why so many puncture sites with tavr and ablations?

Esme12, ASN, BSN, RN · Nov 10, 2013

sounds like they had trouble with access and then being able to feed the catheter to where they needed to go...anyone else?

Editorial Team / Admin · Nov 10, 2013

Can't really give any insight to ablations, but my facility does do TAVRs. Right IJ is generally where we put the 3-lumen central venous access and swan catheter if we use one. Radial is generally for the arterial line. These allow the anesthesiologist to keep an eye on BP, CVP, and PA pressures. Another consideration with TAVRs is the need to rapidly pace the patient while inflating the balloon that expands the collapsed valve. Generally this is done with wires inserted through the IJ. With TAVRs, there are a lot of wires and balloons going into the heart to pass the valve along and expand it, plus anything else they may need to do (why do two separate procedures if the patients needs both a valve and a stent?). Another thing to keep in mind with TAVR patients is that these are the patients who are so sick, they have been deemed non-surgical candidates, and thus are monitored very closely. Also, this is not a risk-free procedure (there really are no risk free procedures), and sometimes further intervention is needed, meaning possibly more access.

You might find this site interesting, as it includes an animation of the TAVR procedure and all that goes into inserting the valve (keep in mind this is an insertion that goes perfectly with absolutely no complications/issues): Transcatheter Heart Valve

Esme12, ASN, BSN, RN · Nov 11, 2013

I got the two....but the addition of the 2 fem lines as well...sounds like they had issues with access?

Flyboy17 · Nov 11, 2013

So with most ablations there are several catheters placed in the heart all at once. Most of these are for diagnostic and pacing reasons. The Right IJ is usually a 7fr sheath that is placed for a Coronary Sinus catheter. This cath is simply to see the internal electrical activity of the heart. Right radial is usually used for pressures since most patients get anesthesia. Bilateral femoral veins are usually two access sites. Right groin superior is for what is called an SLO or SRO Sheath that holds the Abaltion catheter. Right Groin Inferior is usually 7fr short sheath that introduces the a loop or lasso catheter for mapping the Left Atrium. Left Groin Superior is an SLO that holds a quad or decapolar catheter in the RV after the transeptal needle has been removed and the left inferior is a 10fr short sheath that introduces the Intra Cardiac Echo catheter or ICE.

What I explained here is a typical Atrial Fibrillation that requires so many sheaths just for one ablation. Hope this explains it.

Jonathan

Esme12, ASN, BSN, RN · Nov 12, 2013

THANK YOU!

NurseCollins799 · Nov 18, 2013

So with most ablations there are several catheters placed in the heart all at once. Most of these are for diagnostic and pacing reasons. The Right IJ is usually a 7fr sheath that is placed for a Coronary Sinus catheter. This cath is simply to see the internal electrical activity of the heart. Right radial is usually used for pressures since most patients get anesthesia. Bilateral femoral veins are usually two access sites. Right groin superior is for what is called an SLO or SRO Sheath that holds the Abaltion catheter. Right Groin Inferior is usually 7fr short sheath that introduces the a loop or lasso catheter for mapping the Left Atrium. Left Groin Superior is an SLO that holds a quad or decapolar catheter in the RV after the transeptal needle has been removed and the left inferior is a 10fr short sheath that introduces the Intra Cardiac Echo catheter or ICE.
What I explained here is a typical Atrial Fibrillation that requires so many sheaths just for one ablation. Hope this explains it.
Jonathan

Thanks Jonathan, I figured it wasn't missed sticks because I see approximately one post ablation patient per week and they almost always have multiple bilateral venous sticks. Your explanation helps me visualize everything, thanks!

Bossy Boss · Feb 23, 2014

We would call this a super ablation on the floor. This lets the nurse know that their will be multiple lines (sheaths), an art line and a RIJ to remove later when their patient comes up to the floor from EP lab.