4.
Never use excessive force in moving the catheter or guidewire. If
resistance is encountered, an x-ray should be performed to
identify the reason for the resistance.
5.
Passage of the guidewire into the right heart can cause
dysrhythmias, right bundle branch block, vessel wall, atrial or
ventricular perforation.
6.
Use only sterile normal saline for catheter priming. It is the
circulating fluid in the catheter.
7.
The catheter should be routinely inspected for flow rate, security
of dressing, correct catheter position, and for secure Luer-Lock
connections. Use the centimeter markings to identify if the
catheter position has changed. A potential risk associated with
multi-lumen balloon catheters is a lack of therapy, including
failure to infuse drug therapy through the infusion lumens.
8.
Only x-ray examination can ensure that the catheter tip has not
entered the heart or no longer lies parallel to the vessel wall. If the
catheter position has changed, perform an x-ray examination to
confirm the catheter tip position.
9.
For blood sampling, temporarily shut off the remaining infusion
ports through which solutions are being infused.
10. Use only a 30 cc or smaller syringe for blood sampling.
11. Alcohol and acetone can weaken the structure of the shaft
material. Care should therefore be taken when infusing drugs
containing alcohol or when using alcohol or acetone when
performing routine catheter care and maintenance. Alcohol
should not be used to declot the catheter.
12. Use only the ZOLL suture tab and clip provided in the kit to
prevent catheter damage.
13. Use of a syringe smaller than 10 ml to irrigate or declot
an occluded catheter may cause intraluminal leakage or catheter
rupture.
14. Do not infuse into the orange IN and OUT Luer-Lock connections,
as this will result in lack of therapy.
15. Fever may have infectious and/or non-infectious causes in
patients. Mitigation of fever as a sign of possible infection
necessitates daily, meticulous assessment for other signs of
infection.
16. Use care when infusing drugs that may be affected by cool
temperatures (as low as 4ºC). Mannitol-containing solutions are
temperature-sensitive and must not be delivered through the
catheter except for a rapid push of up to a concentration of 20%
mannitol solution, followed by a saline flush. Higher than a 20%
concentration of mannitol drip or infusion pump delivery of
mannitol must be done via a separate line.
17. Cardiac Tamponade: Placement of indwelling catheters in the
right atrium is a practice that may lead to cardiac perforation and
tamponade. Practitioners placing central venous catheters must be
aware of this potentially fatal complication before advancing the
catheter too far relative to patient size. The actual position of the
tip of the indwelling catheter should be confirmed by x-ray after
insertion. Central venous catheters should not be placed in the
right atrium unless specifically required for special relatively short
term procedures, such as aspiration of air emboli during
neurosurgery. Such procedures are nevertheless risk-prone and
should be closely monitored and controlled.
18. The catheter is coated with heparin. This may induce or aggravate
pre-existing heparin induced thrombocytopenia (HIT).
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When connecting infusion sets/injection systems to
ZOLL catheters, do not exceed 100 psi/689 kPa.
19. For patients being made hypothermic, the hypothermia itself may
exacerbate some disease states. Care should be taken to properly
monitor patient homeostasis during hypothermia.
•
Cardiac rhythm disturbances–both bradycardia and ventricu-
lar tachyarrhythmia.
•
Clotting and coagulations function. Patients at risk for distur-
bances of their clotting or coagulation function should be
closely monitored during hypothermia.
•
Blood gas and pH analysis. Hypothermia modifies resting pH
and PaCO
2
. Physicians should be aware of the effect of tem-
perature upon the result.
•
Prolonged hypothermia depresses the immune response and
lung function.
20. Avoid manipulating, advancing, and/or withdrawing the coated
guidewire through a metal cannula or needle. Manipulation,
advancement, and/or withdrawal through a metal device may
result in destruction and/or separation of the outer coating,
resulting in the coating material remaining in the vasculature,
which may result in unintended adverse events (see below)
requiring additional intervention.
•
Sterile inflammation or granulomas at the access site
•
Pulmonary embolism
•
Pulmonary infarct
•
Myocardial embolism
•
Myocardial infarct
•
Embolic stroke
•
Cerebral infarct
•
Tissue necrosis
•
Death
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1.
Stop operation of the console.
2.
Disconnect the Start-Up Kit from the catheter. Properly cap both
the catheter and Start-Up Kit using an aseptic technique.
3.
Fill a sterile 10 ml slip tip syringe with sterile saline.
4.
Connect the syringe to the IN Luer of the catheter and disconnect
the OUT cap. Infuse the 10 ml of saline–it should flow out the
OUT Luer.
5.
Cap the OUT Luer and pull 5 cc of vacuum. Sustain for at least
10 seconds. Approximately 4 ml of saline, but not blood, should
enter the syringe and you should be able to maintain the vacuum.
6.
Ease the vacuum and recap the IN Luer.
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1.
Look for obvious leakage.
2.
Remove the tubing from the pump raceway and inspect for
damage (return it to position if not damaged).
3.
Check along the tubing from the pump to the patient for sources
of fluid loss.
•
Look for damage to the tubing and/or the presence of air
within the tubing.
•
Inspect and tighten each Luer fitting as necessary (do not use
instruments to tighten Luer fittings).
•
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Condensation on the exterior of the tubing is normal.
4.
Similarly, check the tubing that returns to the pump from the
patient. Examine the saline bag to ensure that it has not been
accidentally compromised (for example, the spike may have
damaged the bag wall).
5.
Trace the tubing from the saline bag back to the pump.