Bard Hickman Bedienungsanleitung

Bard Access Systems, Inc.

Hickman*

Hemodialysis/Apheresis

Long Term Central

Venous Catheters

Instructions For Use

Table of Contents

Introduction 1

Indications For Use 3

Contraindications, Warnings, Cautions

and Precautions 3

Possible Complications 7

Hickman* Hemodialysis/Apheresis

Long Term Central Venous Catheter

Placement Procedures 8

Section A: Prepping Procedure

Section B: Tunneling Procedure

Section C: Cutdown Technique

Section D: Percutaneous Technique

Catheter Removal 17

References 18

Patient Information - Catheter Care

and Maintenance 19

Catheter Damage

Site Care

Clamping the Catheter

Flushing the Catheter and“Heparin Lock” Procedure

Changing the Injection Cap

Bard Access Systems, Inc.

Introduction

Description:

Hickman* Hemodialysis/Apheresis Central Venous Catheters are

constructed of specially formulated and processed silicone. The catheters

are radiopaque with female luer locking adapters and SureCu* tissue

ingrowth cu for xation of the catheters in a subcutaneous tunnel. Each

catheter is provided in a double sterile package.

Catheter repair kits are available in sterile packages for the adapter legs.

Placement:

The catheter is placed into one of the large central veins so the tip lies in the

superior vena cava above the right atrium. It is tunnelled subcutaneously

to the desired exit site. The SureCu* Tissue Ingrowth Cu, attached to the

catheter, is positioned 3-5 cms below the skin exit site in the tunnel. The

cu promotes tissue ingrowth to secure the catheter in place.

Schematics:

Single Lumen

Connector

Attached Clamp

SureCuff*Tissue

ngrowth Cuff

Catheter

Protective Clamping Sleeve

Clamp He e

Adapter Legs

Attached Clamps

SureCu* Tissue

Ingrowth Cu

Catheter

Protective

Clamping

Sleeve

Clamp Here

Dual Lumen

Bard Access Systems, Inc.

Indications For Use

Hickman* Hemodialysis/Apheresis Catheters are designed for long-term

vascular access and for use in patients that lack adequate peripheral venous

access. They are available in single lumen (10.8 and 14.4 Fr), and a dual

lumen (13.5 Fr.), catheter congurations in various lengths.

All Hickman* Hemodialysis/Apheresis central venous catheters are

designed for hemodialysis, apheresis, and the administration of I.V. uids,

blood products, drugs, and parenteral nutrition solutions, as well as blood

withdrawal. The Hickman* dual lumen hemodialysis / apheresis catheter

incorporates two large, equal size lumens appropriate for hemodialysis and

apheresis procedures.

Contraindications, Warnings, Cautions

and Precautions

Contraindications

This device is contraindicated whenever:

• The presence of device related infection, bacteremia, or septicemia is

known or suspected.

• The patient’s body size is insucient to accommodate the size of the

implanted device.

• The patient is known or is suspected to be allergic to materials

contained in the device.

• Severe chronic obstructive lung disease exists (percutaneous

subclavian placement only.)

• Past irradiation of prospective insertion site.

• Previous episodes of venous thrombosis or vascular surgical

procedures at the prospective placement site.

• Local tissue factors will prevent proper device stabilization and/or

access.

Warnings

• Intended for Single Patient Use. DO NOT REUSE. These products are

single use devices and should never be reimplanted. Reuse carries

with it the attendant concern of cross-infection regardless of the

cleaning or sterilization method. Resterilization of incompletely

cleaned devices may not be eective. Any device that has been

contaminated by blood should not be reused or resterilized.

• After use, this product may be a potential biohazard. Handle and

dispose in accordance with accepted medical practice and applicable

local, state and federal laws and regulations.

• Pinch-o Prevention: Catheters placed percutaneously or through a

cut-down, into the subclavian vein, should be inserted at the junction

of the outer and middle thirds of the clavicle, lateral to the thoracic

outlet. The catheter should not be inserted into the subclavian

vein medially, because such placement can lead to compression

of the catheter between the rst rib and the clavicle, which can

cause damage and even severance of the catheter. A radiographic

conrmation of catheter placement should be made to ensure that

the catheter is not being pinched by the rst rib and clavicle.1,2

First Rib

Subclavian Vein

Clavicle

Vertebra

nternal Jugular Vein

Superior Vena Cava

Sternum

Pinch-off Area

nfraclavicular Fossa

Axillary Vein

Signs of Pinch-O

Clinical:

• Diculty with blood withdrawal.

• Resistance to infusion of uids.

• Patient position changes required for infusion of uids or blood

withdrawal.

