MedComp HEMO-FLOW Gebrauchsanleitung Seite 8

Caution: DO NOT bend sheath/dilator during insertion as bending
will cause the sheath to prematurely tear. Hold sheath/dilator close
to the tip (approximately 3cm from tip) when initially inserting
through the skin surface. To progress the sheath/dilator towards
the vein, regrasp the sheath/dilator a few centimeters
(approximately 5cm) above the original grasp location and push
down on the sheath/dilator. Repeat procedure until sheath/dilator
is fully inserted.
Note: For alternate sheath method, see Micro Puncture Insertion
Method Section.
Caution: Never leave sheath in place as an indwelling catheter.
Damage to the vein will occur.
12. Install end cap over dilator opening to prevent blood loss or air
embolism.
Caution: Do not clamp the dual lumen portion of the catheter.
Clamp only the extensions. Do not use serrated forceps, use only
the in-line clamps provided.
13. Remove dilator and end cap from sheath.
14. Insert distal tip of catheter into and through the sheath until
catheter tip is correctly positioned in the target vein.
15. Remove the tear-away sheath by slowly pulling it out of the
vessel while simultaneously splitting the sheath by grasping the
tabs and pulling them apart (a slight twisting motion may be
helpful).
Caution: Do not pull apart the portion of the sheath that remains
in the vessel. To avoid vessel damage, pull back the sheath as far as
possible and tear the sheath only a few centimeters at a time.
16. Make any adjustments to catheter under fluoroscopy. The
venous distal tip should be positioned at the level of the caval
atrial junction or beyond into the right atrium to ensure optimal
blood flow.
Note: Femoral catheter tip placement is recommended at the
junction of the iliac vein and the inferior vena cava.
17. Attach syringes to both extensions and open clamps. Blood
should aspirate easily from both arterial and venous sides. If
either side exhibits excessive resistance to blood aspiration,
the catheter may need to be rotated or repositioned to obtain
adequate blood flows.
18. Once adequate aspiration has been achieved, both lumens
should be irrigated with saline filled syringes using quick bolus
technique. Assure that extension clamps are open during
irrigation procedure.
19. Close the extension clamps, remove the syringes, and place an
end cap on each luer lock connector. Avoid air embolism by
keeping extension tubing clamped at all times when not in use
and by aspirating then irrigating the catheter with saline prior
to each use. With each change in tubing connections, purge air
from the catheter and all connecting tubing and caps.
20. To maintain patency, a heparin lock must be created in both
lumens. Refer to hospital heparinization guidelines.
Caution: Assure that all air has been aspirated from the catheter
and extensions. Failure to do so may result in air embolism.
21. Once the catheter is locked with heparin, close the clamps and
install end caps onto the extensions' female luers.
22. Confirm proper tip placement with fluoroscopy. The distal
venous tip should be positioned at the level of the caval atrial
junction or into the right atrium to ensure optimal blood flow
(as recommended in current NKF DOQI Guidelines).
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