MedComp Split-Tip-LT-Katheter Gebrauchsanleitung Seite 6

1. Strict aseptic technique must be used during insertion,
maintenance, and catheter removal procedures. Provide a sterile
operative field. The Operating Room is the preferred location for
catheter placement. Use sterile drapes, instruments, and
accessories. Shave the skin above and below the insertion site.
Perform surgical scrub. Wear gown, cap, gloves, and mask. Have
patient wear mask.
2. The selection of the appropriate catheter length is at the sole
discretion of the physician. To achieve proper tip placement, proper
catheter length selection is important. Routine x-ray should always
follow the initial insertion of this catheter to confirm proper
placement prior to use.
3. Administer sufficient local anesthetic to completely anesthetize the
insertion site.
4. Make a small incision at the exit site on the chest wall
approximately 8-10cm below the clavicle. Make a second incision
above and parallel to the first, at the insertion site. Make the
incision at the exit site wide enough to accommodate the cuff,
approximately 1cm.
5. Use blunt dissection to create the subcutaneous tunnel opening.
If catheter contains a stylet, unthread stylet cap and slide tip into
the arterial lumen until the tip is no longer visible. Attach venous
lumen to trocar. Slide catheter tunneling sleeve over the catheter
making certain that the sleeve covers the arterial holes of the
catheter. Insert the trocar into the exit site and create a short
subcutaneous tunnel. Do not tunnel through muscle. The tunnel
should be made with care in order to prevent damage to
surrounding vessels.
Warning: Do not over-expand subcutaneous tissue during tunneling.
Over-expansion may delay/prevent cuff in-growth.
6. Lead catheter into the tunnel gently. Do not pull or tug the
catheter tubing. If resistance is encountered, further blunt
dissection may facilitate insertion. Remove the catheter from the
trocar and sleeve.
Caution: Do not pull tunneler out at an angle. Keep tunneler straight to
prevent damage to catheter tip.
Note: A tunnel with a wide gentle arc lessens the risk of kinking. The
tunnel should be short enough to keep the Y-hub of the catheter from
entering the exit site, yet long enough to keep the cuff 2cm (minimum)
from the skin opening.
Note: For alternate insertion method, see Insertion Without Stylet
Section.
7. Push stylet back into catheter and tighten stylet cap onto arterial
catheter luer. Thread stylet tip into oval hole of venous lumen to
allow the stylet tip to extend beyond the venous tip.
8. Irrigate catheter with saline, then clamp venous extensions and
cap stylet to assure that saline is not inadvertently drained from
lumens. Use clamp and injection cap provided.
9. Insert the introducer needle with attached syringe into the target
vein. Aspirate to insure proper placement.
10. Remove the syringe and place thumb over the end of the needle to
prevent blood loss or air embolism. Draw flexible end of guidewire
back into advancer so that only the end of the guidewire is visible.
Insert advancer's distal end into the needle hub. Advance guidewire
with forward motion into and past the needle hub into the target
vein.
Caution: The length of the wire inserted is determined by the size of the
patient. Monitor patient for arrhythmia throughout this procedure. The
patient should be placed on a cardiac monitor during this procedure.
Cardiac arrhythmias may result if guidewire is allowed to pass into the
right atrium. The guidewire should be held securely during this
procedure.
11. Remove needle, leaving guidewire in the target vein. Enlarge
cutaneous puncture site with scalpel.
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