Difference between revisions of "UCD Cryo A-fib"

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Line 1: Line 1:
 
==Open==
 
==Open==
 +
 +
*EP Pack
 +
*Flexcath
 +
*28mm Arctic Advance
 
*Probe Cover
 
*Probe Cover
−
*Ice Cover - Shockwave
+
*2 - Ice Cover - Shockwave
 
*Copilot
 
*Copilot
 
*Manifold + dump bag
 
*Manifold + dump bag
 
*Smart Ablate Tubing
 
*Smart Ablate Tubing
−
*EP pack
 
 
*Micropuncture
 
*Micropuncture
 +
*20ml syringes 2-4
 +
*A-line set
 +
*Pressure transducer kit x3
 
*7F locking
 
*7F locking
 
*8F locking
 
*8F locking
−
*8.5 Nonlocking
+
*8.5 Non-locking
−
*Flexcath
 
−
*6fr JSN quad
 
 
*6fr CRD 2 quad
 
*6fr CRD 2 quad
−
*28mm Arctic Advance
+
 
  
  
Line 23: Line 27:
 
!Munir
 
!Munir
 
|-
 
|-
−
|Achieve 20mm
+
|'''Stockroom'''
−
|Achieve 15mm
+
|
 
|
 
|
 
|
 
|
 
|-
 
|-
−
|Long 11fr
+
|Versacross D0
−
|Long 9fr
+
|Versacross D1
 
|
 
|
 
|
 
|
 
|-
 
|-
−
|14fr non-locking
+
|Soundstar 10Fr
 +
|Soundstar 8Fr
 +
|
 
|
 
|
 +
|-
 +
|DecaNav D
 +
|DecaNav F
 
|
 
|
 
|
 
|
 
|-
 
|-
−
|Versacross D0
 
−
|Versacross D1
 
 
|
 
|
 
|
 
|
−
|-
 
−
|Soundstar 10fr
 
−
|Soundstar 8fr
 
 
|
 
|
 
|
 
|
 
|-
 
|-
−
|DecaNav D
+
|'''Lab'''
−
|DecaNav F
+
|
 
|
 
|
 
|
 
|
 
|-
 
|-
 
|Octaray D 2-2-2
 
|Octaray D 2-2-2
−
|Octaray F  
+
|Octaray F 3-3-3
 
|
 
|
 
|
 
|
 
|-
 
|-
 
|Dynamic XT steerable quad
 
|Dynamic XT steerable quad
 +
|CRD 2 Quad
 
|
 
|
 +
|
 +
|-
 +
|Achieve 20mm
 +
|Achieve 15mm
 
|
 
|
 
|
 
|
 
|-
 
|-
−
|Standby
+
|Long 11Fr
−
|colspan = 3 |If needed for touch up post cryo or for redo afib.  
+
|Long 9Fr
 +
|
 +
|
 +
|-
 +
|14fr non-locking
 +
|Zero Gravity drape
 +
|
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|
 +
|-
 +
|'''Standby'''
 +
|colspan = 3 |''If needed for touch up post cryo or for redo afib''.  
 
|-
 
|-
 
|Smart touch thermocool STSF DF
 
|Smart touch thermocool STSF DF
Line 74: Line 98:
 
|Perclose x1
 
|Perclose x1
 
Vascade x3
 
Vascade x3
 +
|
 
|
 
|
 
|}
 
|}
Line 86: Line 111:
 
*Quad cable x 2
 
*Quad cable x 2
 
*Abalator cable
 
*Abalator cable
 +
 +
==Procedure (tech)==
 +
===Pre===
 +
Read [[UCD EP Role]] for pre and post procedural steps.
 +
*Include CMAP when patching for phrenic pacing
 +
**Cable located in C block #31-32
 +
**Attach alligator clips to patches
 +
*Set up pressure lines
 +
**Double spike Hep saline bag under pressure
 +
**Flush and connect blue pressure to transducer closest to patient on rack (P1)
 +
*Zero A-line
 +
*Assist with hooking up
 +
**Vascular US
 +
**EP cables
 +
***Achieve to pin block Blue 1-10
 +
***Deca nav to Deca
 +
***His Quad to Quad B (OK to unplug pin block quad plug)
 +
 +
===During case===
 +
*Open ablation window on live screen
 +
**right click in ablation window to change ablator.
 +
**Check dial for correct ablator.
 +
*Check that ablation switch behind ablation consoles is set to "Cryo"
 +
*Physician will place catheters and access LA.
 +
*Be ready for backup pacing post cardioversion (usually HisD)
 +
*Measure LA pressure
 +
*Measure conduction intervals
 +
*Once Cryo ballon is in LA and ablation starts do the following:
 +
**Save and label freeze frame of fluoro with location of freeze and ablation number ex: "LUPV Cryo #1" copy this text and save
 +
**Monitor ablation sequence
 +
**After ablation ends, record ablation data including copied text to Ablation End log entry comment section ex: "LUPV Cryo #1 180sec -45C"
 +
***If esophagus temp is affected, record this temp also "23C esoph"
 +
**EP study is conducted during Cryo ablation phase of procedure
 +
***Atrial Wenckebach, Atrial ERP, and VERP
 +
**When phrenic nerve is involved. Prepare to pace CMAP
 +
***Channel 4 800msec, 25mA
 +
***When freeze is initiated, come on pacing as temp passes 0C
 +
***When thawing, come off pacing as temp passes 0C
 +
 +
==Procedure (scrub)==
 +
===Pre===
 +
*Label pressure lines
 +
**Blue - Transseptal line connected to P1. Swapped to manifold during cryo ablation.
 +
**Yellow - not transduced connected to flex cath sheath.
 +
**No color - used for Octaray drip. Keep manifold on table.
 +
**A-line setup. Pre labeled red. Connects to sheath for act draws.
 +
*Setup manifold
 +
**Cap 2 middle ports for Srivasta. No dump bag
 +
**Position 1 connects to blue pressure line.
 +
*Position 4 pass off spike for pressurized saline.

