Argon CLEANER 15 Bedienungsanleitung Seite 9

9. Place the device in the covered position by pushing the sliding lever to the
distal position and rotating the sliding lever to lock in the covered position
(refer to Figure 3). When in the covered position, only the flexible tip of the
sinuous wire should extend from the catheter. The device should not be
activated in the covered position.
10. Support the flexible tip between the thumb and index finger during insertion
through the sheath valve. Insert the covered device through the venous
sheath and into the venous limb of the fistula or graft.
11. In a graft, advance the flexible tip up to the venous anastomosis. Warning:
Do not advance it beyond the anastomosis. In a fistula, advance the
flexible tip up to the central most extent of the clot. Uncover the sinuous
wire by unlocking, fully retracting the sliding lever and rotating the sliding
lever until an audible "click" is heard (refer to Figure 4). Confirm device
positioning within the fistula or graft via fluoroscopy. Press the ON/OFF
switch to activate rotation.
Note: Caution should be taken while uncovering the wire to avoid
advancing the wire into the clot and past the anastomosis.
12. With the device activated, slowly withdraw the rotating sinuous wire along
the graft or fistula to break up the clot. Warning: A withdrawal rate of 1-2
cm/second is recommended when sharp radii are encountered. When
the sinuous wire reaches the tip of the venous sheath, release the switch to
turn off the rotator.
13. Cover the device and remove it from the graft or fistula. Flush the catheter
lumen with heparinized saline and manually remove any accumulated fibrin
from the sinuous wire.
14. Aspirate the macerated clot via the sheath and discard the aspirate.
Precaution: Continued unsuccessful aspiration may collapse the
sheath and graft/fistula.
15. Inject a small amount of contrast via the venous sheath to assess the
degree of thrombus removal accomplished. Warning: Avoid over-
injection of contrast to minimize the risk of arterial embolization. Treat
the residual thrombus by repeating steps 11-14 until acceptable thrombus
removal is achieved.
16. Administer local anesthetic at the puncture site for arterial sheath insertion.
Prepare and place the arterial introducer sheath per hospital protocol. The
arterial sheath should be directed toward the arterial anastomosis.
Precaution: The arterial and venous sheath tips must not overlap.
17. Support the flexible tip between the thumb and index finger during insertion
through the sheath valve. Insert the covered device through the arterial
sheath into the arterial limb of the fistula or graft.
18. In a graft, advance the flexible tip up to the arterial anastomosis. Warning:
Do not advance it beyond the anastomosis. In a fistula, advance the
Grafts and Fistulae
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