Terumo Pinnacle Destination Mode D'emploi page 6

III. For All Valve Types (TBV and CCV)
1. Make a small skin incision at the puncture site with a surgical
knife.
2. Insert a cannula into the vessel.
3. Insert a guidewire through the cannula into the vessel.
CAUTION
• Advance or withdraw the guidewire slowly. If resistance is met,
do not advance or withdraw the guidewire until the cause of
resistance has been determined.
4. Remove the cannula over the guidewire.
5. Insert the dilator and sheath together over the guidewire and into
the blood vessel and advance it to the target vessel.
6. Slowly remove the dilator leaving the sheath in the vessel. If
injection or sampling is necessary at this point, remove the
guidewire only and use the dilator hub as an injection port before
removing it.
CAUTION
• TBV Type: Loosen the TBV before removing the dilator. Then
tightly close the TBV to minimize the risk of hemorrhage or air
embolism.
• CCV Type: Be sure to remove the dilator from the sheath slowly.
Rapid withdrawal of the dilator may result in the incomplete
closing of the CCV valve, resulting in blood flow through the
valve. If this occurs, replace the dilator into the sheath and
remove again slowly.
7. The radiopaque marker will identify the sheath tip location under
fluoroscopy. The radiopaque marker is located approximately
5 mm proximal to the sheath's tip (Fig. 1). Insert an interventional
/ diagnostic device through the sheath and into the blood vessel,
then advance it to the desired location.
CAUTION
• Advance or withdraw the sheath slowly. If resistance is met,
do not advance or withdraw the sheath until the cause of
resistance has been determined.
• Before removing or inserting the interventional / diagnostic
device through the sheath, aspirate blood from the 3-way
stopcock to remove any fibrin deposition which may have
accumulated in or on the tip of the sheath.
• When puncturing, suturing, or incising the tissue near the
sheath, be careful not to damage the sheath. Do not put a
clamp on the sheath or bind it with a thread.
• When inflating a balloon at, or close to, the sheath tip, be sure
not to inflate it inside the distal end of the sheath (Fig. 6). The
radiopaque marker is located approximately 5 mm proximal
to the tip (Fig. 1) and therefore does not actually mark the true
distal tip of the sheath.
8. The side tube may also be used as a continuous infusion site by
connecting an infusion line to the 3-way stopcock.
9. When inserting, manipulating or withdrawing an interventional /
diagnostic device from the sheath, always be sure to hold the
sheath in place.
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