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Careflow™ Catheter
The Merit Careflow™ Catheter is a radio-opaque polyurethane
catheter. (Central Venous, Peripheral Venous Catheters and
Radial, Femoral Arterial Catheter).
Intended Use
The Merit Careflow Central Venous Catheter is an
intravenous catheter that is intended for short term use
(no longer than 30 days) to access the human circulatory
system via insertion through either the Internal Jugular
or Subclavian Vein using Seldinger technique, where the
catheter tip resides in the superior vena cava. The Central
Venous Catheter is intended for infusion of drugs, Total
Parenteral Nutrition (TPN) fluids, large volume infusions,
repeated blood sampling and to monitor the central venous
pressure.
The Merit Careflow Arterial Catheter is intended for short term
use (no longer than 30 days) to assess the radial and femoral
arteries for repeated blood sampling and to allow invasive blood
pressure measurement.
Note: Use only as directed by a physician.
A full list of components is shown on the package lid.
General Warnings
1. Physicians must be familiar with the complications associated
with central venous catheterisation, i.e. vessel perforation, air
embolism, catheter embolism, pleural and mediastinal damage,
septicaemia, thrombosis and cardiac tamponade secondary to
vessel wall or atrial perforation.
2. Complications are associated with right atrial and inadvertent
right ventricular catheterisation. Physicians must be aware of
these complications before advancing the catheter beyond
the depth required for normal vena cava placement. Do not
advance the catheter past this depth unless procedure requires
right atrial placement. If catheter is advanced beyond normal
vena cava placement depth, monitor electrocardiogram during
insertion and confirm final position by chest X-Ray.
3. It is recommended that patients be placed in a slight
Trendelenburg position during insertion procedure to reduce the
risk of air embolism.
4. We recommend that Careflow™ Catheter lumens (Central
Venous, Peripheral Venous Catheters and Radial, Femoral
Artery Catheter) are flushed with sterile saline solution prior to
catheter insertion.
5. All catheter placements must be inspected for flow rates,
security of dressing and security of luer connections.
6. To reduce or eliminate the potential for catheter migrations,
we advise that every catheter placement be secured by suturing
at the eyelets of the junction boot housing/hub and that, where
the use of the secondary fixation device is necessary, it should
be used as additional support and not the only means of fixation.
Additionally, the security of catheter fixation and position of the
catheter tip should be checked throughout use.
7. When removing dressings at or close to catheter sites, care
must be taken to avoid severing the catheter.
8. Acetone must not come into contact with the catheter as
the material may weaken and this may result in leakage or
aspiration.
9. Exposure of product componentry to topicals containing
alcohol is not recommended.
10. Do not attempt to re-insert a partially or completely withdrawn
introducer cannula.
11. Percutaneous puncture of a central vein may be
contraindicated in patients with pulmonary hypertension.
12. Use of a syringe smaller than 5 mL to irrigate or de-clot an
occluded catheter may cause intraluminal or catheter rupture.
13. Syringes are supplied for blood aspiration only.
14. Luer connections: as standard practice the security of luer
connections must be checked routinely.
15. Physicians should be aware that central venous and arterial
catheters are intended for use no longer than 30 days.
16. Patients with suspected hypersensitivity to nickel should
undergo skin test to assess hypersensitivity prior to use of Merit
Guidewires in the placement of central venous catheters.
Warnings - Seldinger Technique
1. Do not withdraw the guidewire against needle bevel, as this
increases the risk of severing the guidewire.
2. During insertion do not reinsert a partially or completely
withdrawn needle into the cannula.
3. Ensure the flexible end of the guidewire is advanced into
the vein.
4. Ensure the guidewire moves freely in the needle introducer.
5. A firm grip must be maintained on the guidewire at all times.
6. When using the 'J' wire straightener maintain a firm grip on
the plastic sleeve.
7. Ensure the dilator is removed prior to catheter advancement.
8. The moveable suture devices are designed as additional
support and must not be used as the only means of fixation.
9. Potential for guidewire breakage. Although the incidence of
guidewire breakage is extremely uncommon, physicians must
be aware of the potential of guidewire breakage if undue force
is applied to the wire. If resistance is met when attempting to
remove the guidewire after central venous placement, the
wire may be kinked within the area of the catheter tip and the
vessel. Undue force may cause the wire to break. If resistance is
encountered, withdraw the catheter relative to the guidewire (2-
3 cm) and attempt to remove the wire. If resistance is still
apparent remove the wire and the catheter simultaneously.
10. Physicians should be aware that the guidewire can pick
up material from the vein. This may prevent the guidewire from
being withdrawn through the catheter.
11. Do not force the guidewire. If resistance is met, carefully
withdraw the guidewire and re-attempt insertion.
12. If femoral approach is used, place patient in supine position
for insertion procedure.
Suggested Procedure Seldinger Technique
Access)
1. Prepare the insertion site using the full aseptic technique
required for venous access.
2. The guidewire may be introduced either by using a thin
walled steel needle or introducer cannula.
3. Feed the desired flexible end of the guidewire through the
introducer into the vein. If a 'J' wire is to be used, the 'J' can
be straightened prior to insertion by using the plastic insertion
sleeve.