Bard Access Systems, Inc.

Radiologic:

• Grade 1 or 2 distortion on chest X-ray.

Pinch-o should be evaluated for degree of severity prior to

explantation. Patients indicating any degree of catheter distortion

at the clavicle/rst rib area should be followed diligently. There are

grades of pinch-o that should be recognized with appropriate chest

x-ray as follows: 3,4

Grade Severity Recommended Action

Grade 0 No Distortion No Action

Grade 1 Distortion present without

luminal narrowing

Chest x-ray should be taken every one to three

months to monitor progression of pinch o

to grade 2 distortion. Shoulder positioning

during chest xrays should be noted as it can

contribute to changes in distortion grades.

Grade 2 Distortion present with luminal

narrowing

Removal of the catheter should be

considered.

Grade 3 Catheter transection or fracture Prompt removal of the catheter.

Cautions

• Carefully read and follow all instructions prior to use.

• Federal (U.S.A.) law restricts this device to sale by or on the order of a

physician.

• Only qualied healthcare practitioners should insert, manipulate and

remove these devices.

Precautions

• Follow Universal Precautions when inserting and maintaining the

catheter.

• Follow all contraindications, warnings, cautions, precautions and

instructions for all infusates as specied by its manufacturer.

• Use aseptic techniques whenever the catheter lumen is opened

or connected to other devices. Povidone-iodine is the suggested

antiseptic to use with this device and components. Acetone and

tincture of iodine should not be used because they could adversely

aect the performance of the catheter and connectors. 10% acetone/

70% isopropyl alcohol swabsticks used for dressing changes should

not adversely aect the catheter.

I. Prior to beginning placement procedure, do the following:

• Examine package carefully before opening to conrm its integrity and

that the expiration date has not passed. The device is supplied in a

double sterile package and is non-pyrogenic. Do not use if package is

damaged, opened or the expiration date has passed. Sterilized by

ethylene oxide. Do not Resterilize.

• Inspect kit for inclusion of all components.

• Fill (prime) the device with sterile heparinized saline or normal saline

solution to help avoid air embolism.

• When using an introducer kit, verify that the catheter ts easily through

the introducer sheath.

II. To avert device damage and/or patient injury during placement:

• Avoid accidental device contact with sharp instruments and

mechanical damage to the catheter material. Use only smooth-edged

atraumatic clamps or forceps.

• Avoid perforating, tearing or fracturing the catheter when using a

guidewire.

• Do not use the catheter if there is any evidence of mechanical

damage or leaking.

• Avoid sharp or acute angles during implantation which could

compromise the patency of the catheter lumen(s).

• If sutures are used to secure the catheter, make sure they do not occlude

or cut the catheter.

• When using percutaneous introducers:

- Carefully insert the introducer and catheter to avoid inadvertent

penetration to vital structures in the thorax.

- To avoid blood vessel damage, do not allow the percutaneous

introducer sheath to remain indwelling in the blood vessel

without the internal support of a catheter or dilator.

- Simultaneously advance the sheath and dilator with rotational

motion to help prevent sheath damage.

Bard Access Systems, Inc.

III. After placement, observe the following precautions to avoid device

damage and/or patient injury:

• Do not use the catheter if there is any evidence of mechanical

damage or leaking. Damage to the catheter may lead to rupture,

fragmentation and possible embolism and surgical removal.

• Accessories and components used in conjunction with this device should

incorporate Luer lock connections.

• If signs of extravasation exist, discontinue injections. Begin appropriate

medical intervention immediately.

• Infusion pressure greater than 25 psi (172 kPa) may damage blood vessels

and viscus and is not recommended. DO NOT USE A SYRINGE SMALLER

THAN 10 mL!

Possible Complications

The use of an indwelling central venous catheter provides an important

means of venous access for critically ill patients; however, the potential

exists for serious complications including the following:

• Air Embolism

• Bleeding

• Brachial Plexus Injury

• Cardiac Arrhythmia

• Cardiac Tamponade

• Catheter or Cu Erosion Through

Skin

• Catheter Embolism

• Catheter or Cu Occlusion

• Catheter Occlusion, Damage or

Breakage due to Compression

Between the Clavicle and First Rib

• Catheter-related Sepsis

• Endocarditis

• Exit Site Infection

• Exit Site Necrosis

• Extravasation

• Fibrin Sheath Formation

• Hematoma

• Hemothorax

• Hydrothorax

• Intolerance Reaction to Implanted

Device

• Laceration of Vessels or Viscus

• Perforation of Vessels or Viscus

• Pneumothorax

• Spontaneous Catheter Tip

Malposition or Retraction

• Thoracic Duct Injury

• Thromboembolism

• Venous Thrombosis

• Ventricular Thrombosis

• Vessel Erosion

• Risks Normally Associated with

Local and General Anesthesia,

Surgery, and Post-Operative

Recovery

These and other complications are well documented in medical literature

and should be carefully considered before placing the catheter.

