2
Insert Guidewire:
Guidewire:
Kits/Sets are available with a variety of guidewires. Guidewires are provided in diff erent diameters,
lengths and tip confi gurations for specifi c insertion techniques. Become familiar with the guidewire(s)
to be used with the specifi c technique before beginning the actual insertion procedure.
Arrow Advancer (where provided):
Arrow Advancer is used to straighten “J” Tip of guidewire for introduction of the guidewire into Arrow
Raulerson Syringe or a needle.
•
Using thumb, retract “J” (refer to Figure 2).
Figure 2
•
Place tip of Arrow Advancer – with “J” retracted – into the hole in rear of Arrow Raulerson Syringe
plunger or introducer needle (refer to Figure 3).
Figure 3
10. Advance guidewire into Arrow Raulerson Syringe approximately 10 cm until it passes through
syringe valves or into introducer needle.
•
Advancement of guidewire through Arrow Raulerson Syringe may require a gentle rotating motion.
11. Raise thumb and pull Arrow Advancer approximately 4 - 8 cm away from Arrow Raulerson
Syringe or introducer needle. Lower thumb onto Arrow Advancer and while maintaining a fi rm
grip on guidewire, push assembly into syringe barrel to further advance guidewire. Continue until
guidewire reaches desired depth.
12. Use centimeter markings (where provided) on guidewire as a reference to assist in determining
how much guidewire has been inserted.
NOTE: When guidewire is used in conjunction with Arrow Raulerson Syringe (fully aspirated) and a
2-1/2” (6.35 cm) introducer needle, the following positioning references can be made:
•
20 cm mark (two bands) entering back of plunger = guidewire tip at end of needle
•
32 cm mark (three bands) entering back of plunger = guidewire tip approximately 10 cm
beyond end of needle
Caution: Maintain fi rm grip on guidewire at all times. Keep suffi
cient guidewire length
exposed for handling purposes. A non-controlled guidewire can lead to wire embolus.
Warning: Do not aspirate Arrow Raulerson Syringe while guidewire is in place; air may enter
syringe through rear valve.
Caution: Do not reinfuse blood to reduce risk of blood leakage from rear (cap) of syringe.
Warning: Do not withdraw guidewire against needle bevel to reduce risk of possible
severing or damaging of guidewire.
13. Remove introducer needle and Arrow Raulerson Syringe (or catheter) while holding guidewire in place.
14. Use centimeter markings on guidewire to adjust indwelling length according to desired depth of
indwelling catheter placement.
15. If necessary, enlarge cutaneous puncture site with cutting edge of scalpel, positioned away from
guidewire.
Warning: Do not cut guidewire to alter length.
Warning: Do not cut guidewire with scalpel.
•
Position cutting edge of scalpel away from guidewire.
•
Engage safety and/or locking feature of scalpel (where provided) when not in use to
reduce the risk of sharps injury.
16. Use tissue dilator to enlarge tissue tract to the vein as required. Follow the angle of the guidewire
slowly through the skin.
Warning: Do not leave tissue dilator in place as an indwelling catheter. Leaving tissue
dilator in place puts patient at risk for possible vessel wall perforation.
Advance Catheter:
17. Thread tip of catheter over guidewire. Suffi cient guidewire length must remain exposed at hub
end of catheter to maintain a fi rm grip on guidewire.
18. Grasping near skin, advance catheter into vein with slight twisting motion.
Warning: Do not attach catheter clamp and fastener (where provided) until guidewire is removed.
19. Using centimeter marks on catheter as positioning reference points, advance catheter to fi nal
indwelling position.
NOTE: Centimeter marking symbology is referenced from catheter tip.
•
numerical: 5, 15, 25, etc.
•
bands: each band denotes a 10 cm interval, with one band indicating 10 cm, two bands
indicating 20 cm, etc.
•
dots: each dot denotes a 1 cm interval
20. Hold catheter at desired depth and remove guidewire.
Caution: If resistance is encountered when attempting to remove guidewire after catheter
placement, guidewire may be kinked around tip of catheter within vessel (refer to Figure 4).
