Ingredients

Sterile field – gown, gloves, swabs, drapes, povidone-iodine, wound kit with scissors, scalpel, forceps, swab clamp

Local anaesthetic – syringe, large needle, small needle, LA agent

Balloon – introducer needle, 11 scalpel, guide-wire, dilator(s), balloon

Pressure trace – pressurised hepsal bag, long connector

Pump – connector

Securing – #1 suture, swabs, adherent dressing

Preparation

Position the patients so both groins are accessible. Feel the femoral pulses.

Assess for peripheral vascular disease – feel distal pulses, check for imaging if appropriate

Retract abdominal fat apron with Sleek tape if needed.

After scrubbing in, prepare the sterile field with povidone-iodine, apply drapes.

Technique

Use left hand to feel pulse, keep a swab on the right side to catch any blood, and the guidewire for easy-access

Insert the needle into the femoral artery, looking for pulsating flow.

Insert the wire all the way, don’t force it, and remove the needle, always control the guide-wire.

Incise the fascia lata with the scalpel.

Apply the smallest dilator. Bleeding may be expected. Leave the dilator in until balloon ready to be inserted to minimise bleeding.

Wipe the wire with a wet sponge if bloody.

Measure the length of insertion (sternal angle to umbilicus to insertion point), and move the proximal holder to the desired length.

Remove the stylet already present in the balloon’s pressure lumen.

Ensure balloon is empty of air by aspirating 30ml with an empty syringe.

Insert the balloon over the wire. Withdraw the wire until it is seen on the other side of the balloon.  Insert the balloon upto the proximal holder.

Attach 3-way valve – aspirate blood and discard, flush the balloon with saline.

Attach the pressure transducer and observe the pressure-wave.

Secure the balloon at both points on the thigh with sutures, and apply sterile dressings.

Connect the balloon to the pump.