Mitral Clip: Difference between revisions

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*Baylis cable
*Baylis cable
*Grounding pad
*Grounding pad
====Standby====
*BRK1 transseptal needle (Rarely used)


===Wires:===
===Wires:===


====Open====
====Open====
*.032 X 260 “J” wire
*.032 X 260 “J” wire
*Amplatz SuperStiff 1cm Tip
*Amplatz SuperStiff 1cm Tip
 
*150J
====Standby====
*.014 X 190 BMW wire
*Cordis 150J


===Catheters:===
===Catheters:===
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*(5) High Pressure Stopcock
*(5) High Pressure Stopcock
*8F Sheath for dilator - (also used as a backup sheath)
*8F Sheath for dilator - (also used as a backup sheath)
*Perclose (x2 for Spies)
*(2)Perclose
*0 Prolene suture on a CT-1 needle (Spies)
*4-0 Vicryl/monocryl
*4-0 Vicryl
*Pickups (Either from a suture removal kit or individual from SPD)
*Pickups (Either from a suture removal kit or individual from SPD)
*(2) 60cc syringe
*(2) 60cc syringe
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*Pre procedure TEE imaging performed
*Pre procedure TEE imaging performed


*Prior to prepping patient, place MitraClip Plate (plexiglass board – hinge side up) under patient’s leg off center to the right. Place MitralClip Lift (step stool) over patients right leg, angled down towards the head. Measure 80cm from mid-sternum to leading edge of stool. Make sure there is direct contact between stool and plate.
*Prior to prepping patient, place MitraClip Plate (plexiglass board – hinge side up) under patient’s leg off center to the right. Place MitralClip Lift (step stool) over patients right leg, angled down towards the head. Measure 75cm from subxyphoid to leading edge of stool. Make sure there is direct contact between stool and plate.


*Prep patient and drape per usual. Drape anesthesia pole and/or xray shield.
*Prep patient and drape per usual. Drape anesthesia pole and/or xray shield.
*Obtain RFV access, dilate with 8F, preclose. Hand MD .032wire loaded into micropuncture sheath after Perclose deployment.
*Obtain RFV access, dilate with 8F, preclose. .032 wire inserted into perclose.
*SL1 introduced over .032 wire.
*SL1 introduced over .032 wire.
*Baylis needle inserted and echo imaging performed. Transseptal puncture performed.
*Baylis needle inserted and echo imaging performed. Transseptal puncture performed.
*Baylis needle removed. .032wire inserted. Wire and dilator removed.
*Baylis needle removed. .032wire inserted. Dilator removed
*MPA and Jwire inserted to pulmonary vein. LA pressure measured. Give MD Amplatz SuperStiff to shape.
*MPA advanced over the wire to pulmonary vein. LA pressure measured. Give MD Amplatz SuperStiff to shape.
*Jwire removed and Amplatz SuperStiff advanced.
*Amplatz SuperStiff advanced.
*MPA removed.
*MPA removed.
*SL1 removed
*SL1 removed
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*Setup stabilizer and silicone sheet. Hand MD 60ml syringe with short extension tubing for aspiration.
*Setup stabilizer and silicone sheet. Hand MD 60ml syringe with short extension tubing for aspiration.
*Amplatz wire and dilator removed. Clip inserted.
*Amplatz wire and dilator removed. Clip inserted.
*Drips should be maintained at 1 drip every 4 seconds.  If bubbles are seen on echo, turn drips down.
*Drips should be maintained at 1 drip every 3 seconds.  If bubbles are seen on echo, turn drips down.
*When clip is being deployed turn room lights up and drips up. Place bowl below to catch drips while deploying.
*When clip is being deployed turn room lights up and drips up. Place bowl below to catch drips while deploying.
*Hand MD 60ml syringe with extension tubing for aspiration while delivery system is removed.
*Hand MD 60ml syringe with extension tubing for aspiration while delivery system is removed.
*LA pressure measured. Set up for subsequent clips if needed.
*LA pressure measured. Set up for subsequent clips if needed.
*Vicryl and Prolene used for groin closure.
*Vicryl used for groin closure.


