TTVR
Sheaths:[edit | edit source]
- 5Fr Micropuncture Kit
- 8Fr x 10 cm sheath (Dilator used only)
Wires[edit | edit source]
- (1) Cordis 150J
- 1 cm Amplatz Extra Stiff 260cm
Catheters:[edit | edit source]
- 6Fr Ang Pigtail
Medications on table:[edit | edit source]
- Lido/Bupivicaine 50/50
- Epinephrine 10mcg/ml in red medallion syringe (From anesthesia)
- 10 ml Rotaglide
Miscellaneous Supplies[edit | edit source]
- (4) Sterile Bowls
- Back table cover
- High Pressure stopcock
- 60ml syringe
- 20 ml syringe
- (1) Perclose
- Fluoro cover
- (3) hemostats
Transvenous pacemaker supplies[edit | edit source]
- Medtronic alligator pacing cables
- MYO/WIRE Temporary Cardiac Pacing Wire (Suture)
Standby ECMO & Pericardial Effusion supplies[edit | edit source]
Procedure[edit | edit source]
Patient on defib pads. IF PATIENT HAS ICD: DEVICE DISABLED FOR PROCEDURE, COMPANY REP PRESENT IF POSSIBLE. IF PATIENT HAS A PPM/ICD RAPID PACING WILL BE PERFORMED VIA PROGRAMER.
Leg strap secured above knees. Wrists restrained.
Patient prepped from naval to mid thigh using chlorhexidine soap followed by chloraprep with 3 minute dry time.
Towel off site. Extend Femoral drape all the way to chin.
Fluoro cover used to drape anesthesia's IV pole/x-ray shield.
No venous or arterial lines for anestesia.
Ultrasound guided access for Dr.Spies only.
FRONT TABLE
50/50 Lido and Bupivacaine mix used for local anesthetic. Have extra available on front table.
10ml of Rotaglide on table (for E sheath just prior to valve insertion)
10ml syringe of 10mcg/ml of Epinephrine taped on table.
BACK TABLE- valve prep
4 Bowls: (2) Normal Saline (1) Hep Saline (1) 30ml contrast, 170ml Hep Saline mix (15%)
60ml Syringe with contrast mixture for balloon prep
20ml Syringe for flushing delivery system
Indelator: volume dependent upon valve size
Crimper
Hemostats and scissors for valve opening
PROCEDURE STEPS
- RFV access obtained with cook needle. Verify wire position with fluoro and save an image.
- Dilate with 8F dilator than pre-close with perclose device. Perclose suture secured with hemostat.
- After perclose Esheath is advanced with .035 exchange J wire.
- Pigtail advanced to cross tricuspid valve. Once pigtail is in RV the .035 exchange J wire is exchanged for the Amplatz ES wire.
- Pigtail is removed.
- Pacing will be performed via pacing suture and alligator clip cables if patient doesn't have an existing PPM.
- Rotoglide in sheath as delivery system advanced.
- Insert valve delivery system
- Pace -> Deploy valve
- Cine length set at 40 seconds or more
- TTE
if post dilation is needed...
Rep will come up and re-prep valve, adding desired amount of additional volume
If Amplatz ES was pulled back, recross wire will be needed (260cm straight stiff glide)
- Pigtail readvanced to AO for AO gram (15/30 standard injection)
- Amplatz ES exchanged for 260 J
- Delivery system removed
- Have perclose tools and dilator ready
- Protamine given, Preclosure completed, manual pressure for 5ish minutes
EMERGENT PERICARDIOCENTESIS[edit | edit source]
Call Echo
Supplies:[edit source]
Emergency Kit located in each lab containing the following items:
- Eye drape
- Chiba biopsy needle 10cm 18g
- Skater introducer set
- Bard locking pigtail (6f or 8f)
- (3) 60ml luer lock syringe
- Standard .035 150cm j wire
- Amplatz super stiff .035 180cm wire
- Probe cover
- Stopcock
- Accordion drainage bag