MedComp Symetrex Mode D'emploi page 9

DIRECTIONS FOR CATHETER EXCHANGE
Only a qualified, licensed physician or other qualified health care professional
under the direction of a physician should insert, manipulate, and remove this
catheter. The medical procedures, technique, and methods outlined in these
Instructions For Use are not meant to be a replacement for the physician's ex-
perience and judgment in treating any particular patient nor do they represent
the only medically acceptable protocols available. K/DOQI Guidelines recom-
mend the use of fluoroscopic visualization for placement.
CAUTION:
Hospital or unit protocol, potential complications and their
treatment, warnings and precautions must be reviewed prior to catheter
removal.
CAUTION:
Insert, maintain and remove catheter under strict Aseptic
conditions and technique.
1. If necessary, cut sutures from suture wings following hospital protocol
for skin sutures.
2. Use blunt or sharp dissection to free cuff from the tissue at exit site.
3. Advance guidewire with forward motion through the venous lumen into
the designated position, unless contraindicated.
NOTE:
Guidewire must be the proper length so the guidewire will extend distal
to the tip of the catheter for the duration of the placement procedure.
4. Hold the guidewire in place while gently pulling out the catheter over the
wire.
CAUTION:
Remove catheter with care. Sharp, jerking motions and undue
force may tear catheter.
5. Immediately apply manual pressure to the puncture site after removal to
control bleeding.
6. Flush each lumen of the replacement catheter with flushing solution.
7. Insert a stylet into each lumen of catheter and secure to catheter using
luer lock connector.
8. Using standard technique, pass stylets and catheter over guidewire.
9. Once the guidewire exits through the luer connector, hold the guidewire
securely and advance the catheter over the wire, through the existing
tunnel until proper catheter tip positioning is confirmed with fluoroscopic
visualization, per K/DOQI guidelines.
CAUTION:
The guidewire should be held securely during this procedure. For
jugular insertion, allowing the guidewire to pass into the right atrium may
result in cardiac arrhythmias. Patient should be placed on a cardiac monitor
and monitored for arrhythmia throughout the jugular insertion procedure.
Do not advance the catheter and stiffener past the tip of the guidewire as this
could cause vessel perforation and/or bleeding.
10. Once position is confirmed, slowly remove guidewire.
11. Leaving the catheter in place, gently remove stylet and immediately
clamp extension lines.
12. Attach needleless injection site luer caps.
13. Attach syringes to both extensions and open clamps. Aspirate blood from
both lumens. Blood should aspirate easily. Once proper blood aspiration
has been established, ensure both luers are unclamped and flush both
lumens with flushing solution.
CAUTION:
Take the following steps to avoid air embolism. Ensure that the
internal valve of the needleless injection site caps are in their closed position
between uses. Aspirate then irrigate the catheter with saline prior to each
use. Purge air from the catheter and all connecting tubing whenever tubing
connections are changed.
CAUTION:
Clamp only the extension tubes with the in-line clamps provided
with the Symetrex® Long Term Hemodialysis Catheter. Do not use forceps and
do not clamp the distal portion of the catheter. Do not clamp over stylets.
14. Attach syringes filled with an anticoagulant solution (per designated
priming volume as labeled on catheter) and instill the solution into the
lumens of the catheter. Clamp each extension line.
15. Immediately after insertion, make any adjustments to catheter un-
der fluoroscopy. Note: For jugular insertion, the distal tip should be
placed within the right atrium confirmed by fluoroscopy for optimal flow
(National Kidney Foundation Dialysis Outcomes Quality Initiative (DOQI)
Guideline 2, K/DOQI Update 2006).
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