F. Assembly of Catheter and Extensions
31. (As applicable) using a scalpel or scissors, cut catheter squarely at desired pre-printed mark to produce a clean, smooth surface (Figure 5).
Ensure at least 6 cm of catheter extend from exit site to allow for connection.
35 cm/2.0ml
35 cm/x.xml
40 cm/2.2ml
45 cm/2.4ml
Figure 5
CAUTION:
Cutting the catheter anywhere but the pre-printed marks will result in the inability to read the catheter length and priming
volumes.
Figure 6
Female Connector
Figure 7
Blue
Compression
Sleeve
Female Connector
WARNING:
The blue Compression Sleeve is a necessary component of the Extension Leg Assem-
bly. Always visually confirm that the Compression Sleeve remains in the Female Connector during
assembly (Figure 7).
32. Hold unclamped Extension Leg Assembly and attach sterile 10 mL syringe and prime with normal sterile saline, leaving syringe attached
(Figure 8).
WARNING:
To avoid damage to vessels and viscus, infusion pressures should not exceed 25 psi (172 kPa). The use of a 10 mL or
larger syringe is recommended because smaller syringes generate more pressure than larger syringes.
Figure 8
33.
With catheters cut per Step 31, slip Female
Connector over catheter visually confirming
blue Compression Sleeve remains inside
Female Connector
(Figure 9).
Note:
Attach the appropriate color-coded
(blue-venous, red-arterial) Extension Leg assembly.
Figure 9
34. Slide proximal end of catheter over metal cannula on the Extension Leg Body, ensuring that catheter is attached entire length of metal
cannula and no metal is visible (Figure 10).
Figure 10
35. Slide Female Connector towards Extension Leg Body and assemble the two together until the two are fully seated (Figure 11).
WARNING:
The blue Compression Sleeve is a necessary component of the Extension Leg Assembly. Always visually confirm that the Com-
pression Sleeve remains in the Female Connector during assembly (Figure 7 and Figure 11).
Figure 11
Blue Compression Sleeve must be present during assembly.
36. After Extension Leg Assembly is on catheter, ensure catheter length and priming volume printing is visible.
37. Grasping the connector in one hand, and the catheter tubing in the other, gently tug on the joint to test the security of the connector. If the
connector pulls out of catheter, repeat the attachment procedure. A connection failure may be due to one, or a combination of the following:
• The Extension Leg Connector metal cannula is not fully inserted into the catheter.
• Missing blue compression sleeve in female connector.
38. With the 10 mL syringe attached to the Extension Leg Assembly, remove Slide Clamp from catheter.
WARNING:
The Slide Clamp, Thumb Clamp and Plug are provided for use during catheter placement only. Do not reuse.
39. Verify catheter function by aspirating to ensure adequate blood flow. Note that extension clamps must be unclamped to aspirate.
40. Once flow is satisfactory, flush catheter with a minimum of 10 mL of sterile saline.
WARNING:
To avoid damage to vessels and viscus, infusion pressures must not exceed 25 psi (172 kPa). The use of a 10 mL or larger syringe is
recommended because smaller syringes generate more pressure than larger syringes.
41. Inject heparin solution of 1,000 to 5,000 units/mL in amounts equal to the priming volume as denoted on the catheter. Inject quickly and
clamp extension while under positive pressure. Attach a sterile end cap.
WARNING:
Failure to clamp extensions when not in use may lead to
air embolism, bleeding, and possible occlusions.
42. Repeat steps 31-41 for second catheter (Figure 12).
Figure 12
Cuff
G. Placement Verification and Securement
43. After insertion, confirm placement of the catheter using x-ray or fluoroscopy.
44. For additional security, suture the insertion site, or if preferred, use a
StatLock*
Catheter Stabilization Device Securement device to anchor the catheter.
45. Manage the exit site per hospital protocol.
46. Dress the catheter per hospital protocol.
WARNING:
Acetone and PEG-containing ointments can cause failure of this device
and should not be used with polyurethane catheters. Chlorhexidine patches or
bacitracin zinc ointments (e.g.,
Polysporin*
ointment) are the preferred alterna-
tive.
47. Record indwelling catheter length and insertion site on patient’s chart.
PERFORMANCE GUIDELINES
Priming Volumes
Refer to individual catheters for priming volume information printed at pre-defined centimeter markings.
As suggested by
In Vitro
data
Flow Rate vs Lumen Pressure
Venous
Arterial
35 cm Length (400 ml/min)
50 cm Length (350 ml/min)
199 mmHg
229 mmHg
-208 mmHg
-235 mmHg
Note:
Reverse flow will result in higher recirculation
INSERTION TECHNIQUE
For percutanenous placement, the catheter is inserted through a sheath introducer into the superior vena cava via the internal jugular vein
3,6
(preferred), external jugular vein, or subclavian vein. The patient should be placed in Trendelenburg position with the head turned to the op-
posite side of the entry site.
CATHETERS MUST BE INSERTED UNDER STRICT ASEPTIC CONDITIONS.
WARNING:
Cannulation of the left internal jugular vein was reportedly associated with a higher incidence of complications compared to cath-
eter placement in the right internal jugular vein.
4
CAUTION:
Left sided catheter placement may provide unique challenges due to the right angles formed by the innominate vein and at the left
brachiocephalic junction with the SVC.
2,5
A. Sterile Field and Skin Preparation
1. Provide a sterile field throughout the procedure. Use sterile gloves, masks, caps, sterile gowns, and use a large sterile drape to cover the
patient. If hair removal is needed use clippers or depilatories.
2. Prepare the access site using standard surgical technique and drape the prepped area with sterile towels.
3. (If applicable) administer local anaesthesia to the insertion site.
