TEER with PASCAL
From Bay Area Structural Heart Wiki
| Anethesia | Imaging | Access |
|---|---|---|
| General | Fluoro, TEE | 4F Femoral Vein for drawing ACT's
**If functional MR/low EF Anesthesia to obtain A line and femoral venous sheath not needed |
| Pre-Procedure Watchouts | ||
| ** Tidal Volume during time-out! | ||
Big Equipment:
- Cath pack
- Clear Plexiglass base support
- Non-Sterile stabilizer provided by Rep
- Baylis generator
* NEW - Baylis Transseptal
- VersaCross system
- Grounding pad
Bellow items on standby!
- SL1 sheath
- Large curve Baylis needle
- Baylis cable
Note: When using the Philips 4D ICE probe use a 10F 30 cm (from EP) sheath for ACT draws.
Misc supplies:
- 4fr. Pinnacle sheath for ACT (not needed if anesthesia has an A line.)
- Micropuncture
- 8F Sheath for dilator only
- (1)Perclose (If Spies is primary, NO perclose if Daniles is primary.)
- 0-prolene Suture for woggle
- (2) 60cc syringe
- Sterile towel pack for back table
- Naked 3-port manifold to measure LA pressure only
- Fluoro cover to anesthesia IV pole or moving xray shield
- U/S probe cover
- back table cover
- Large and small bowl for back table
Standby
- 20fr. DrySeal for recovering wire to LUPV
- 8x40 135cm Mustang balloon
- 12fr. Short Cook sheath
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 PASCAL Lift (step stool) over patients right leg. Make sure there is direct contact between stool and plate.
- Prep patient and drape per usual. Drape anesthesia pole and/or xray shield.
- GUIDE and CLIP prepped by rep.
- Obtain RFV access, dilate with 8F, versacross pigtail wire inserted into perclose.
- Versacross sheath advaned
- Transeptal puncture, pigtail wire advanced
- Versacross sheath removed, dilate over pigtail wire
- Setup stabilizer.
- PASCAL Guide sheath inserted. Asperate 45ml of blood with a 60 cc syringes than flush with 45ml of hep saline.
- Amplatz wire and dilator removed. Clip inserted.
- Set up for subsequent clips if needed.
- Vicryl used for groin closure.
BACK TABLE SETUP
Rep's will need (2) 60 mL syringes, (1) 10 mL syringe, a large and small bowl.
All equipment prepped by reps.
