MedComp SPLIT CATH III Instructions D'utilisation page 6

1. Strict aseptic technique must be used during insertion, maintenance, and
catheter removal procedures. Provide a sterile operative field. The Operating
Room is the preferred location for catheter placement. Use sterile drapes,
instruments, and accessories. Shave the skin above and below the insertion
site. Perform surgical scrub. Wear gown, cap, gloves, and mask. Have patient
wear mask.
2. The selection of the appropriate catheter length is at the sole discretion of the
physician. To achieve proper tip placement, proper catheter length selection
is important. Routine x-ray should always follow the initial insertion of this
catheter to confirm proper placement prior to use.
3. Administer sufficient local anesthetic to completely anesthetize the insertion
site.
4. Make a small incision at the exit site on the chest wall approximately 8-10cm
below the clavicle. Make a second incision above and parallel to the first, at
the insertion site. Make the incision at the exit site wide enough to
accommodate the cuff, approximately 1cm.
5. Use blunt dissection to create the subcutaneous tunnel opening. Attach
the catheter to the trocar. Slide catheter tunneling sleeve over the catheter
making certain that the sleeve covers the arterial holes of the catheter. Insert
the trocar into the exit site and create a short subcutaneous tunnel. Do not
tunnel through muscle. The tunnel should be made with care in order to
prevent damage to surrounding vessels.
5a. For Femoral Vein Insertion: Create subcutaneous tunnel with the catheter exit
site in the pelvic region.
Warning: Do not over-expand subcutaneous tissue during tunneling. Over-
expansion may delay/prevent cuff in-growth.
6. Lead catheter into the tunnel gently. Do not pull or tug the catheter tubing. If
resistance is encountered, further blunt dissection may facilitate insertion.
Remove the catheter from the trocar with a slight twisting motion to avoid
damage to the catheter.
Caution: Do not pull tunneler out at an angle. Keep tunneler straight to prevent
damage to catheter tip.
7. Split the arterial and venous lumens by grasping the distal ends and gently
pull apart the lumens to the point printed "DO NOT SPLIT BEYOND THIS
POINT".
Warning: Splitting the lumens beyond this point may result in excess tunnel
bleeding, infection, or damage to the catheter lumens.
Note: A tunnel with a wide gentle arc lessens the risk of kinking. The tunnel
should be short enough to keep the Y-hub of the catheter from entering the exit
site, yet long enough to keep the cuff 2cm (minimum) from the skin opening.
8. Irrigate catheter with saline, then clamp catheter extensions to assure that
saline is not inadvertently drained from lumens. Use clamps provided.
9. Insert the introducer needle with attached syringe, or into the target
vein. Aspirate to insure proper placement.
10. Remove the syringe, and place thumb over the end of the needle to prevent
blood loss or air embolism. Draw flexible end of guidewire back into advancer
so that only the end of the guidewire is visible. Insert advancer's distal end
into the needle hub. Advance guidewire with forward motion into and past the
needle hub into the target vein.
Caution: The length of the wire inserted is determined by the size of the patient.
Monitor patient for arrhythmia throughout this procedure. The patient should be
placed on a cardiac monitor during this procedure. Cardiac arrhythmias may result
if guidewire is allowed to pass into the right atrium. The guidewire should be held
securely during this procedure.
11. Remove needle, leaving guidewire in the target vein. Enlarge cutaneous
puncture site with scalpel.
12. Thread dilator(s) over guidewire into the vessel (a slight twisting motion may
be used). Remove dilator(s) when vessel is sufficiently dilated, leaving guide-
wire in place.
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