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Table of Contents

Introduction 1

Indications For Use

Contraindications, Warnings, Cautions

and Precautions

Possible Complications

Hickman* Hemodialysis/Apheresis

Long Term Central Venous Catheter

Placement Procedures

Section A:

Prepping Procedure

Section B:

Tunneling Procedure

Section C:

Cutdown Technique

Section D:

Percutaneous Technique

Catheter Removal

References 18

Patient Information - Catheter Care

and Maintenance

Catheter Damage

Site Care

Clamping the Catheter

Flushing the Catheter and “Heparin Lock” Procedure

Changing the Injection Cap

Содержание Hickman

Страница 1: ...Bard Access Systems Inc Hickman Hemodialysis Apheresis Long Term Central Venous Catheters Instructions For Use ...

Страница 2: ...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 ...

Страница 3: ... 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 SureCuff Tissue Ingrowth Cuff attached to the catheter is positioned 3 5 cms below the skin exit site in the tunnel The cuff prom...

Страница 4: ...2 Adapter Legs Attached Clamps SureCuff Tissue Ingrowth Cuff Catheter Protective Clamping Sleeve Cl am p He re Cla mp He re Dual Lumen ...

Страница 5: ...heter 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 insufficient to accommodate the size of the implanted device The patient i...

Страница 6: ...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 first rib and the clavicle which can cause damage and even severance of the catheter A radiographic confirma...

Страница 7: ...n 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 qualified healthcare practitioners should insert manipulate a...

Страница 8: ...ert 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 durin...

Страница 9: ...tically ill patients however the potential exists for serious complications including the following Air Embolism Bleeding Brachial Plexus Injury Cardiac Arrhythmia CardiacTamponade Catheter or Cuff ErosionThrough Skin Catheter Embolism Catheter or Cuff Occlusion Catheter Occlusion Damage or Breakage due to Compression Between the Clavicle and First Rib Catheter related Sepsis Endocarditis Exit Sit...

Страница 10: ...ter 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 SureCuff Ti...

Страница 11: ...el to the venous entry site Initial resistance may be felt as the SureCuff Tissue Ingrowth Cuff first enters the tunnel Gently holding the catheter proximal to the cuff while pulling the tunneler and catheter through the subcutaneous tunnel should result in smooth passage of the cuff into the tunnel Caution The catheter must not be forced d Cut off the end of the catheter tied by suture e Estimate...

Страница 12: ...e of the lumen tips onto the tunneler barb with a twisting motion Barb threads must be completely covered by the catheter tip to adequately secure the catheter as it is pulled through the tunnel e Pull the catheter up through the tunnel to the venous entry site Initial resistance may be met as the SureCuff Tissue Ingrowth Cuff first enters the tunnel Gently holding the catheter proximal to the cuf...

Страница 13: ...ing procedure 3 Insert the catheter through a small venotomy into the isolated vein and advance to desired position in vessel 4 Verify catheter tip location radiographically The preferred location of the catheter tip is at the junction of the superior vena cava and the right atrium Warning Avoid positioning the catheter tip in the right atrium 5 Unclamp catheter and draw blood through the lumen s ...

Страница 14: ...be coiled and taped Avoid tension on the catheter segment to prevent dislodging the catheter Section D Percutaneous Technique Before beginning procedure read the Contraindications Warnings Cautions and Precautions and Possible Complications sections of this manual 1 Locate desired vessel using a small needle attached to a syringe Note The subclavian vein is entered percutaneously at the point that...

Страница 15: ...n The risk of air aspiration is reduced by performing this part of the procedure with the patient performing the Valsalva maneuver 5 Straighten J tip of guidewire with tip straightener and insert tapered end of tip straightener into the needle Tip straightener should not be advanced over the guidewire beyond the guidewire tip Caution Do not insert guidewire beyond the bevel of the needle while rem...

Страница 16: ...nneling procedure 8 Make a small approx 1 cm wide incision parallel to the clavicle positioning the guidewire at the center of the incision to permit proper entry of vessel dilator and sheath introducer Peel Apart Sheath Introducer Instructions 9 Advance the vessel dilator and sheath introducer as a unit over the exposed guidewire using a rotational motion Advance it into the subclavian vein as a ...

