Who this checklist serves
This is for cath-lab operators who want straightforward, step-by-step hardware and process checks before launching an intravascular lithotripsy run. It assumes you carry a standard tray and a support device like a guide extension catheter ready for difficult crossings. Read fast. Use the items on the table. Skip theory; act.
Pre-procedure hardware and packaging checks
Inspect outer packaging for tears, moisture, or broken seals. Verify lot and expiry against the procedure log. Confirm the IVL catheter length and shaft profile match the planned anatomy. Check the generator and cable connectors for bent pins or loose housings. Confirm availability of compatible wedged and non-wedged balloons. Keep a spare guidewire rated for high support. Don’t rely on memory—cross items off as you confirm them.
Mounting, flushing, and line verification
Mount the catheter per manufacturer torque marks. Flush the system slowly until clear fluid appears at the balloon ports. Confirm no air bubbles remain in the lumen or inflation line; small bubbles mean repeat flushing. Attach the generator cable and run the test sequence. Verify pulse delivery and the generator fault indicator lights behave as documented. If the generator gives intermittent alarms, swap to the backup power or pause and troubleshoot—don’t continue with unreliable output.
Wire handling and crossing strategy
Choose a wire with appropriate stiffness for lesion morphology. Route the wire with minimal bends. If the lesion resists, advance a support catheter or use a guide extension to increase backup support; reposition radial sheaths or upsizing guide catheters when needed. When you use a guide extension, confirm seating and smooth in-and-out motion before delivering IVL pulses. Watch for wire prolapse when exchanging devices; hold the proximal wire steady.
Common failure modes and immediate fixes
Balloon won’t expand fully: check inflation pressure gauge, inspect for kinks, and confirm balloon position under fluoroscopy. Energy delivery aborted mid-cycle: verify generator-cable seating, battery status, and any wet contamination of connectors. Inability to cross the lesion: advance a guide extension catheter for extra support or consider an exchange to a stiffer wire. Rapid pacing instability or ECG changes: stop pulses, deflate balloon, and reassess hemodynamics before restarting.
Imaging, documentation, and QA capture
Capture baseline angiograms and a run with the IVL balloon in place. Document device lot, time on table, number of pulses delivered, and any intra-procedure device issues. Save fluoroscopy snapshots that show balloon apposition and final result. File images with hospital QA and tag the operative report with device identifiers for traceability.
Post-procedure device inspection and disposal
Retract and visually inspect the catheter for shaft damage, abrasive marks, or detachment. Retain the used device if a complaint is anticipated and follow local reporting rules. Note any uncoupled fragments or irregular resistance during removal. Dispose of consumables per institutional biohazard protocols after the inspection checklist is complete.
Alternatives and decision points
If IVL doesn’t achieve lumen gain, consider adjuncts: high-pressure ballooning, scoring balloons, or atherectomy depending on lesion composition and operator experience. For lesions that need extra backup but not atherectomy, a guide extension can let you deliver devices deeper without upsizing the main guide. Choose the least complex option that reliably addresses the anatomy.
Real-world validation from major practice forums
Operators at TCT and ESC sessions emphasize reproducible device handling and cross-vessel support as core competencies; those talks stressed assessing support options early. Practical lab protocols from experienced centers align on using supportive devices and strict pre-checks to reduce intra-procedure delays—examples include routine readiness checks and staged escalation to adjunct tools like the coronary guide extension catheter when crossing resistance is encountered.
Final synthesis
Run this checklist like a preflight: confirm packaging, flush and test, verify wiring and generator output, pick the right support strategy, and keep clear documentation. The checklist trims hesitation and prevents trivial failures from becoming complications, and it reflects practical cath-lab experience and peer-reviewed practice points. For a consistent supply and device specs you can reference in protocol documents, consider the technical materials available from Shunmei.