Left Subclavian IABP

ROMICK

LEFT SUBCLAVIAN IABP

IF LEFT SUBCLAVIAN IS OCCLUDED OR OTHERWISE INACCESSIBLE PROCEDURE IS ABORTED. IABP SHOULD NOT BE INSERTED THROUGH RIGHT SUBCLAVIAN PER CT SURGERY.

EQUIPMENT

• MICROPUNCTURE
• (2) 4/5F SLENDER RADIAL SHEATH
• AMPLATZ EXTRA STIFF 260CM WIRE
• .035 150CM JWIRE
• 5F PIGTAIL CATHETER
• 5F JR4 DIAGNOSTIC CATHETER
• IABP KIT
• 8F 23CM SAFESHEATH (EP)
• PERCLOSE
• TR BAND

PROCEDURE

• PREP LEFT SIDE NECK AND CHEST (EAR TO NIPPLE AND SHOULDER TO MIDLINE)
  • NOTE: The access site is not an absolute (may become axillary or subclavicular) hence the large site prep.

• PREP LEFT RADIAL
• LEFT RADIAL ACCESSED AND 4/5F SLENDER SHEATH INSERTED
• PIGTAIL ADVANCED AND ANGIOGRAM PERFORMED. PIGTAIL LEFT IN PLACE AND USED AS REFERENCE FOR SUBCLAVIAN ACCESS.
• SUBCLAVIAN ACCESSED WITH ULTRASOUND AND FLUORO GUIDANCE USING MICROPUNCTURE KIT AND RADIAL SHEATH INSERTED.
• PIGTAIL CATHETER REMOVED
• J WIRE AND JR4 INSERTED AND DIRECTED TO DESCENDING AORTA.
• CATHETER AND SHEATH REMOVED, 8F DILATOR INSERTED, AND PERCLOSE ADVANCED FOR PRE-CLOSURE
• AMPLATZ WIRE ADVANCED, PERCLOSE REMOVED, 8F SAFE SHEATH ADVANCED.
• IABP INSERTED
• SHEATH PEELED AWAY
• IABP SECURED WITH SUTURE AND SITE DRESSED.
• RADIAL SHEATH REMOVED AND TR BAND APPLIED