TAVI - Sapien 3 (Edwards)
Transcatheter Aortic Valve Repair (Wikipedia) procedures utilize a femoral approach to deliver a stent-based aortic valve to the patients heart. There are two valve types available:
This procedure is usually done in Room 1, and requires a 5 person team: Front table scrub, Back table scrub (device prep), Circulator, Pacer/Circulator, and Recorder. The rep for the respective company will be present to assist with device prep except in the case of an emergency valve placement.
In rare cases, the BASILICA procedure will be necessary to split the existing valve leaflets to prevent blockage of the coronary arteries. In that situation, the equipment on the BASILICA page will be needed in addition to the equipment listed below.
Per Rosalie:
TAVR/TMVI
- Edwards Sapien 3 Ultra (20, 23 & 26mm) and Sapien 3 (29mm) – scan the valve barcode (box) in McKesson for documentation and charges. Bundle includes valve, delivery system, crimper, e sheath intro set, balloon cath & locking syringe. With the new inventory system (POU) space is limited in entering item full description. If pre dilatation Edwards balloon is necessary free text the balloon used in procedure notes (McKesson).
- Medtronic Core Valve – all items are charge separately. Scan all barcodes (delivery system, loading system and valve).
MITRAL CLIP (Mitral/Tricuspid):
- Use the barcode on Mckesson screen in Lab 1 – Mitraclip (Abbott) bundle consists of (1) Steerable Guide Catheter, (2) NTR Clip Delivery System & (1) XTR Clip Delivery System.
Daniels/Spies - Draft
ACIST A1000V SYRINGE USED WITH 50/50 CONTRAST MIX
Sheaths:
- 5Fr Micropunture Kit
- 6Fr x 10cm sheath
- 8Fr x 10 cm sheath (Dilator used only)
- 8Fr x 35 cm Brite Tip Sheath
- 9Fr x 10cm sheath
Wires
- (2) Cordis 150J
- Cordis 260J
- Amplatz Extra Stiff 260cm
- Terumo Stiff Straight Glidewire 0.035 x 150 cm
Catheters:
- 5Fr AL1 diagnostic
- 5Fr Ang Pigtail
- 5Fr JL4/JR4 (when doing coronary angiography)
Medications on table:
- Lido/Bupivicaine 50/50
- Epinephrine 10mcg/ml in red medallion syringe (From anesthesia)
- 10 ml Rotaglide
Miscellaneous Supplies
- Daniel’s TAVR 3-port manifold kit
- Acist hand control
- 25g 1 ½ “ Daniels Lido Needle"
- Suture Lock
- (4) Sterile Bowls
- ¾ sterile sheet or back table cover
- (2) High Pressure stopcocks
- (2) 60ml syringe
- 20 ml syringe
- (3) Perclose
Transvenous pacemaker supplies
- 5Fr Josephson Pacing catheter
- Dual Red/Black Pacing Remington cables
- EP Quad Cable
Standby ECMO & Pericardial Effusion supplies
Procedure
- Contralateral access artery -> 6fr. Sheath (normally LFA)
- RFV access -> 8.5 Brite -tip
- Primary access -> 8fr dilator -> Perclose -> Amplatz ES -> e-sheath (normally RFA)
- Use micropuncture dilator on Amplatz ES as a cheater
- Suture eSheath
- Pigtail -> LFA -> AO root
- Insert and test pacemaker
- AL1 inserted into eSheath -> Str. Stiff glide
- Cross valve
- Measure gradient
- Amplatz ES -> LV
- 8fr. Dilator on Amplatz ES as a cheater
- Insert valve delivery system
- Multiple AO grams for positioning
- Pace -> AO gram -> Pigtail pulled back -> Deploy valve
- TTE
- Pigtail advanced to AO for AO gram
- Amplatz ES exchanged for 260 J
- Delivery system removed
- Temp pacer removed
- Close primary access
- Iliac angio subtraction run for Primary access site
- Pigtail removed
- Secondary access Perclosed
- Venous sheath exchanged for 9fr. Sheath -> suture-locked
EMERGENT PERICARDIOCENTESIS
Not DD or CS
Call Echo
- Micropuncture
- 75 Amplatz SS
- Pericardiocentesis tray
- Accordion drain bag
Spies
Call Echo
Supplies:
- Micro puncture
- 150cm J wire
- 4/5fr slender sheath
- 5fr straight pigtail diagnostic
- gravity drainage bag
- brown reservoir lab canister
- Two 50 or 60ml syringes
Daniels
Call Echo
Supplies
Open
Emergency Kit located in each lab containing the following items:
- Eye drape
- Skater introducer set
- Bard locking pigtail (6f or 8f)
- (3) 60ml luer lock syringe
- Amplatz super stiff .035 180cm wire
- Probe cover
- Stopcock
- Accordion drainage bag
Standby
- Chiba biopsy needle 10cm 18g
- Standard .035 150cm j wire
Approved: MM/YY
