AngioVac Tips and Tricks Procedure List Here is the products list of everything needed for an AngioVac used on EVERY case: Annex room 

  • Spectrum “Charlotte” pump frame with Viper workstation and 3/8” Flow-probe
  • X4 Pump/tubing clamps - non-sterile
  • Holder for the bubble-trap filter

 VAD/ECMO room 

  • AngioVac System Kit has sterile Circuit with 2 Capiox bubble-trap filters and 2 Waste-bags.
  • The 2nd Bubble-Trap Filter good chance it’s needed especially for IVC cases. (# CX*BT15, 150mL capacity, 170 micron filter)
  • Gore DrySeal Flex Sheath (DSF 2633 or DSF 2665)
  • AngioVac Venous cannula (C180 or C20 - depends on clot location)

 Pump room 

  • BioMedicus Arterial cannula percutaneous reinfusion - 17Fr or 19Fr
  • Quantum CP37 Centrifugal pump head
  • 60cc syringes x2 (after priming circuit attach to stopcock on top of bubble-trap filter)
  • 3L Isolyte to prime circuit, flushing during the case and expose clot in bubble-trap filter. (circuit approximately 500mL)

 CVOR core 

  • ECMO Change-out Instruments (x6 sterile Pump/tubing Clamps)

  • FYI - Ahmed DOESN’T like Avalon dilator set!

  • CathLab supplies
  • Sterile lubricant (surgilube or mineral oil)
  • Dilator set such as “Estech dilators”.  Sequential dilation with individual dilators, starting with 10, up to at least 18 (physician preference/comfort / Ahmed DOESN’T like Avalon set!)
  • Contrast
  • Indeflator
  • Stiff wire (exchange length Lunderquist wire, Amplatz superstiff)
  • Silk suture
  • 125cm or longer diagnostic catheter for venogram during IVC or PE
  • Bear Hugger (used to keep the patient warm)
  • For PE cases, having a 150cm Braided Bernstein catheter may be helpful and if possible should be stocked
  • Balloon tip catheter for crossing tricuspid valve (0.035” wire compatible preferable, Arrow, Medtronic,  or Swan-Ganz)

  If you want to “Y” in a second AngioVac filter into the system also get the following: 

  • Sterile 3/8 inch tubing, cut four pieces, 4 inches long
  • Sterile gloves
  • Sterile scissors
  • Sterile drape
  • 2 Sterile 3/8 x 3/8 x 3/8 “Y” connectors
  • A second holder for second bubble trap

 Steps to actually build the AngioVac: 

  • Open up the AngioVac box and pass up the AngioVac Circuit to the sterile field.
  • Open the bubble-trap filter that comes in the AngioVac box and place it in its respective holder on the Spectrum pump.
  • Have the sterile person remove the T-piece and connect it to bottom outlet of BTF and to top inlet of centrifugal pump head.
  • If you just want to use one filter at a time, skip to step 5. If you want to build the double filter “Y”, see below.
  • Find a small table that no one is using and open the sterile drape
  • Place all your sterile stuff on the field and dawn your sterile gloves
  • Cut four pieces of 4 inch of 3/8 inch tubing
  • Connect tubing to inlets and outlets of each filter and then connect the two 3/8 “Y” connectors to the other sides of the tubing
  • Take your recently built contraption and place in holders on Bio Console.
  • High five someone nearby for a job well done.
  • Proceed to step 5.
  • Open the Quantum centrifugal head and place it in its holder on the console as well.
  • Graciously receive lines from the field. Place the blood inlet (blue) into the inlet of the bubble-trap filter and connect the blood outlet (red) to the outlet of the centrifugal head.
  • Place a clamp on blue tape at BTF inlet tubing of the completed AngioVac circuit and spike 1 liter of Isolyte.
  • Squeeze really hard and fast to retrograde fill/prime the AngioVac circuit venting out of BTF stopcock.  (if you put two inline then clamp out one of the bubble traps at a time) Make sure that there is a 1/4” air meniscus that is present at the top of each bubble trap. The air helps to gather micro air that gets pulled out during the case. Of which there will be a ton of. Mercy there is a lot of micro air. A concerning amount, if you ask me.
  • Acquire an ACT of greater than 300 seconds and cannulate the patient with the AngioVac cannula and a femoral arterial cannula for the return. You might get 2-3-4 L/min of flow so don’t get too crazy with the Cheeze-Whiz on cannula size.
  • Make a fluid to fluid connection with the cannulas via baby-squeeze with Isolyte bag and turn the Spectrum on to begin the case.
  • Flow as good as you can. You will be pulling a ton of negative pressure to begin with as you are sucking on the clot. So get ready to pull some air out of solution, cause it’s going to happen.
  • Once you start pulling clot out, the flows will go up and down. Like a yo-yo of flow. Or a flow-yo, if you choose to call it that. As you get more clot, the meniscus of air will start to go away. When it goes away completely, you need to open up the second filter and continue to let the good times roll.
  • If you want to replace the first filter that is clotted off with a 3rd filter, you will have to ask either the sales rep, Carl, or Steve how to do this. Because Steve and Carl relieved me from the case at this point and I went home. This is the end of my tips and tricks. Good luck!