Arrow Arrowg+ard Blue Advance PICC Bedienungsanleitung Seite 4

slight twisting motion to a depth sufficient to enter vessel.
22. If necessary, enlarge cutaneous puncture site with cutting edge of scalpel, positioned
away from guidewire.
Warning: Do not cut guidewire to alter length.
Warning: Do not cut guidewire with scalpel.
• Position cutting edge of scalpel away from guidewire.
• Engage safety and/or locking feature of scalpel (where provided) when not in
use to reduce the risk of sharps injury.
Precaution: Do not withdraw dilator until sheath is well within vessel to reduce
risk of damage to sheath tip.
Precaution: Sufficient guidewire length must remain exposed at hub end of
sheath to maintain a firm grip on guidewire.
23. Check peel-away sheath placement by holding sheath in place, twisting dilator hub
counterclockwise to release dilator hub from sheath hub, withdraw guidewire and
dilator sufficiently to allow blood flow.
24. Holding sheath in place, remove guidewire and dilator as a unit (refer to Figure 5).
Warning: Do not apply undue force on guidewire to reduce risk of possible
breakage.
Warning: Do not leave tissue dilator in place as an indwelling catheter. Leaving
tissue dilator in place puts patient at risk for possible vessel wall perforation.
25. Quickly occlude sheath end upon removal of dilator and guidewire to reduce risk of
air entry.
Warning: Do not leave open dilators or sheaths uncapped in venous puncture
site. Air embolism can occur if air is allowed to enter a central venous access
device or vein.
26. Verify entire guidewire is intact upon removal.
27. Retract contamination guard (where provided).
Insertion using 80 or 130 cm Guidewire (where provided) under
fluoroscopy:
•
Prepare guidewire for insertion by wetting guidewire with sterile normal saline for
injection. Ensure that guidewire remains lubricious until it is inserted into patient/
catheter. Image guidance or fluoroscopy is used to gain initial venous access; catheter
placement with 80 or 130 cm guidewire is done under fluoroscopy.
• Insertion through the peel-away sheath:
• If 80 cm guidewire is used, insert guidewire into distal lumen until soft tip of
guidewire extends beyond catheter tip. Advance guidewire/catheter as a unit
through peel-away sheath to final indwelling position, while maintaining position
of distal end of guidewire.
• If 130 cm guidewire is used, insert soft tip of the guidewire through peel-away
sheath to desired depth. Thread catheter over guidewire and advance catheter over
guidewire to final indwelling position using image guidance or fluoroscopy.
• If resistance is met while advancing catheter, retract and/or gently flush while
advancing catheter.
Warning: Passage of guidewire into the right heart can cause dysrhythmias or
perforation of vessel, atrial or ventricular wall.
Precaution: Maintain firm grip on guidewire at all times. Keep sufficient
guidewire length exposed for handling purposes. A non-controlled guidewire
can lead to guidewire embolus.
Insertion using Placement wire (where provided):
•
Insert catheter through peel-away sheath to final indwelling position. Retract and/or
gently flush while advancing catheter if resistance is met.
28. Withdraw peel-away sheath over catheter until sheath hub and connected portion of
sheath is free from venipuncture site. Grasp tabs of peel-away sheath and pull away
from the catheter (refer to Figure 6), while withdrawing from vessel until sheath splits
down its entire length.
Precaution: Avoid tearing sheath at insertion site which opens surrounding
tissue creating a gap between catheter and dermis.
Figure 5
29. If catheter migrated during sheath removal, re-advance catheter to
final indwelling position.
30. Remove placement wire or guidewire. Always verify guidewires are intact upon
removal.
Warning: Remove placement wire and side-port connector as a unit. Failure to
do so may result in wire breakage.
Warning: Do not use short (33-45 cm) guidewire as a stiffening device.
31. If there is any difficulty removing placement wire or guidewire, catheter and wire
should be removed as a unit.
Warning: Do not apply undue force on placement wire or guidewire to reduce
the risk of possible breakage.
Complete Catheter Insertion:
32. Check lumen patency by attaching a syringe to each extension line and aspirate until
free flow of venous blood is observed.
33. Flush lumen(s) to completely clear blood from catheter.
34. Connect all extension line(s) to appropriate Luer-Lock connector(s) as required.
Unused port(s) may be "locked" through Luer-Lock connector(s) using standard
institutional policies and procedures.
•
Clamp(s) are provided on extension line(s) to occlude flow through each lumen
during line and Luer-Lock connector changes.
Warning: Open clamp prior to infusion through lumen to reduce risk of damage
to extension line from excessive pressure.
Secure Catheter:
35. Use catheter stabilization device and/or catheter clamp and fastener to secure
catheter (where provided).
• Use catheter hub as primary securement site.
• Use catheter clamp and fastener as a secondary securement site as necessary.
Precaution: Minimize catheter manipulation throughout procedure to maintain
proper catheter tip position.
Catheter Stabilization Device (where provided):
A catheter stabilization device should be used in accordance with manufacturer's
instructions for use.
Catheter Clamp and Fastener (where provided):
A catheter clamp and fastener are used to secure catheter when an additional securement
site other than the catheter hub is required for catheter stabilization.
Warning: Do not attach catheter clamp and fastener until either guidewire or
placement wire is removed.
•
After placement wire or guidewire has been removed and necessary lines have been
connected or locked, spread wings of rubber clamp and position on catheter body
making sure catheter surface is not moist to maintain proper securement.
•
Snap rigid fastener onto catheter clamp.
•
Secure catheter clamp and fastener as a unit to patient by using either catheter
stabilization device, stapling or suturing. Both catheter clamp and fastener need to
be secured to reduce risk of catheter migration (refer to Figure 7).
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Figure 6