4. Remove the introducer.
5. A vessel dilator may be used to enlarge the cutaneous
puncture site. If further enlargement of puncture site is
necessary, use a scalpel.
6. When using multi lumen catheters, lumens other than distal
should be flushed and attached to desired fluid administration
set or, alternatively, heparin locked as standard hospital practice.
7. Pass the distal tip of the catheter over the guidewire.
(Sufficient guidewire length must remain exposed at the hub
end of the catheter to maintain a firm grip on the guidewire.)
Grasping the catheter near the skin, push the catheter into the
vein with a slight twisting motion and advance into the final
position.
8. Hold the catheter in position, withdraw the guidewire and
aspirate with a syringe to ensure correct placement.
9. The distal hub should be connected to the appropriate fluid
administration set. If a hub with Floswitch™ is being used this
can now be switched off.
10. The catheter may now be secured by suturing eyelets of the
junction boot housing/hub to the skin.
11. Apply sterile dressing as appropriate.
Suggested Procedure Seldinger Technique
Access)
1. Prepare the insertion site using the full aseptic technique
required for arterial access.
2. Using the needle, puncture the artery, aspirate and advance
the needle into the artery.
3. Feed the desired flexible end of the guidewire through the
needle into the artery. If a 'J' guidewire is to be used, the 'J' can
be straightened prior to insertion by using the plastic insertion
sleeve.
4. Hold the guidewire in place and remove the needle.
5. Pass the tip of the catheter over the guidewire. (Sufficient
guidewire length must remain exposed at the hub end
of the catheter to maintain a firm grip on the guidewire.)
Grasping the catheter near the skin, advance the catheter to the
final indwelling position.
6. Hold the catheter in position, withdraw the guidewire and
aspirate with a syringe to ensure correct placement.Attach
monitoring kit or luer lock plug as appropriate.
7. The catheter can be secured by suturing the hub to the skin.
8. Apply sterile dressings as appropriate.
Secondary Fixation Device (5Fr-8.5Fr catheters)
1/28
1. Position the secondary fixation device on catheter. To close
the device, press down on each wing. A 'click' sound confirms
that the device is secured and cannot be moved easily.
2. To ensure fixation, suture at each eyelet on the wings of the
Secondary Fixation Device.
3. To open the device, press down on the 2nd hinge, pull up
on each wing.
Secondary Fixation Device (7Fr and 9.5Fr catheters)
Note: This device is found in certain models only.
1. Ensure the Secondary Fixation Device is in place at the point
of suture.
2. To close the device, snap the top plate in place.
3. To ensure fixation, suture at each eyelet on the wings of the
Secondary Fixation Device.
4. To open the device, hold the lock device down and pull the
plate up, using the lever.
Venaguide™
Note: This device is found in certain models only.
1. Release guidewire by removing the guidewire cap.
2. Straighten guidewire 'J' by retracting into introducer system
with thumb.
3. Insert into hub of introducer needle and advance guidewire
into vein. Advance to required depth.
(Venous
WARNING: To prevent over-insertion stop when last depth mark
reaches the venepuncture site.
Guiding Syringe
Note: This accessory is found in certain models only.
This device is used for introducing guidewires for use
with Merit central or peripheral venous catheters.
1. Insert introducer needle attached to Guiding Syringe into
vessel and aspirate.
2. Feed the desired flexible end of the guidewire through the
hole in rear of Guiding Syringe plunger into the vein. If a 'J'
wire is to be used, straighten guidewire 'J' by retracting into
introducer system with thumb.
3. Hold the guidewire in place and remove introducer needle
and Guiding Syringe.
WARNING: Do not aspirate with guidewire in place or air may
enter the syringe
Caution: Do not reinfuse blood to minimize the risk of blood
leakage from rear of syringe.
Floswitch™ Introducer
This device is used for introducing guidewires for use
with Merit central or peripheral venous catheters.
Using a Floswitch™ introducer cannula, puncture the vein,
aspirate and advance the cannula into the vein and remove the
needle. At this stage the Floswitch™ may be switched off. The
switch must be opened again to facilitate guidewire or catheter
passage.
Floswitch™ Luer Lock Attachment
This device may be attached to a luer hub of a central or
peripheral venous catheter.
(Arterial
1. As standard practice the catheter should be secured to the
skin.
2. To attach the Floswitch™, insert the Floswitch™ luer into the
catheter hub. Tighten the rotating collar ensuring that 'hand tight'
connection has been made and that the catheter hub is fully
advanced into the Floswitch™ collar (see figure 1.1).
3. The Floswitch™ should be fixed in position by either suturing
or taping the wings. The recommended procedure for taping is
shown in figure 2.
4. The black markings indicate flow status. When visible the
catheter is open and there is free flow. When covered, the
catheter is closed.
Figure 1. Floswitch™ Inspection Procedure
1.1 Catheter hub fully advanced
into Floswitch collar
Figure 2. Floswitch™ Taping Procedure
sticky
side up
1.2 Inspection of connection
necessary
extra strips
of tape
fold over
wings