Watchman EP Misc
last updated 10/18/24 zr
See Cath Lab's Watchman Page for additional info.
(ICE/VERISIGHT IS ON HOLD as of 10/1/24. Start with TEE.
Set fluoro to 10p/s, Card Alt.
For concomitant PVI/LAAO, Woods/Spies have been omitting ICE and using TEE for the entire procedure - so subtract ICE, one 8f, and your ice sleeve.
RN:
-Large bottle of visipaque (ex, 500mL if 4 cases) + contrast spike
-3x 500cc bags of normal saline with 5000 units of heparin per bag (2 for table, 1 for transducer)
-1x 1L bag of saline with 2000 units of heparin, premade in pyxis (manifold saline - on 1L pressure bag)
-Lido w/ Epi
-Vanco (premixed in OR)
-Check with PACU for pre-op - NS 500cc bolus, 4 chewable aspirins, precedex
-Labs day of: PT-INR, Type & Screen
-Labs within 30 days: CBC, BMP, EKG
-Tell Anesthesia - Ancef + General Anesthesia
-Tell PACU - shave groins + subxiphoid
Pull list
-standby (spies): 16f Gore DrySeal, Silk + Needle Driver
-6fr Straight Pig
-Contrast Spike
-3 Port Manifold (TAVR leftover kit if possible, if not, drop a simple kit + the below 5 items) (ref 63160612)
-12" Extension
-Morse Syringe
-Pressure transducer kit
-Rotoblator Tubing
-Contrast tubing kit with large squeeze chamber/green float ball
-Long Versacross kit (230cm) (ref VXSK0032)
-Perclose
-3cc syringe for ACT
-EP Pack
-Micropuncture
-8F pinnacle (just for dilator)
-Ultrasound Cover
-RadPad
-Light Handle Cover
-The CCL Watchman Page mentions use of a 150 J Cordis - but Dr. Woods has been loading the 5fr pigtail over the 230cm versacross pigtailwire directly as of 4/2023.
-Exofin
-Ioban
-Ground pad, defib, dots, sp02, bp cuff
NOTES FOR ICE/VERISIGHT (not being used as of 10/1/24)
2 x RFV access. Please make sure to separate the wires by 10mm.
If DrySeal: 8F RFV, preclose, upsize to Dryseal, 230cm VersaCross thru Dryseal, upsize VersaCross to fixed Watchman sheath
If TrueSteer: 8F RFV, preclose, upsize to 230cm VersaCross, cross septum, upsize to TrueSteer
Either way, drop 10F 30cm Check-Flo for Philips VeriSight Pro ICE Catheter. As of 9/5/24 we're working on attaching a 10F Mullins or SL0/SL1 to VNC which we'd upsize to from Check-Flo for a second transeptal puncture for ICE. Locate a catheter in the store room in the hallway.
--check with MD whether to drop16f DrySeal OR TrueSteer (dropped by rep - deflectable watchman delivery sheath),
--10f 30cm checkflo, Verisight ICE, ice sleeve, a second perclose for the ice sheath (postclose)
--0.0 silk + needle driver only if using DrySeal
0.035" 260cm J
14f checkflo
10.5F SL1
Caudal - 10.5F RFV --> Verisight
Cranial - 8f RFV
preclose, upsize to 16f Dryseal
versacross into Dryseal, transeptal access
upsize to watchman sheath
leave pigtailwire across LA
add 0.035" 260cm J, remove pigtailwire
-Decision: 5 min timer to get ICE thru transeptal hole
if successful, proceed as normal
if unsuccessful, put ice through the watchman sheath alongside 0.035" J, withdraw watchman sheath to RA and leave ICE in RA to guide second transeptal
upsize 10.5f to 14F checkflo
VC through 14F checkflo
Second transeptal, remove VC sheath and leave pigtailwire, upsize to 10.5F SL1 in LA
Remove ICE from watchman sheath, advance through SL1 into LA
6f straight pig/Watchman delivery through watchman sheath as normal.
