TTVR

From Bay Area Structural Heart Wiki
Revision as of 22:48, 15 January 2020 by Warneh (talk | contribs)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)


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