Merit Medical Flex-Neck Classic ARC Catheter - Manual (Page 3)

NOTE: The Classic and ARC Stencil cannot be used with
other brands of PD catheters, or with other sizes or styles of
Flex-Neck PD Catheters.
Flex-Neck Classic and ARC Coiled Adult Catheters are each
available in three sizes – Small, Standard, and Large. The
notched cutouts (Small, Standard, and Large) apply to both
Classic and ARC catheter styles. The exit-site options for the
various sizes of catheters are denoted by circles 1-5.
ALWAYS verify that all location choices and markings are
not at belt lines, skin fold apexes, or blind sides of skin
folds, and that the patient is able to see and reach the
proposed exit-site.
The Flex-Neck ExxTended Catheter is highly recommend-
ed for patients who are not candidates for the Classic or
ARC catheter, according to the stencil exit-site markings.
Please consult Exxtended Catheter Instructions for Use for
additional information.
For all Classic Catheters, do not make the arcuate bend too
acute. If the bend is too acute, the catheter may migrate;
the exit cuff may erode; and/or a kink may occur occluding
the catheter. For all ARC Catheters, do not attempt to
change the preformed arcuate bend; doing so will greatly
increase the risk of catheter migration.
INSTRUCTIONS FOR STENCIl USE
Pre-Procedure Stencil Marking
The Stencils can be used in the clinic prior to the scheduled
implantation or on the day of the implantation procedure
in the surgical suite as part of the preoperative prepara-
tions. Proper Stencil use is done in 2 to 3 stages, first with
the patient supine, and then with the patient sitting and/
or standing.
1. Determine from OR staff which Flex-Neck Catheter size
and style will be implanted in the patient.
2. Based on the chosen size and style, with the patient
supine, align the Stencil on the patient’s midline, with
the appropriate notched cut-out placed on the
upper border of the public symphysis. See figure A.
3. With the Stencil located properly based on the chosen
catheter, mark the T-bar cutout , which is the
location of the primary incision site and the rectus cuff.
Mark the Rectangles cutout which indicate the
tunnel track.
4. Choose the most appropriate exit-cuff location, as
indicated by the Diamond cutout , and exit-site
location, as indicated by the Circle cutout , as appro-
priate both to patient physique and chosen catheter size
and style.
5. Verify the markings with the patient supine, sitting, and
standing. This ensures that the markings, and the cathe-
ter placement locations that they indicate, will be ideally
located and readily visible and accessible to the patient.
figure A
Stencil Marking in
the Surgical Suite
Sterile Stencils are
included in each
Flex-Neck catheter kit.
If no patient marking was done in advance in the clinic,
the Stencil can be used during the procedure, particularly
after laparoscopic or peritoneoscopic visualization of the
peritoneum to:
• Coordinate and verify the location choices
and markings.
• Adapt or adjust those markings, if necessary.
1. Determine from OR staff which Flex-Neck Catheter size
and style will be implanted in the patient.
2. Based on the chosen size and style, with the patient
supine, align the Stencil on the patient’s midline, with
the appropriate notched cut-out placed on the
upper border of the public symphysis.
3. With the Stencil located properly based on the chosen
catheter, mark the T-bar cutout , which is the
location of the primary incision site and the rectus cuff.
Mark the Rectangles cutout which indicate the
tunnel track.
4. Choose the most appropriate exit-cuff location, as
indicated by the Diamond cutout , and exit-site
location, as indicated by the Circle cutout , as appro-
priate both to patient physique and chosen catheter size
and style.
Flex-Neck Catheter Options:
Style, Size and location
ARC Catheter Options: Size and location
ARC Coil Exit-Site Exit-Cuff
Catheter Size Location Location Location
Adult Small Small 5 ARC
Adult Standard Standard 5 ARC
Adult Large Large 5 ARC
Classic Catheter Options: Size and location
Classic Coil Exit-Site Exit-Cuff
Catheter Size Location Location Location
Adult Small Small 1 or 2 Small
Adult Standard Standard 2 or 3 Standard
Adult Large Large 3 or 4 Large
INSTRUCTIONS FOR USE
CAThETER IMPlANTATION
Flex-Neck Peritoneal Dialysis Catheters can be implanted
via a number of implantation methods according to stan-
dard hospital protocols, including:
• Peritoneoscope
• Laparoscopy
• Surgery (Open; Blind; Cut-down)
• Percutaneous (with or without fluoroscopy; with or
without guide wire)
For specific instructions, please consult Instructions for Use,
included with all Merit peritoneal dialysis catheter Implan-
tation System Kits (sold separately).
CAUTIONS: Use the radiopaque stripe as a guide to keep
the Flex-Neck catheter straight. The catheter must not be
twisted or rotated during the implantation procedure. Any
twist or rotation in the catheter can lead to kinks, migra-
tion, and/or occlusion.