE performed. Procedure aborted if clot
  3. Prep bilateral groins and drape once probe has been inserted.
  4. Micropuncture ultrasound-guided RFV access
  5. 5 Fr Micropuncture sheath
  6. Baby J wire from sheath
  7. 8 Fr dilator
  8. 6 Fr Perclose pre-close RFV. .032 wire inserted after preclosure deployment.
  9. 8.5 Fr SL 1 Sheath
  10. Baylis needle inserted
  11. TEE & fluoro guided transeptal access & images of Left Atrial Appendage
  12. Anesthesia gives Heparin IV. ACT GOAL >250-300
  13. Transeptal puncture
  14. Needle removed and .032 wire inserted to advance SL1 into LA
  15. Measure LA pressure
  16. MPA preloaded with J wire inserted through SL1
  17. J wire removed and 260cm SS Amplatz advanced to LA (preshaped by MD)
  18. Straight 260cm Super Stiff Amplatz wire to LUPV
  19. MPA and SL1 removed
  20. 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
  21. 5 Fr Str Pigtail advanced over back loaded J wire to the LAA
  22. Hook pigtail up to manifold for angiogram of LAA
  23. Measure and select size of Watchman device
  24. Open and prep Watchman Device -
    • Open touhy
    • Exercise delivery
    • Advance feet of device to just inside of marker
    • Leave touhy open and attach to manifold with pressurized hep saline open, close touhy and flush to device. Tap through delivery system while flushing. (Size: 21, 24, 27, 30, 33mm)
  25. Pigtail removed just prior to delivery system insertion.
  26. Insert delivery with a wet-to-wet connection (leaving pressurized saline on)
  27. Once inserted, begin filling delivery system with contrast. Delivery system takes 20ml to fill.
  28. Deploy Device. Confirm placement to meet PASS criteria: Position Anchor, Size, Seal. Can be recaptured/reposition. Fully unscrew to deploy device.
  29. Placement confirmed by LA angiogram
  30. Delivery system removed as MD tamps perclose knot.


APPROVED: MD initials MM/YY

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