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11. Thread tunneler and catheter from insertion site to the incision at the
catheter exit site.
12. Pull the catheter through the tunnel until the cuff is appropriately positioned.
13. Place the slide clamp on the catheter immediately proximal to the exit site.
14. Separate the catheter from the tunneler.
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15. Go to "Catheter to Valve Assembly Connection Procedure" section.
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(fig. 4a)
(fig. 4d)
PLACEMENT INTO THE PERITONEAL SPACE
ANTEGRADE TUNNEL INSERTION PROCEDURE (PERITONEAL PROCEDURE)
1. Make an incision at the desired catheter insertion site. Make another incision
superior and medial to the insertion site at a distance selected for tunnel length
(generally 5 to 8 cm). (fig. 5a)
2. Create a tunnel between the two incision sites. (fig. 5b)
3. Attach distal end of the catheter to the tunneler.
4. Thread tunneler and catheter from the superior incision or catheter exit site
to 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. 5c)
8. Thread the peel-apart introducer sheath over the guide wire into the
peritoneal cavity. (fig. 5d)
9. Remove the guide wire and dilator as a unit, leaving the peel-apart introducer
sheath in place. (fig. 5d)
NOTE: Do not pinch the introducer sheath. Instead, place thumb over the
sheath hub to prevent excess fluid from draining out of the peritoneal cavity.
10. Pass the distal tip of the catheter into the peel-apart introducer sheath
ensuring that all fenestrations are within the peritoneal cavity. (fig. 5e)
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. 5f )
13. Place the slide clamp on the catheter immediately proximal to the exit site.
14. Cut catheter below Y-connector.
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15. Go to "Catheter to Valve Assembly Connection Procedure" section.
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(fig. 5a)
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(fig. 5d)
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Dilator
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(fig. 4b)
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(fig. 4e)
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(fig. 5b)
(fig. 5e)
RETROGRADE TUNNEL INSERTION PROCEDURE (PERITONEAL DRAINAGE)
1. Make an incision at the desired catheter insertion site. (fig. 6a)
2. Dilate the insertion site, guiding the dilators over the guide wire. (fig. 6b)
3. Thread the peel-apart introducer sheath over the guide wire into the
peritoneal cavity. (fig. 6c)
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4. Remove the guide wire and dilator as a unit. (fig. 6c)
NOTE: Do not pinch the introducer sheath. Instead, place thumb over the
sheath hub to prevent excess fluid from draining out of the peritoneal cavity.
5. Pass the distal tip of the catheter into the peel-apart introducer sheath
ensuring that all fenestrations are within the peritoneal space. (fig. 6d)
NOTE: The most proximal fenestration is placed through the barium stripe to
Dilator
enable verification of catheter placement using fluoroscopy or x-ray.
6. Peel away the introducer sheath keeping the catheter in place.
7. Make an incision superior 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. 6e)
9. Remove the stylet from the catheter. (fig. 6f )
(fig. 4c)
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.
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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.
15. Separate the catheter from the tunneler.
16. Go to "Catheter to Valve Assembly Connection Procedure" section.
(fig. 4f)
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OVER-THE-WIRE INSERTION PROCEDURE (PERITONEAL DRAINAGE)
1. Make an incision at the desired catheter insertion site. (fig. 7a)
2. Dilate the insertion site, guiding the dilators over the guide wire. (fig. 7b)
3. Thread the peel-apart introducer sheath over the guide wire into the
peritoneal cavity. (fig. 7c)
4. Remove the dilator leaving the guide wire and peel-apart introducer in place.
(fig. 7c)
5. Pass the catheter over the guide wire and through the peel-apart introducer.
Ensure that all fenestrations lay within the peritoneal cavity. (fig. 7d)
NOTE: The most proximal fenestration is placed through the barium stripe to
enable verification of placement using fluoroscopy or x-ray.
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6. Peel away the introducer sheath keeping the catheter in place.
7. Make an incision superior and medial to the insertion site at a distance
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selected for tunnel length (generally 5-8 cm).
8. Create a tunnel between the 2 incision sites. (fig. 7e)
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9. Remove the guide wire and stylet from the catheter as a unit. (fig. 7f )
10. Cut catheter below Y-connector. Attach proximal end to tunneler.
11. Thread the tunneler and catheter from the insertion site to the incision at the
catheter exit site.
12. Pull the catheter through the tunnel until the cuff is appropriately positioned.
13. Place the slide clamp on the catheter immediately proximal to the exit site.
(fig. 5c)
14. Separate the catheter from the tunneler.
15. Go to "Catheter to Valve Assembly Connection Procedure" section.
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(fig. 5f)
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(fig. 6a)
(fig. 6e)
(fig. 6d)
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(fig. 6b)
(fig. 6c)
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(fig. 6f)
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