B. Pre-flush the Catheters
Slide Clamp Thump Clamp
Plug
4. Irrigate, prime, and clamp both catheter lumens with heparin solution or according to hospital proto-
col. With catheters full of fluid, clamp each catheter using Slide Clamp or Thumb Clamp between the
proximal end of the catheter and the 50 cm marking or use plug.
C. Perform Venipuncture
5. Insert the introducer needle with an attached syringe to the desired location using ultrasound guidance (preferred). Aspirate gently as the
insertion is being made.
6. When the vein has been entered, remove the syringe leaving the needle in place and occlude end of needle with thumb.
7. Insert the flexible J end of the standard guidewire through the introducer needle hub that will permit passage of a 0.038 in. (0.97 mm) guide-
wire. Advance the standard guidewire to the desired location in vessel.
WARNING:
Cardiac arrhythmias may result if the guidewire is allowed to pass into the right atrium.
WARNING:
Do not advance guidewire or catheter if unusual resistance is encountered.
8. Remove the needle while holding the guidewire in place. Wipe the exposed guidewire clean and secure it in place.
CAUTION:
If the guidewire must be withdrawn while the needle is inserted, remove both the needle and guidewire as a unit to prevent the
needle from damaging or shearing the guidewire.
9. Repeat steps 5-8 above to introduce second needle and guidewire into same target vein approximately 1-2 cm adjacent to the first incision
site.
10. After second wire has been placed, make a small incision at each venous insertion site to remove any dermal bridge and ease insertion.
D. Insert Sheath and Advance Catheter
11. Advance the dilator sheath introducer over the exposed guidewire into the vessel.
CAUTION:
Care should be taken NOT to force the dilator sheath introducer into the vessel during insertion as vessel damage including
perforation could result.
WARNING:
Cardiac arrhythmias may result if the guidewire is allowed to pass into the right atrium.
12. Withdraw the dilator and guidewire, leaving the sheath introducer in place.
CAUTION:
Care should be taken not to advance the split sheath too far into vessel as a potential kink would create an impasse to the cath-
eter.
WARNING:
To prevent air embolism and/or blood loss, place thumb over the exposed orifice of the sheath introducer.
13. Remove thumb and feed distal section of catheter into the sheath introducer until tip is correctly positioned. The depth markings in one cm.
increments may be used to determine insertion length.
WARNING:
Ensure the catheter is filled with heparinized saline, is clamped and is free of air bubbles before inserting it into the vein.
WARNING:
Do not advance guidewire or catheter if unusual resistance is encountered.
14. With the catheter advanced, peel away the sheath introducer by gripping the “T” handle and breaking it apart with a downward and outward
motion to initiate separation and withdrawal of the sheath introducer.
CAUTION:
Ensure that the sheath introducer is only torn externally. Catheter may need to be further pushed into the vessel as sheath intro-
ducer is torn.
CAUTION:
For optimal product performance, do not insert any portion of the cuff into the vein.
15. Repeat steps 11-14 above for second catheter.
16. Verify catheter position under fluoroscopy and make necessary adjustments.
The venous (infusion) tip should be located at the level of
the caval atrial junction or into the right atrium and approximately 4 cm past the arterial (withdrawal) catheter tip.
CAUTION:
Catheter tips must be staggered by 4 cm to minimize recirculation.
E. Subcutaneous Tunneling of Catheters and Cuff Placement
Tunnel Tract
Catheter
Exit Site
Catheter
Insertion
Site
Figure 1
17. Identify desired tunnel location and exit site to insure a gentle arc. Ensure
that the exposed proximal portion of catheter is long enough to cut the
catheter to the desired length and to read lengths/priming volumes.
18. Make note of the desired location at which the cuff will reside in the tunnel.
19. (If applicable) administer local anaesthesia to tunnel tract.
20. Make an incision at the catheter exit site (Figure 1).
21. Using the metal tunneler provided, create a subcutaneous tunnel from the
insertion site to emerge at the catheter exit site (Figure 2b).
WARNING:
Do not tunnel through muscle.
22. Once metal tunneler emerges from catheter exit site, place tapered end
of tunnel slide dilator over tip of tunneler at insertion site. While holding
end of metal tunneler, expand tunnel tract from insertion site to half way
through the tunnel to desired cuff location or within 2 cm of the catheter
exit site using a back-and-forth motion (Figure 3a and 3b).
Figure 2b
Figure 2a
Tunneler
Tunnel Slide Dilator
Figure 2c
23. Remove tunnel slide dilator while holding metal tunneler in place. If used, remove plug.
24. Attach catheter to tunneler so that catheter’s proximal end slides over barbed end of metal tunneler.
Tunneler
Tunnel
Slide
Dilator
Figure 3a
Figure 3b
25. Remove Slide Clamp or Thumb Clamp.
Figure 4
Cuff
WARNING:
The Slide Clamp, Thumb Clamp and Plug are provided for use
during catheter placement only. Do not reuse.
26. Pull metal tunneler carefully until catheter emerges from catheter exit site.
The catheter should not be forced through the tunnel.
CAUTION:
Do not create a sharp bend in catheter tunnel as this may cause
kinking and impact flow.
27. Engage Slide Clamp between desired cut length and catheter exit site to
prevent blood loss and air embolism.
28. Remove tunneler by cutting catheter squarely at desired pre-printed mark to
produce a clean, smooth surface (Figure 5).
CAUTION:
Cutting the catheter anywhere but the pre-printed marks will result
in the inability to read the catheter length and priming volumes.
29. Recheck tip positioning using x-ray or fluoroscopy.
30. Repeat steps 17-29 for second catheter (Figure 4).
