Idiomas disponibles
Idiomas disponibles
12275967 IFU_361-19901 12/13/11 10:25 AM Page 6
RC081195-2
McGaw Park, IL
Richard Cisneroz
12-07-11
12275967
Note: It is important to use an oblique approach
while passing the introducer needle through the
peritoneal wall to minimize the chance of ascitic
fluid leakage.
Caution: Care must be taken when inserting the
needle to avoid puncturing or lacerating the liver or
bowel.
6. Insert the 18 G needle, attached to a syringe,
through the peritoneum using an oblique angle.
7. Ensure free aspiration of ascitic fluid, then
remove the syringe, leaving the needle in place.
8. Insert the guidewire through the needle and
advance the distal end into the peritoneal cavity.
9. Remove the needle, leaving the guidewire in
place.
Caution: Damage to the guidewire may result if
withdrawn through the needle.
10.Make a 1 cm incision at the guidewire insertion
site.
11.Make a second 1-2 cm incision 5-8 cm superior
and medial to the guidewire insertion site. This
incision will be the catheter exit site. Consider the
patient's ease of access in determining its
location. See Diagram (3).
Note: A smaller incision may provide better security
of the catheter.
Note: Take care to ensure that the tunnel track has
been anesthetized.
12.Attach the fenestrated end of the catheter onto
the tunneler.
Caution: Exercise care when placing the catheter to
prevent it from coming into contact with surfaces
such as drapes or towels. Silicone rubber is highly
electrostatic and attracts airborne particles and
surface contaminates.
Caution: Use rubber-shod instruments when
handling the catheter. Possible cuts or tears can
occur if rubber-shod instruments are not used.
13.Pass the tunneler (A) and catheter (B)
subcutaneously from the second incision down
to and out through the first incision at the
guidewire insertion site. See Diagram (4).
Continue to draw the catheter through the tunnel
until the polyester cuff lies inside the tunnel,
about 1 cm (C) from the second incision. See
Diagram (5). Disconnect the tunneler from the
catheter.
Note: If the cuff is advanced further into the tunnel,
it can make later removal of the catheter difficult.
14.Thread the 16 Fr. peel-away introducer sheath
over the guidewire into the peritoneal cavity.
15.Remove the guidewire and dilator as a unit,
leaving the 16 Fr. peel-away introducer sheath in
place.
Proofed by:
Dimensions checked:
Caution: Place a thumb over the end of the sheath
as the dilator is removed to avoid peritoneal fluid
leakage. Care must be taken not to bend or kink the
sheath. Damage to the sheath may prevent passage
of the catheter.
16.Insert the fenestrated end of the catheter into the
sheath advancing it until all the fenestrations are
within the peritoneal cavity. This can be verified
under fluoroscopy as fenestrations are located
along the barium sulfate stripe.
17.Peel away the sheath while ensuring the catheter
remains in place. Adjust the catheter so that it
lies flat in the tunnel without any kinks.
Caution: Do not use forceps on the introducer to
break the handle and/or peel the sheath.
18.Close the incision at the guidewire insertion site.
19.Close the incision site around the catheter and
suture the catheter to the skin taking care not to
restrict the diameter of the catheter. This suture
is intended to remain in place at least until there
is tissue ingrowth around the cuff.
Caution: Exercise care when placing ligatures to
avoid cutting or occluding the catheter.
Drainage Procedure
The drainage procedure can be performed using:
a) PleurX Vacuum Bottle(s)
b) PleurX Drainage Line with other vacuum bottle(s)
or
c) Wall Suction
If using PleurX Vacuum Bottle(s), refer to PleurX
Drainage Kit Instructions for Use.
Caution: In malignant ascites patients, paracentesis-
related hypotension is uncommon, but has been
documented. Use of IV fluid replacement and/or
administration of colloidal agents can reduce the
risk of hypotension. Additionally, initial drainage
should be no more than 6L in the first 24 hours.
1. Clamp the drainage line completely closed using
the pinch clamp found on the tubing.
See Diagram (6)
Caution: The pinch clamp must be fully closed to
occlude the drainage line. When not connected to a
suction source, make sure the pinch clamp is fully
closed. Otherwise the drainage line may allow air
into the body or let fluid leak out.
Caution: When connecting to a vacuum bottle make
sure the pinch clamp on the drainage line is fully
closed, otherwise, it is possible for some, or all of
the vacuum in the bottle to be lost.
2. If using wall suction, attach the 5-in-1 adapter to
the Luer fitting on the drainage line. If using a
vacuum bottle other than PleurX, attach a 17 G
needle to the Luer fitting on the drainage line.
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