How Supplied - COOK Medical Gianturco-Roehm Bird's Nest Mode D'emploi

10. Loosen the Tuohy-Borst valve (Fig. 8) and while holding the wire guide
pusher stationary, withdraw the filter catheter/introducer sheath assembly
to the mark on the wire guide pusher. (Fig. 9) This movement will expose
the distal anchoring hooks. Fluoroscopically, this corresponds to the
position of the junction point of the hook wires remaining just within
the tip of the filter catheter. (Fig. 10) If this can be clearly visualized with
fluoroscopy, the mark can be ignored.
NOTE: At the end of the filter, the V-shaped hook wire struts are readily
visible, but filter wires are too fine to be identified fluoroscopically.
11. Gently advance the filter catheter/introducer sheath assembly one time,
1-3 mm, to secure the hooks to the vena cava wall. (Fig. 11)
Be certain the junction point of the distal pair of hooks is in the
catheter tip when positioning these hooks into caval wall. If there is
uncertainty regarding hook fixation, the catheter may be advanced
up over the hook wires to the edge of the hooks. The catheter may
then be repositioned, and the filter placement re-initiated in a
slightly different caval orientation or level.
CAUTION: Overly forceful or multiple jabs with the filter catheter/
introducer sheath assembly could result in perforation of the wall of
the inferior vena cava by the exposed hooks and struts of the filter.
12. Again, hold the wire guide pusher stationary and withdraw the filter
catheter/introducer sheath assembly 1-3 cm. (Fig. 12) This will facilitate
subsequent passage of the filter wires through the tip of the filter catheter
and provide room for filter formation within the vena cava.
CAUTION: Do not withdraw the filter catheter/introducer sheath
assembly into the iliac vein. Repositioning into the inferior vena cava
may prove difficult.
13. Holding the filter catheter/introducer sheath assembly stationary and
with fluoroscopic control, advance the wire guide pusher with a steady,
smooth motion until the junction point of the proximal hook wires is seen
fluoroscopically at the filter catheter tip. (Fig. 13)
CAUTION: Do not advance too quickly or forcefully as wire kinking
within filter catheter may occur, making advance ment difficult.
14. Advance the filter catheter/introducer sheath assembly so that the
proximal junction point is in close proximity to or overlaps the junction
point of previously positioned hook wires. (Fig. 14)
NOTE: The approximation or slight overlap of the junction points ensures
adequate compression and formation of the filter wires and places the
second pair of hooks in the inferior vena cava. Placement of a hook in a
renal vein or passage of filter wires distal to the first hook position (wire
prolapse) may occasionally occur and is of no consequence.
15. While maintaining slight forward pressure on the wire guide pusher,
slowly withdraw the filter catheter/introducer sheath assembly. (Fig. 15)
This will permit the proximal hook wires to exit the catheter, springing
open to engage with the caval wall. This is readily seen fluoroscopically.
To be sure the hooks are completely free from the filter catheter tip,
the filter catheter/introducer sheath assembly should be withdrawn
to within approximately 1 cm of the Bird's Nest Filter handle attached
to the wire guide pusher.
CAUTION: Do not advance the wire guide pusher after the proximal
hook wires have exited the filter catheter tip. Forceful advancement
of the wire guide pusher may alter the orientation of the filter
attachment site, making disengagement difficult.
16. Gently tug or use a slight to-and-fro motion on the wire guide pusher to
secure the second pair of hooks to the vena cava wall before disengaging
the filter. (Fig. 16)
17. To release filter:
a. Maintaining wire guide pusher position, remove the red safety lock from
the handle by grasping both sides and pulling up and away from the
handle. (Fig. 17)
b. Holding the wire guide pusher steady, use the handle to fully depress
the thumb grip of the wire guide pusher forward into the cannula.
Maintaining this position will release the filter. (Fig. 18) Separation can
be seen fluoroscopically.
c. Release pressure on the thumb grip of the han dle. (Fig. 19)
d. Pull the wire guide pusher's distal end back into the filter catheter.
(Fig. 20)
18. Remove the wire guide pusher and filter catheter, leaving the introducing
sheath in place. Reposition the sheath for a final vena cavogram.

HOW SUPPLIED

Supplied sterilized by ethylene oxide gas in peel-open packages. Intended
for one-time use. Sterile if package is unopened or undamaged. Do not use
the product if there is doubt as to whether the product is sterile. Store in a
dark, dry, cool place. Avoid extended exposure to light. Upon removal from
package, inspect the product to ensure no damage has occurred.
REFERENCES
These instructions for use are based on experience from physicians and (or)
their published literature. Refer to your local Cook sales representative for
information on available literature.
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