Bard Power-Trialysis, Инструкция по эксплуатации, Страница: 5 / 10

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
• Arterial Puncture
• Bleeding
• Brachial Plexus Injury
• Cardiac Arrhythmia
• Cardiac Tamponade
• Catheter Erosion Through
the Skin
• Catheter Embolism
• Catheter Occlusion
• Catheter Occlusion, Damage or Breakage
due to Compression between the Clavicle
and First Rib 1
• Catheter-Related Sepsis
• Endocarditis
• Exit Site Infection
• Exit Site Necrosis
• Extravasation
• Fibrin Sheath Formation
• Hematoma
• Hemomediastinum
• Hemothorax
• Hydrothorax
• Inflammation, Necrosis or Scarring of Skin
Over Implant Area
• 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 Stenosis
• 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 must be carefully considered before placing the catheter.
Placement and care of the catheter must be performed only by persons knowledgeable of the risks involved and qualified in the proce-
dures.
Instructions for Catheter Insertion
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 catheter placement in the right internal jugular vein.
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CAUTION: As reported in literature, 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.
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1. The catheter must be inserted only under strict aseptic conditions in which the operator must wear a cap, mask, sterile gown, ster-
ile gloves, and use a large sterile drape to cover the patient. For jugular or subclavian insertion, the patient must be in a modified
Trendelenburg position, with the head turned to the side opposite that of the insertion site. A small rolled towel may be inserted
between the shoulder blades. For femoral insertion, place patient in supine position to expose the side of the groin to be accessed.
2. Prepare the access site using standard surgical technique and drape the prepped area with sterile towels. If hair removal is necessary,
use clippers or depilatories. Next, scrub the entire area preferably with chlorhexidine gluconate unless contraindicated, in which case,
povidone-iodine may be used. Use a back-and-forth friction scrub for at least 30 seconds
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. Do not wipe or blot. Allow antiseptic to air
dry completely before puncturing the site. Remove and discard gloves. If using the ChloraPrep™ Solution One-Step Applicator per-
form skin preparation using the following steps:
• Prepare the site with the ChloraPrep™ Solution One-Step Applicator or according to institution protocol using sterile
technique.
• Pinch the wings of the ChloraPrep™ Solution One-Step Applicator to break the ampule and release the antiseptic. Do not
touch the sponge.
• Wet the sponge by repeatedly pressing and releasing the sponge against the treatment area until fluid is visible on the skin.
• Use repeated back-and-forth strokes of the sponge for approximately 30 seconds. Completely wet the treatment area with
antiseptic. Allow the area to dry for approximately 30 seconds. Do not blot or wipe away.
• Maximum treatment area for one applicator is approximately 130 cm 2 (approximately 4 x 5 in.). Discard the applicator after a
single use.
• Remove and discard gloves.
3. Prepare a sterile field.
4. The insertion site is identified. A local anesthetic is injected over the site.
5. A syringe is attached to an introducer needle that will permit passage of the guidewire. The maximum guidewire that may be
used is 0.035 in (0.89 mm).
6. The introducer needle is inserted into the identified vein.
7. The syringe is removed leaving the introducer needle in place.
WARNING: For jugular and subclavian insertion, the patient must be placed on a cardiac monitor during this procedure.
Cardiac arrhythmia may result if the guidewire is allowed to pass into the right atrium. The guidewire must be held securely during the
procedure.
8. The guidewire can be inserted into the needle hub and passed through the needle. Advance the guidewire to the desired
location in the vessel.
CAUTION: Do not pull back guidewire over needle bevel as this may sever the end of the guidewire. The introducer needle must be
removed first. Also, if unusual resistance is met during manipulation of the guidewire, discontinue the procedure
and determine the cause of resistance before proceeding. Withdraw needle and guidewire if cause of resistance cannot
be determined.