PROCEDURE

FOR LAA
DEVICE
CLOSURE
Atrendynurse
DISCRIPTION
 Left atrial appendage closure is a treatment strategy to reduce the
risk of left atrial appendage blood clots from entering the
bloodstream and causing a stroke in patients with non-valvar atrial
fibrillation.
ARTICLES NEEDED
 Puncture needle-2(18 g or 20 g) for artery and vein Sheath introducer 11cm 10f
 long Mullen sheath 8f
 Guidewire Teflon 035 150 st tip
 Catheter marker pigtail
 Guidewire Teflon 035 150 j tip
 Septal puncture needle Long sheath with dilator Device delivery cable
 Cath lab kit with kidney tray set 3 way with pressure line
 pressure injector and syringe or contrast in 50ml syringe
PREPARATION OF STERILE
TROLLY
 Sterile Scrubbing, Gowning and Gloving Preparation of sterile
trolley Antimicrobial painting( From umbilicus to middle of thigh)
 Draping the patient in such a way that inguinal fold lies diagonal to
the hole
 Load 10 ml of xylocaine in BD syringe Load Heparin
5000iu(According to patient's weight) in 2ml syringe Flush the
puncture needle sheath, dilator catheters and guide wire
PROCEDURE
 Puncture the femoral vein and artery with puncture needle (18 GX 7CM)
Introducing 0.035"Teflon introducer wire Removing puncture needle
 Making a small incision with scalpel blade no 11
 Introducing 10F sheath with dilator in the vein
 Introducing 5F sheath with dilator in the artery Remove the dilators with wire
& flush the sheaths with heparinized saline.
 Monitor the arterial pressure through the femoral arterial sheath.
PROCEDURE
 Insert the long sheath with straight Teflon wire through the femoral
vein sheath to RA - Get an access to the LA by puncturing the
septum by using septal puncture needle with the help of echo and
fluoroscopy.
 Position the long sheath in the LA and adequate flushing to be done
with heparinized saline and monitor LA pressure.
PROCEDURE
 Heparin 5000 iu should be administered once the sheath positioned
in LA.
 Advance marker pigtail through the long sheath with Teflon wire
and reach the LA appendage.
 Take proper cine to make out the appendage size with 50ml of
contrast.
 Exchange the pigtail catheter with a Long sheath which is
compactable with the Device by using stiff Teflon wire.
PROCEDURE
 Preload the Device in the delivery cable.
 Push the device through the long sheath and position the device in
the LA appendage.
 Deploy the device with the guidance of echocardiogram(TEE is
recommended) and adequate fluoroscopy.
 Remove the sheath and compress the site till bleeding stops.
Pressure dressing to be applied to avoid bleeding complications
AAA