Figure 4
•
In this circumstance, pulling back on guidewire may result in undue force being applied
resulting in guidewire breakage.
•
If resistance is encountered, withdraw catheter relative to guidewire about 2-3 cm and attempt
to remove guidewire.
•
If resistance is again encountered, remove guidewire and catheter simultaneously.
Warning: Do not apply undue force on guidewire to reduce risk of possible breakage.
21. Always verify entire guidewire is intact upon removal.
Complete Catheter Insertion:
22. Check lumen patency by attaching a syringe to each extension line and aspirate until free fl ow of
venous blood is observed.
23. Flush lumen(s) to completely clear blood from catheter.
24. Connect all extension line(s) to appropriate Luer-Lock connector(s) as required. Unused port(s) may
be “locked” through Luer-Lock connector(s) using standard institutional policies and procedures.
•
Slide clamp(s) are provided on extension lines to occlude fl ow through each lumen during line
and Luer-Lock connector changes.
Warning: Open slide clamp prior to infusion through lumen to reduce risk of damage to
extension line from excessive pressure.
Secure Catheter:
25. Use a catheter stabilization device, catheter clamp and fastener, staples or sutures (where
provided).
•
Use triangular juncture hub with side wings as primary suture site.
•
Use catheter clamp and fastener as a secondary suture site as necessary.
Caution: Minimize catheter manipulation throughout procedure to maintain proper
catheter tip position.
Catheter Stabilization Device (where provided):
A catheter stabilization device should be used in accordance with manufacturer’s instructions for use.
Catheter Clamp and Fastener (where provided):
A catheter clamp and fastener are used to secure catheter when an additional securement site other
than the catheter hub is required for catheter stabilization.
•
After guidewire has been removed and necessary lines have been connected or locked, spread
wings of rubber clamp and position on catheter making sure catheter is not moist, as required, to
maintain proper tip location.
•
Snap rigid fastener onto catheter clamp.
•
Secure catheter clamp and fastener as a unit to patient by using either catheter stabilization
device, stapling or suturing. Both catheter clamp and fastener need to be secured to reduce risk of
catheter migration (refer to Figure 5).
Figure 5
26. Ensure insertion site is dry before applying dressing per manufacturer’s instructions.
27. Assess catheter tip placement in compliance with institutional policies and procedures.
28. If catheter tip is malpositioned, assess and replace or reposition according to institutional policies
and procedures.
Care and Maintenance:
Dressing:
Dress according to institutional policies, procedures, and practice guidelines. Change immediately if the
integrity becomes compromised e.g. dressing becomes damp, soiled, loosened or no longer occlusive.
Catheter Patency:
Maintain catheter patency according to institutional policies, procedures and practice guidelines. All
personnel who care for patients with central venous catheters must be knowledgeable about eff ective
management to prolong catheter’s dwell time and prevent injury.
Catheter Removal Instructions:
29. Position patient as clinically indicated to reduce risk of potential air embolus.
30. Remove dressing.
31. Release catheter and remove from catheter securement device(s).
32. Ask patient to take a breath and hold it if removing internal jugular or subclavian catheter.
33. Remove catheter by slowly pulling it parallel to skin. If resistance is met while removing
catheter
STOP
Caution: Catheter should not be forcibly removed, doing so may result in catheter breakage
and embolization. Follow institutional policies and procedures for diffi
cult to remove catheter.
34. Apply direct pressure to site until hemostasis is achieved followed by an ointment-based occlusive
dressing.
Warning: Residual catheter track remains an air entry point until site is epithelialized.
Occlusive dressing should remain in place for at least 24 hours or until site appears
epithelialized.
35. Document catheter removal procedure including confi rmation that entire catheter length and tip
has been removed per institutional policies and procedures.
For reference literature concerning patient assessment, clinician education, insertion
technique, and potential complications associated with this procedure, consult
standard textbooks, medical literature, and Arrow International, Inc. website:
www.telefl ex.com
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