==Tricuspid Procedure==
==Tricuspid Procedure==
*MicroPuncture/US access
*MicroPuncture/US access
*Obtain RFV access, dilate with 8F, preclose.
*Obtain RFV access, dilate with 8F, preclose.
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*MitraClip Guide inserted.
*MitraClip Guide inserted.
*Proceed with normal case
*Proceed with normal case




Revision as of 18:31, 27 March 2020

DRAFT

Mitral Clip
Anesthesia Imaging Access Pre-Procedure
General Fluoro, TEE, and ICE

Femoral Vein

Procedural Gems:

  • When using the PDOII plug In MitraClip setting use TorqView 180 (smaller cable needed)

Big Equipment:

Open

  • Cath pack
  • Lift / Footstool / Support base
  • Clear Plexiglass base support
  • Sterile System Stabilizer
  • Baylis generator (Mitral only)
  • ICE 8fr. and SwiftLink cover (Tricuspid only)
    • 9fr x 23cm Pinnacle for ICE

Baylis/transseptal:

Not used for Tricuspid clipping

Open

  • SL1 TransSeptal sheath
  • Large curve Baylis needle
  • Baylis cable
  • Grounding pad

Wires:

Open

  • .032 X 260 “J” wire
  • Amplatz SuperStiff 1cm Tip
  • 150J

Catheters:

Open

  • 5F MPA2

Misc supplies:

Open

  • (2) 108cm High pressure IV Lines
  • (5) High Pressure Stopcock
  • 8F Sheath for dilator - (also used as a backup sheath)
  • (2)Perclose
  • 4-0 Vicryl/monocryl
  • Pickups (Either from a suture removal kit or individual from SPD)
  • (2) 60cc syringe
  • 12” extension (Keep stickers to label flush tubing)
  • (2) Sterile towel packs for back table
  • 3 port manifold to measure LA pressure only (not needed for Tricuspid)
  • Fluoro cover to anesthesia IV pole or moving xray shield
  • 20F Dilator
  • Micropuncture
  • U/S probe cover

Standby

  • 20fr. DrySeal for recovering wire to LUPV
  • Additional Perclose
  • Pericardiocentesis supplies

Non-Sterile Supplies

  • (2) Liter bags of heparinized saline
  • (2) Liter sized pressure bags

Procedure

  • Anesthesia will obtain radial art line prior to draping.
  • Pre procedure TEE imaging performed
  • Prior to prepping patient, place MitraClip Plate (plexiglass board – hinge side up) under patient’s leg off center to the right. Place MitralClip Lift (step stool) over patients right leg, angled down towards the head. Measure 75cm from subxyphoid to leading edge of stool. Make sure there is direct contact between stool and plate.
  • Prep patient and drape per usual. Drape anesthesia pole and/or xray shield.
  • Obtain RFV access, dilate with 8F, preclose. .032 wire inserted into perclose.
  • SL1 introduced over .032 wire.
  • Baylis needle inserted and echo imaging performed. Transseptal puncture performed.
  • Baylis needle removed. .032wire inserted. Dilator removed
  • MPA advanced over the wire to pulmonary vein. LA pressure measured. Give MD Amplatz SuperStiff to shape.
  • Amplatz SuperStiff advanced.
  • MPA removed.
  • SL1 removed
  • 20F dilator inserted and removed
  • MitraClip Guide inserted.
  • Setup stabilizer and silicone sheet. Hand MD 60ml syringe with short extension tubing for aspiration.
  • Amplatz wire and dilator removed. Clip inserted.
  • Drips should be maintained at 1 drip every 3 seconds. If bubbles are seen on echo, turn drips down.
  • When clip is being deployed turn room lights up and drips up. Place bowl below to catch drips while deploying.
  • Hand MD 60ml syringe with extension tubing for aspiration while delivery system is removed.
  • LA pressure measured. Set up for subsequent clips if needed.
  • Vicryl used for groin closure.

Tricuspid Procedure

  • MicroPuncture/US access
  • Obtain RFV access, dilate with 8F, preclose.
  • MPA2 loaded with J wire inserted. J wire removed for Amplatz Super Stiff.
  • MPA2 removed.
  • 20F dilator inserted and removed
  • MitraClip Guide inserted.
  • Proceed with normal case


BACK TABLE SETUP

  • 108" Tubing spikes handed off to circulator, keep rollers on sterile field.
  • Follow Rep instructions for device prep.


APPROVED: MD initials MM/YY

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