Страница 17: ...e risk of air aspiration is reduced by performing this part of the procedure with the patient performing the Valsalva maneuver 12 Insert catheter into lumen of sheath and advance to desired position in vessel 13 Verify catheter tip location radiographically Warning Avoid positioning the catheter tip in the right atrium Preferred location of the catheter tip is at the junction of the superior vena ...

Страница 18: ...ine to clear catheter of blood Instill sterile heparinized saline per lumen to create heparin lock Clamp catheter 17 Attach injection cap s or connect to intravenous fluid source 18 Suture catheter at exit site Note For dual lumen catheters the attachable suture wing may be used to secure the catheter A Using your fingers squeeze the suture wing together so that it splits open and place the wing a...

Страница 19: ...ainst resistance as this may cause catheter breakage and embolism Free up the resistance e g by repositioning the patient before proceeding further 1 Traction Removal Pull the catheter external segment downward in a straight line away from the exit site with a series of gentle tugs When separation of the cuff from the surrounding tissue and or catheter occurs there will be a break away feeling Con...

Страница 20: ... dressing to prevent air embolism through the tract Catheter care and maintenance procedures are included in the Hickman Leonard and Broviac Catheters Nursing Procedure Manual available through Bard Access Systems Customer Service 1 800 545 0890 For outside the U S contact your local sales representative or distributor References 1 Aitken D R and Minton J P The Pinch Off Sign A Subclavian Catheter...

Страница 21: ...terile gloves if required 3 Alcohol swabsticks Hydrogen peroxide Sterile cotton tipped applicators 3 Povidone iodine swabsticks Povidone iodine ointment packet Tape 1 Sterile cover dressing transparent or tape 1 Alcohol wipe 1 Sterile 2 in x 2 in 5 cm x 5 cm gauze dressings 1 Sterile pre cut 2 in x 2 in 5 cm x 5 cm gauze dressings 1 Clean the work surface by wiping with a paper towel that has been...

Страница 22: ...f you are instructed to use gloves put on the pair of sterile gloves following the procedure you were taught Be careful to not touch anything except the supplies being used for site care 8 Carefully clean the catheter exit site with an alcohol swabstick or sterile cottontipped applicator soaked in hydrogen peroxide starting at the exit site and spiraling outward until a circle at least 8 cm in dia...

Страница 23: ...llow the povidone iodine on the skin to air dry at least two minutes 13 Apply a small amount of povidone iodine ointment to the exit site optional 14 Place the pre cut gauze dressing over the ointment at the exit site fitting it snugly around the catheter Place the 2 in x 2 in 5 cm x 5 cm gauze over the pre cut gauze and catheter 15 Apply the cover dressing tape or transparent dressing following t...

Страница 24: ...e reinforced clamping sleeve or tape tab as instructed by your nurse Never clamp over the reinforced segment directly adjacent to the connector see diagram 3 Follow the directions of your doctor or nurse regarding when to clamp Hickman catheters come with pre attached clamps and reinforced clamping sleeves When should you clamp Your doctor or nurse may instruct you to clamp your catheter whenever ...

Страница 25: ...uring this time Do not blow on the area or allow the clean cap to dangle since this increases the chance of contamination of the area with germs 5 Remove the needle cover and carefully insert the needle into the center of the catheter injection cap 6 Release the clamp 7 Inject the heparin into the catheter As you inject the last 0 5 mL of heparin solution withdraw the needle from the injection cap...

Страница 26: ...o your instructions Be sure the cap does not touch the outer surface of the package NOTE You may need to pre fill the injection cap with heparin if it is a long cap with significant air space Your doctor or nurse will teach you this additional procedure 4 Remove the old tape from around the cap by unpeeling the tape NEVER attempt to cut the tape with scissors as you may damage the catheter 5 Using...

Страница 27: ... a 5 cm piece of tape and make tabs on each end by folding back 1 cm Apply the sticky part of the tape around the connection of the cap and catheter and fasten securely Press ends of the tape together The tabs on the end of the tape will enable you to remove it very easily 9 Follow the directions your doctor or nurse has given you regarding whether to leave the clamp in place ...

Страница 28: ...date for these instructions is included for the user s information In the event two years have elapsed between this date and product use the user should contact Bard Access Systems to see if additional product information is available Revised Date March 2013 Bard Broviac Hickman Leonard and SureCuff are trademarks and or registered trademarks of C R Bard Inc 2013 C R Bard Inc All rights reserved P...

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