MedComp Symetrex Mode D'emploi page 6

CAUTION:
The valved pull-apart sheath/introducer is designed to reduce
blood loss and the risk of air intake but it is not a hemostasis valve. The valve
pull-apart sheath/introducer is not intended to create a complete two-way
seal nor is it intended for arterial use. The valve will substantially reduce air
intake. The valve will substantially reduce the rate of blood flow but some
blood loss through the valve may occur.
10. Remove the peel-away dilator and guidewire and gently withdraw the
dilator from the sheath.
CAUTION:
Insufficient tissue dilation can cause compression of the catheter
lumen against the guidewire causing difficulty in the insertion and removal of
the guidewire from the catheter. This can lead to bending of the guidewire.
Part B: Tunnel Catheter (Common Steps)
1. Enlarge cutaneous puncture site with scalpel. Make secondary incision
at the exit site. Ensure incision is wide enough to accommodate the
catheter and dilate skin with hemostats to accommodate the cuff,
approximately 1cm. NOTE: For jugular insertion, exit site is
approximately 8-10cm below the clavicle on chest wall.
2. Irrigate each lumen of catheter with heparinized saline and inspect for
leakage. Connect injection caps to each catheter luer.
3. Align jaws of tunneling tool with channels of distal tip of catheter. Insert
septum of distal tip of catheter into jaws of tunneling tool until the tip of
the septum meets the base of the jaws. Maintain the connection between
tunneling tool and catheter and slide tunneling sleeve over catheter until
it stops.
4. Insert tunneler into exit site and create a short subcutaneous tunnel,
emerging at the insertion site. Do not tunnel through muscle. Advance
tip of tunneler through lateral portion of incision with care to prevent
damage to surrounding vessels and nerves.
5. Gently lead the catheter through subcutaneous tract. Position proximal
catheter allowing for standard polyester cuff placement (Approx. 2cm
within tract).
6. Remove tunneler from catheter by sliding tunneling sleeve away from
catheter and completely off tunneling tool. Gently remove jaws of
tunneling tool from distal tip of catheter.
WARNING:
To prevent severe damage to catheter tip, Do not attempt to
remove tunneling tool from catheter without first removing closing sheath.
NOTE:
A tunnel with a gentle arc lessens the risk of kinking. Avoid sharp
or acute angles during implantation which could occlude the opening of the
catheter lumen(s).
Part C: Catheter Insertion Technique (Common Steps)
1. Re-flush each lumen of the catheter with heparinized saline.
2. Introduce distal section of the catheter through the valved sheath
introducer and advance it into the vein, grasping catheter close to the
sheath and using small steps to prevent kinking if necessary.
3. Position catheter. Note: For jugular insertion, the distal tip should be
placed within the right atrium confirmed by fluoroscopy for optimal flow
(National Kidney Foundation Dialysis Outcomes Quality Initiative (DOQI)
Guideline 2, K/DOQI Update 2006).
4. Break the sheath handle in half.
5. Peel the sheath apart, away and out of the vessel and remove the sheath
from the patient.
CAUTION: To avoid vessel damage, do not pull-apart any section of the sheath
until it is withdrawn from the vessel. Pull the sheath out as far as possible and
tear the sheath only a few centimeters at a time.
NOTE: It is normal to experience some resistance while pulling the catheter
through the slit on the valve. If alternate sheath is used, follow manufacturer's
instructions.
Part D: Catheter Aspiration (Common Steps)
1. Attach syringes to both extensions and open clamps. Aspirate blood from
both lumens. Blood should aspirate easily.
CAUTION: Should either side exhibit excessive resistance to blood aspiration,
the catheter may need to be rotated or repositioned to obtain adequate blood
flows. Make any adjustments to catheter under fluoroscopy.
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