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Caution: Do not allow the guidewire to inadvertently
advance totally within the patient. Ensure that the
guidewire exits the proximal end of the needle,
dilator, or sheath prior to and during placement of
each component.
9. Remove the introducer, leaving the guidewire in
place.
Caution: Damage to the guidewire may result if
withdrawn through the needle.
10.Make a 1 cm incision at the guidewire insertion
site.
11.Make a second 1-2 cm incision 5-8 cm from the
guidewire insertion site. This incision will be the
catheter exit site. Consider the patient's ease of
access in determining its location. (Figure 3)
Note: A smaller incision may provide better security
of the catheter.
Note: Take care to ensure that the tunnel track has
been anesthetized.
12.The fenestrated end of the catheter may be cut
shorter depending on an individual patient's
anatomy. If desired, cut a portion of the
fenestrated end of the catheter by using a scalpel
to make a straight cut between fenestrations.
Leave at least one (1) fenestration on the catheter.
13.Attach the fenestrated end of the catheter onto
the tunneler.
Caution: Exercise care when handling the catheter to
prevent it from coming into contact with surfaces
such as drapes or towels. Silicone rubber is highly
electrostatic and attracts airborne particles and
surface contaminates.
Caution: Use rubber-shod instruments when
handling the catheter. Possible cuts or tears can
occur if rubber-shod instruments are not used.
14.Pass the tunneler (A) and catheter (B)
subcutaneously from the second incision down
to and out through the first incision at the
guidewire insertion site. (Figure 4) Continue to
draw the catheter through the tunnel until the
polyester cuff lies inside the tunnel, about 1 cm
(C) from the second incision. (Figure 5)
Disconnect the tunneler from the catheter.
Note: If the cuff is advanced further into the tunnel,
it can make later removal of the catheter difficult.
15.Thread the 16 Fr peel-away introducer sheath
over the guidewire into the peritoneal cavity.
16.Remove the guidewire and dilator as a unit,
leaving the 16 Fr peel-away introducer sheath in
place.
Caution: Place a thumb over the end of the sheath
as the dilator is removed to avoid peritoneal fluid
leakage. Care must be taken not to bend or kink the
sheath. Damage to the sheath may prevent passage
of the catheter.
DCN 60578-2
Vernon Hills, IL
Proofed by:
Richard Cisneroz
Dimensions checked:
05-30-17
361-35001
17.Insert the fenestrated end of the catheter into the
sheath advancing it until all the fenestrations are
within the peritoneal cavity. This can be verified
under fluoroscopy as fenestrations are located
along the barium sulfate stripe.
18.Peel away the sheath while ensuring the catheter
remains in place. Adjust the catheter so that it
lies flat in the tunnel without any kinks.
Caution: Do not use forceps on the introducer to
break its handle and/or peel the sheath.
19.Close the incision at the guidewire insertion site.
20.Close the incision site around the catheter and
suture the catheter to the skin taking care not to
restrict the diameter of the catheter. This suture
is intended to remain in place at least until there
is tissue ingrowth around the cuff.
Caution: Exercise care when placing ligatures to
avoid cutting or occluding the catheter.
Note: After suturing, Dermabond™ Topical Skin
Adhesive (not included) may be applied topically
over the guidewire insertion site and catheter exit
site. This may aid in preventing leakage by assisting
in wound closure. Follow the instructions for use
provided by the manufacturer.
Drainage Procedure
The drainage procedure can be performed using:
a) PleurX Vacuum Bottle(s)
b) PleurX Lockable Drainage Line with glass
vacuum bottle(s) or with Wall Suction
If using PleurX Vacuum Bottle(s), refer to PleurX
Drainage Kit Instructions for Use.
Caution: In malignant ascites patients, paracentesis-
related hypotension is uncommon, but has been
documented. Use of IV fluid replacement and/or
administration of colloidal agents can reduce the
risk of hypotension. Additionally, initial drainage
should be no more than 6L in the first 24 hours.
Connect the Drainage Line to Wall Suction
Caution: Keep the valve on the PleurX Catheter and
the lockable access tip on the drainage line clean.
Keep them away from other objects to help avoid
contamination.
Caution: If wall suction is used, it must be regulated
to no greater than -60 cm H
O, or to drain no more
2
than 400 ml of fluid per minute.
(-60 cm H
O = -1.7 in Hg = -44 mm Hg = -0.8 psi)
2
1. Close the roller clamp completely by rolling the
wheel on the roller clamp toward the suction
source. (Figure 6)
Caution: The roller clamp must be fully closed to
occlude the drainage line. When not connected to a
suction source, make sure the roller clamp is fully
closed; otherwise the drainage line may allow air
into the body or let fluid leak out.
2. Attach the 5-in-1 adapter to the Luer fitting on
the drainage line.
3
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