COOK Medical Ciaglia Blue Rhino G2, Инструкция по эксплуатации

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9. Introduce the J-tipped wire guide several cm into the trachea. (Fig. 9)
NOTE: The wire should advance freely, without resistance. If resistance
is encountered, do not force wire guide. Confirm correct FEP sheath or
introducer needle placement via bronchoscopy, then advance wire guide
into the trachea until the distal mark on the wire guide reaches skin level.
10. Remove the FEP sheath or introducer needle while maintaining wire
guide position within the tracheal lumen. (Fig. 9)
11. Maintaining the wire guide‘s position at the skin level mark, dilate the
initial tracheal access site by advancing the short, 14 French introducer
dilator over the wire guide with a slight twisting motion. (Fig. 10)
12. Remove the dilator while maintaining wire guide position.
13. Activate the hydrophilic coating by immersing the distal end of the
Ciaglia Blue Rhino G2 Advanced dilator in sterile water or saline.
14. Advance the Ciaglia Blue Rhino G2 Advanced dilator and the guiding
catheter as a unit over the wire guide, while maintaining wire guide
position. (Fig. 11) NOTE: Align the proximal end of the guiding catheter
at the mark on the proximal portion of the wire guide. (Fig. 1) This will
ensure that the distal end of the guiding catheter is properly positioned
back on the wire guide, preventing possible trauma to the posterior
tracheal wall during subsequent manipulations. NOTE: Bronchoscopic
guidance may also prevent possible trauma to the posterior tracheal wall.
15. Begin to dilate the tracheal access site by advancing the guiding catheter
and Ciaglia Blue Rhino G2 Advanced dilator into the trachea. To properly
align the dilator on the wire guide/guiding catheter assembly,
position the proximal end of the dilator at the single positioning
mark on the guiding catheter. This will ensure that the distal tip of
the dilator is properly positioned at the safety ridge on the guiding
catheter to prevent possible trauma to the posterior tracheal wall
during introduction. While maintaining the visual reference points and
positioning relationships of the wire guide, guiding catheter and dilator,
advance them as a unit to the skin level mark on the Ciaglia Blue Rhino
G2 Advanced dilator. (Fig. 11) NOTE: proper positioning and alignment
may help minimize complications (e.g., stenosis).
16. Advance and pull back the dilating assembly several times to effectively
dilate the tracheal access site.
NOTE: The wire guide must always lead the dilator and the guiding
catheter assembly to prevent possible trauma to the posterior tracheal
wall during dilation. Care should be taken to keep the guiding catheter
assembly properly aligned with the mark on the proximal portion of the
wire guide. This will ensure that the tip of the guiding catheter assembly
does not advance beyond the distal tip of the wire guide within the
trachea.
17. Remove the Ciaglia Blue Rhino G2 Advanced dilator, leaving the wire
guide/guiding catheter assembly in position. Respiratory air leak
through the tracheostomy stoma should be noted to confirm
intratracheal location of the wire guide and guiding catheter.
18. Advance the tracheostomy tube (loaded on the dilator) over the wire
guide/guiding catheter assembly to the safety ridge of the guiding
catheter, then advance wire guide, guiding catheter, loading dilator and
tracheostomy tube as a unit into trachea. (Fig. 12)