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Mechanical Thrombectomy (MT)
Mechanical Thrombectomy (MT)
Print worksheet here and have nurse document all data points and scan to patients chart when complete
Pre-intervention pressures must be measured from all of the following locations via a pigtail flush catheter if possible:
Right atrium
Right ventricle
Pulmonary artery
Pulmonary angiography (if desired)
Rates should be between 10 and 20 mL/second, for a total volume of 20-40 mL
Injections should be performed into one lung at a time
Thrombectomy should be performed using a device that is FDA cleared for pulmonary artery thrombus removal
Inari FlowTriever
Penumbra Flash 16
Post-intervention pressures must be measured from all of the following locations:
Right atrium
Right ventricle
Pulmonary artery
Obtain post-intervention venous blood gas from the main pulmonary artery
Document post-intervention O2 saturation from pulse ox
Catheter Directed Thrombolysis (CDL)
Catheter Directed Thrombolysis (CDL)
Intra-procedure
Intra-procedure
Print worksheet here and have nurse document pre-intervention pressures and scan to patients chart when complete
Pre-intervention pressures must be measured from all of the following locations via a pigtail flush catheter if possible:
Right atrium
Right ventricle
Pulmonary artery
Advance at least 1 sheath (7 French or greater) into the main pulmonary artery for post-procedure pressure measurements
Pulmonary angiography (if desired)
Rates should be between 10 and 20 mL/second, for a total volume of 20-40 mL
Injections should be performed into one lung at a time
Thombolysis should be performed using a device that is FDA cleared for pulmonary circulation (EKOS) according to the following recommendations:
0.5-1 mg/hr per catheter
2 mg bolus may be administered at operator's discretion
Recommended total tPA infusion: 7-8 mg per catheter (14-16 mg if 2 catheters used)
Total amount of tPA administered must not exceed 20 mg
Post-procedure
Post-procedure
Monitor the following labs every 6 hours:
anti-Xa level
CBC
Discontinue lysis at or before maximum tPA administration (20 mg) reached
Measure and document post-intervention main pulmonary artery pressure through the sheath prior to removal of lysis catheter(s)
Obtain post-intervention venous blood gas from the main pulmonary artery through the sheath
Document post-intervention O2 saturation from pulse ox
Remove lysis catheter(s) and sheath(s)
Resume systemic therapeutic anticoagulation once hemostasis obtained
Clinical Worsening or Trial Arm Crossover
Clinical Worsening or Trial Arm Crossover
If a participant becomes hypotensive, severely hypoxemic or dyspneic, or otherwise unstable the physician may use any life-saving measure that he/she deems necessary (including systemic thrombolysis, MT, CDL, surgical therapy, intubation with mechanical ventilation, or mechanical circulatory support).
Please document in chart one of the guidelines for instability justifying crossover from "Anticoagulation Alone" to CDT:
Cardiac arrest or need for CPR
Signs of shock (any of the following):
new-onset persistent arterial hypotension (systolic blood pressure (SBP) below 90 mmHg or SBP drop by at least 40 mm Hg, over at least 15 minutes and despite an adequate volume status
need for vasopressors to maintain SBP of at least 90 mmHg), accompanied by end-organ hypoperfusion (altered mental status; oliguria/anuria)
increased serum lactate
Placement on extracorporeal membrane oxygenation (ECMO)
Intubation, or initiation of noninvasive mechanical ventilation
National Early Warning Score (NEWS) of 8 or higher (calculate here). The NEWS score tallies points based on respiratory rate, oxygen saturation and need for supplementation, temperature, systolic blood pressure, heart rate, and level of consciousness
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