Publicité
CAUTION: Avoid puncturing or lacerating the lung, liver, bowel or any other
organs with the introducer needle.
7. Remove the syringe from the introducer needle.
8. Insert the guide wire through the introducer needle into the drainage space.
(fig. 1c)
NOTE: If using over-the-wire technique, select a guide wire that is
approximately 1 1/2 times the length of the catheter.
9. Remove the introducer needle over the guide wire and discard it. (fig. 1c)
CAUTION: If the guide wire must be withdrawn while the needle is inserted,
remove both the needle and guide wire as a unit to prevent the needle from
damaging or shearing the guide wire.
10. Estimate desired length of catheter. Trim catheter if necessary.
NOTE: If fenestrated section is too long for the patient, it may be trimmed to
length by cutting between the fenestrations.
(Fig. 1a)
PLACEMENT INTO THE PLEURAL SPACE
ANTEGRADE TUNNEL INSERTION PROCEDURE (PLEURAL DRAINAGE)
1. Make an incision at the desired catheter insertion site. Make another incision
inferior and medial to the insertion site at a distance selected for tunnel length
(generally 5 to 8 cm). (fig. 2a)
2. Create a tunnel between the two incision sites. (fig. 2b)
Guide Wire
3. Attach distal end of the catheter to the tunneler.
4. Thread tunneler and catheter from the inferior incision or catheter exit site to
Dilator
the incision at the insertion site.
5. Pull the catheter through the tunnel until the cuff is appropriately positioned.
6. Separate the catheter from the tunneler.
7. Dilate the insertion site, guiding the dilators over the guide wire. (fig. 2c)
8. Thread the peel-apart introducer sheath over the guide wire into the pleural
space. (fig. 2d)
9. Remove the guide wire and dilator as a unit, leaving the peel-apart introducer
sheath in place. (fig. 2d)
NOTE: Do not pinch the introducer sheath. Instead, place thumb over the
sheath hub to prevent either air entering or excess fluid draining from the
pleural space.
10. Pass the distal tip of the catheter into the peel-apart introducer sheath
ensuring that all fenestrations are within the pleural space. (fig. 2e)
NOTE: The most proximal fenestration is placed through the barium stripe to
enable verification of the catheter placement using fluoroscopy or x-ray.
11. Peel away the introducer sheath keeping the catheter in place.
12. Remove the stylet from the catheter. (fig. 2f )
13. Place the slide clamp on the catheter immediately proximal to the exit site.
14. Cut catheter below Y-connector.
15. Go to "Catheter to Valve Assembly Connection Procedure" section.
Guide Wire
Dilator
Guide Wire
Guide Wire
(fig. 2a)
Guide Wire
(fig. 1b)
Guide Wire
Dilator
Guide Wire
Guide Wire
Guide Wire
(fig. 2b)
Guide Wire
Guide Wire
Guide Wire
Dilator
Dilator
Dilator
RETROGRADE TUNNEL INSERTION PROCEDURE (PLEURAL DRAINAGE)
1. Make an incision at the desired catheter insertion site. (fig. 3a)
2. Dilate the insertion site, guiding the dilators over the guide wire. (fig. 3b)
3. Thread the peel-apart introducer sheath over the guide wire into the pleural
space. (fig. 3c)
4. Remove the guide wire and dilator as a unit. (fig. 3c)
NOTE: Do not pinch the introducer sheath. Instead, place thumb over the
Guide Wire
Guide Wire
sheath hub to prevent either air entering or excess fluid draining from the
pleural space.
5. Pass the distal tip of the catheter into the peel-apart introducer sheath
ensuring that all fenestrations are within the pleural space. (fig. 3d)
NOTE: The most proximal fenestration is placed through the barium stripe to
enable verification of catheter placement using fluoroscopy or x-ray.
(fig. 1c)
6. Peel away the introducer sheath.
7. Make an incision inferior and medial to the insertion site at a distance
selected for tunnel length (generally 5 to 8 cm).
8. Create a tunnel between the two incision sites. (fig. 3e)
9. Remove the stylet from the catheter. (fig. 3f )
10. Cut catheter below Y-connector.
11. Attach proximal end of the catheter to the tunneler.
12. Thread tunneler and catheter from the insertion site to the incision at the
catheter exit site.
13. Pull the catheter through the tunnel until the cuff is appropriately positioned.
14. Place the slide clamp on the catheter immediately proximal to the exit site.
Guide Wire
15. Separate the catheter from the tunneler.
16. Go to "Catheter to Valve Connection" section.
Guide Wire
Dilator
Guide Wire
Dilator
OVER-THE-WIRE INSERTION PROCEDURE (PLEURAL DRAINAGE)
1. Make an incision at the desired catheter insertion site. (fig. 4a)
2. Dilate the insertion site, guiding the dilators over the guide wire. (fig. 4b)
3. Thread the peel-apart introducer sheath over the guide wire into the pleural
space. (fig. 4c)
(fig. 2c)
4. Remove the dilator leaving the guide wire and peel-apart introducer in place.
(fig. 4c)
5. Pass the catheter over the guide wire and through the peel-apart introducer.
Ensure that all fenestrations lay within the pleural space. (fig. 4d)
NOTE: The most proximal fenestration is placed through the barium stripe to
enable verification of placement using fluoroscopy or x-ray.
6. Peel away the introducer sheath keeping the catheter in place.
7. Make an incision inferior and medial to the insertion site at a distance
selected for tunnel length (generally 5-8 cm).
8. Create a tunnel between the two incision sites. (fig. 4e)
9. Remove the guide wire and stylet from the catheter as a unit. (fig. 4f )
10. Cut catheter below Y-connector. Attach proximal end to tunneler.
(fig. 2e)
(fig. 2d)
Guide Wire
Guide Wire
Guide Wire
Guide Wire
Guide Wire
(fig. 3a)
(fig. 3b)
(fig. 3d)
(fig. 3e)
(fig. 2f)
Guide Wire
Guide W
Guide W
Guide Wire
Guide Wire
Dilator
Dilator
Guide Wire
(fig. 3c)
(fig. 3f)
Publicité