Hickman* Hemodialysis /Apheresis Long-Term

Central Venous Catheter Placement Procedures

Section A: Prepping Procedure

Before beginning procedure, read the“Contraindications, Warnings,

Cautions and Precautions” and “Possible Complications” sections of

this manual.

1. Create sterile eld and open tray.

2. Prep venipuncture/cutdown area, tunnel and tunnel exit areas.

3. Perform local anesthetic inltration in venipuncture/cutdown, tunnel

and tunnel exit site areas.

4. Irrigate the catheter with sterile heparinized saline (100 u/mL) and

inspect for leakage. Clamp the catheter over the clamping sleeve(s).

5. Place patient in the Trendelenburg position with head turned away

from the intended venipuncture site.

Note: Refer to Section C or D Prior to Tunneling Procedure.

Section B: Tunneling Procedure

1. Measure catheter against chest wall of patient to determine desired

location of SureCu* Tissue Ingrowth Cu and exit site. Mark locations.

2. Tunneling procedure.

Note: The subcutaneous tunnel should be approximately 10 to 15 cm

long with the SureCu* Tissue Ingrowth Cu positioned in the tunnel.

The cu will be less prominent if positioned over an intercostal space.

Inhaltsverzeichnis

Andere Bard Medizinische Geräte Handbücher

Bard

Bard Button Device Continuous Feeding Tube Technisches Datenblatt

Bard

Bard E-Luminexx Vascular Stent Bedienungsanleitung

Bard

Bard Sherlock 3CG Tip Confirmation System Bedienungsanleitung

Bard

Bard PowerPICC SOLO 2 Bedienungsanleitung

Bard

Bard ENCOR ECMRINTLOC Bedienungsanleitung

Bard

Bard vas-cath Bedienungsanleitung

Bard

Bard Groshong Midline Bedienungsanleitung

Bard

Bard AirGuard Bedienungsanleitung

Bard

Bard Ultrasound System Bedienungsanleitung

Bard

Bard Site-Rite IV Bedienungsanleitung

Bard

Bard PureWick Bedienungsanleitung

Bard

Bard Poly RadPICC Bedienungsanleitung

Bard

Bard PowerPICC Provena Bedienungsanleitung

Bard

Bard Poly Per-Q-Cath Bedienungsanleitung

Bard

Bard MAGNUM Bedienungsanleitung

Bard

Bard Onflex Bedienungsanleitung

Bard

Bard Magic3 Go Bedienungsanleitung

Bard

Bard PowerGlide Bedienungsanleitung

Bard

Bard PowerPICC Solo2 Bedienungsanleitung

Bard

Bard PowerPICC SOLO 2 Bedienungsanleitung

Bard

Bard CROSSER Bedienungsanleitung

Bard

Bard DuoGlide Bedienungsanleitung

Bard

Bard Composix L/P Bedienungsanleitung

Bard

Bard PowerMidline Bedienungsanleitung

Beliebte Medizinische Geräte Handbücher anderer Marken

TekTone

TekTone Tek-CARE160 Bedienungsanleitung

NeuroMetrix

NeuroMetrix Quell 2.0 Bedienungsanleitung

AMT

AMT XLR8 Bedienungsanleitung

EDAN

EDAN SONOTRAX Pro Bedienungsanleitung

Restorative Therapies

Restorative Therapies RT300 Bedienungsanleitung

Gendex

Gendex Expert DC Bedienungsanleitung

Dexcowin

Dexcowin ADX4000W Bedienungsanleitung

Libelium

Libelium MySignals Bedienungsanleitung

Acelity

Acelity V.A.C.ULTA 4 Bedienungsanleitung

Caputron

Caputron ActivaDose II tDCS Bedienungsanleitung

Plinth 2000

Plinth 2000 93CDT Bedienungsanleitung

GE SENOGRAPHE 800T Bedienungsanleitung

GE Definium 5000 Bedienungsanleitung

Kanmed

Kanmed GE-1380 Bedienungsanleitung

Huntleigh

Huntleigh FD1 Bedienungsanleitung

Stryker

Stryker SPR Plus Bedienungsanleitung

Tobii Dynavox

Tobii Dynavox I-Series Bedienungsanleitung

S-Capepod

S-Capepod Evac Cocoon Bedienungsanleitung