Latest revision as of 20:34, 26 October 2023

Open

  • EP Pack
  • Flexcath
  • 28mm Arctic Advance
  • Probe Cover
  • 2 - Ice Cover - Shockwave
  • Copilot
  • Manifold + dump bag
  • Smart Ablate Tubing
  • Micropuncture
  • 20ml syringes 2-4
  • A-line set
  • Pressure transducer kit x3
  • 7F locking
  • 8F locking
  • 8.5 Non-locking
  • 6fr CRD 2 quad


Pezeshkian Srivatsa Cortez Munir
Stockroom
Versacross D0 Versacross D1
Soundstar 10Fr Soundstar 8Fr
DecaNav D DecaNav F
Lab
Octaray D 2-2-2 Octaray F 3-3-3
Dynamic XT steerable quad CRD 2 Quad
Achieve 20mm Achieve 15mm
Long 11Fr Long 9Fr
14fr non-locking Zero Gravity drape
Standby If needed for touch up post cryo or for redo afib.
Smart touch thermocool STSF DF Smart touch thermocool ST FJ
Perclose x1

Vascade x3

Cables

  • Achieve cable
  • Electrical umbilical cable
  • Coaxial umbilical cable
  • DecNav cable
  • Pentaray cable
  • Quad cable x 2
  • Abalator cable

Procedure (tech)

Pre

Read UCD EP Role for pre and post procedural steps.

  • Include CMAP when patching for phrenic pacing
    • Cable located in C block #31-32
    • Attach alligator clips to patches
  • Set up pressure lines
    • Double spike Hep saline bag under pressure
    • Flush and connect blue pressure to transducer closest to patient on rack (P1)
  • Zero A-line
  • Assist with hooking up
    • Vascular US
    • EP cables
      • Achieve to pin block Blue 1-10
      • Deca nav to Deca
      • His Quad to Quad B (OK to unplug pin block quad plug)

During case

  • Open ablation window on live screen
    • right click in ablation window to change ablator.
    • Check dial for correct ablator.
  • Check that ablation switch behind ablation consoles is set to "Cryo"
  • Physician will place catheters and access LA.
  • Be ready for backup pacing post cardioversion (usually HisD)
  • Measure LA pressure
  • Measure conduction intervals
  • Once Cryo ballon is in LA and ablation starts do the following:
    • Save and label freeze frame of fluoro with location of freeze and ablation number ex: "LUPV Cryo #1" copy this text and save
    • Monitor ablation sequence
    • After ablation ends, record ablation data including copied text to Ablation End log entry comment section ex: "LUPV Cryo #1 180sec -45C"
      • If esophagus temp is affected, record this temp also "23C esoph"
    • EP study is conducted during Cryo ablation phase of procedure
      • Atrial Wenckebach, Atrial ERP, and VERP
    • When phrenic nerve is involved. Prepare to pace CMAP
      • Channel 4 800msec, 25mA
      • When freeze is initiated, come on pacing as temp passes 0C
      • When thawing, come off pacing as temp passes 0C

Procedure (scrub)

Pre

  • Label pressure lines
    • Blue - Transseptal line connected to P1. Swapped to manifold during cryo ablation.
    • Yellow - not transduced connected to flex cath sheath.
    • No color - used for Octaray drip. Keep manifold on table.
    • A-line setup. Pre labeled red. Connects to sheath for act draws.
  • Setup manifold
    • Cap 2 middle ports for Srivasta. No dump bag
    • Position 1 connects to blue pressure line.
  • Position 4 pass off spike for pressurized saline.
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