Watchman

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)
• 5fr Straight Pigtail
• 5fr 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)

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

1. Look up patient. Make sure Type & Screen completed prior to pickup.
2. Cath Lab staff pick up patient
3. Circulating RN initiate Anesthesia SIGN-IN/Time Out
4. Anesthesia intubates patient & no longer placing arterial line. Give prophylaxis Ancef IV
5. TEE performed. Procedure aborted if clot
6. Prep patient & drape: Bilateral groin & bilateral clavicle to SUBZYPHOID
7. Micropuncture ultrasound-guided RFV access
8. 5 Fr Micropuncture sheath
9. 150 cm J Wire
10. 6 Fr Perclose pre-close RFV
11. 8 Fr dilator
12. 8.5 Fr SL 1 Sheath
13. TEE & fluro guided transeptal access & images of Left Atrial Appendage
14. Anesthesia gives Heparin IV. ACT GOAL >250-300
15. Transeptal puncture with Large Curve C1 71cm Baylis Needle
16. Measure LA pressure
17. Straight 260cm Super Stiff Amplatz wire to LA
18. SL1 exchanged out for 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
19. 6 Fr Str Pigtail to LAA. Angiogram of appendage
20. Measure and select size of Watchman device
21. Open and insert Watchman Device (Size: 21, 24, 27, 30, 33mm)
22. Deploy Device. Confirm placement to meet PASS criteria: Position Anchor, Size, Seal. Can be recaptured/reposition. Fully unscrew to deploy device.
23. Placement confirmed by LA angiogram
24. Pull out pigtail & delivery guidecatheter
25. Deploy Perclose Vein. SPIES: Hemostatic surgical suture. MD removes later.
26. Patient disposition
    1. If device deployed → PACU → ICU Stepdown.
    2. If case cancelled →PACU → Post Op → Home

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APPROVED: MD initials MM/YY