amym
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A sterile preparation of the right groin and a 8-French sheath was introduced into the right femoral vein, and using a ---- steerable octapolar catheter, location of the coronary sinus was marked. After the sterile preparation of the skin surrounding the previous defibrillator implant in the left deltopectoral area with antiseptic scrub, this area was carefully covered with a Steri-Drape followed by the application of sterile towels and a split laparotomy sheet.
Then 0.25% Marcaine was administered into the area of the previously performed defibrillator pocket for local anesthesia. An incision was made over the previous incisional site, and using sharp and blunt dissection, the defibrillator pocket was explored, and the leas were then carefully dissected to their insertion into the defibrillator header. The device was then removed from the ICD pocket, and the leads were carefully separated from the device with an appropriate wrench.
At this point, under the guide of fluoroscopy and a left upper extremity venogram, the left axillary vein was accessed, and a 9-French sheath was introduced. Using a long coronary sinus sheath over a Glidewire, the coronary sinus was cannulated, and a selective venogram was performed through a balloon tipped catheter. Using a subselect coronary sinus catheter, a new LV lead was placed into the high lateral coronary sinus branch with good pace sense parameters.
Patient lead parameters were measured for the following:
1. RV Lead, Right atrial lead and the new LV lead
The new lead was secured to the underlying pectoral fascia with 0 Ethibond sutures. At this point, the leads were then inserted into the appropriate posts of the new defibrillator device, with particular attention so that the terminal pins were aligned correctly into the header and the set screws were then tightened, and the leads were then inserted into the previously performed ICD pocket, and proper device function was confirmed. The pocket was irrigated with antibiotic solution, and then the subcutaneous tissue was closed with absorbable suture, and skin was closed with continuous absorbable suture.
A sterile occlusive dressing was applied and compression dressing was applied on top of that.
A sterile preparation of the right groin and a 8-French sheath was introduced into the right femoral vein, and using a ---- steerable octapolar catheter, location of the coronary sinus was marked. After the sterile preparation of the skin surrounding the previous defibrillator implant in the left deltopectoral area with antiseptic scrub, this area was carefully covered with a Steri-Drape followed by the application of sterile towels and a split laparotomy sheet.
Then 0.25% Marcaine was administered into the area of the previously performed defibrillator pocket for local anesthesia. An incision was made over the previous incisional site, and using sharp and blunt dissection, the defibrillator pocket was explored, and the leas were then carefully dissected to their insertion into the defibrillator header. The device was then removed from the ICD pocket, and the leads were carefully separated from the device with an appropriate wrench.
At this point, under the guide of fluoroscopy and a left upper extremity venogram, the left axillary vein was accessed, and a 9-French sheath was introduced. Using a long coronary sinus sheath over a Glidewire, the coronary sinus was cannulated, and a selective venogram was performed through a balloon tipped catheter. Using a subselect coronary sinus catheter, a new LV lead was placed into the high lateral coronary sinus branch with good pace sense parameters.
Patient lead parameters were measured for the following:
1. RV Lead, Right atrial lead and the new LV lead
The new lead was secured to the underlying pectoral fascia with 0 Ethibond sutures. At this point, the leads were then inserted into the appropriate posts of the new defibrillator device, with particular attention so that the terminal pins were aligned correctly into the header and the set screws were then tightened, and the leads were then inserted into the previously performed ICD pocket, and proper device function was confirmed. The pocket was irrigated with antibiotic solution, and then the subcutaneous tissue was closed with absorbable suture, and skin was closed with continuous absorbable suture.
A sterile occlusive dressing was applied and compression dressing was applied on top of that.
