Merit Medical Flex-Neck ExxTended Catheter User Manual

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finalizing catheter Placement

merit medical Systems, Inc. provides three options for tunneling

the catheter through the skin exit-site location. The technique

for creating the exit-site will vary according to the particular

tool selected to perform this function. a plastic retrograde

Tunnelor® Tool , plastic antegrade Faller Trocar, and stainless

steel antegrade Faller Trocar are sold separately.

1. The exit-site should be approximately 3-4 cm distal to the

exit site cuff if possible.

note: For reduced infection and optimal placement, the cathe-

ter should have a gentle, curved downward-facing exit-site

WarNING: check catheter at primary site and exit-site to ensure

the catheter is not twisted or kinked.

2. after the catheter has been tunneled to the exit-site, verify

catheter patency by infusing and draining a minimum of 1.0 l of

sterile saline.

3. attach the catheter connector and cap, or alternatively,

a connector and transfer set. See below, “catheter connector

Instruction” for details.

4. close the primary and secondary incision sites, appropriate

to the implantation technique used.

note:

a. do not suture the exit-site.

b. do not use anchoring stitches to secure the catheter to the

skin. Instead, use sterile adhesive strips to immobilize the

catheter on the skin adjacent to the exit-site.

c. apply appropriate dressings to all incision sites and to the

catheter itself.

supplemental Information

• urgent or supportive dialysis can begin immediately with re-

duced volumes (1 liter maximum) and the patient in a supine

position. If possible, the abdomen should be continuously

dry (nocturnally) for 8-12 hours within each 24 hour period

after catheter placement for the first full week of dialysis. If

the patient assumes an upright position, there should be no

fluid in the abdomen for the first 7 days or until the catheter

sites are healed.

• catheter immobilization is important to allow for proper

tissue in-growth.

• The catheter should be flushed with heparinized saline with-

in 24 to 72 hours and a minimum of every 7 days thereafter.

sectIon e

catheter connector InstructIon

a plastic connector is included with each Flex-Neck peritoneal

dialysis catheter. a two-piece Titanium connector for Flex-Neck

adult, adolescent, and pediatric peritoneal dialysis catheters is

available separately from merit medical.

after successful implantation of the Flex-Neck peritoneal dialysis

catheter, attach a merit peritoneal dialysis (pd) catheter con-

nector to the catheter.

each catheter kit contains one connector and one cap.

• Tapered Tip (a)

• raised Shoulder ridge (B)

• Finger Grip (c)

• Threaded luer (d)

• cap (e)

1. Wet the Tapered Tip (a) of the connector with sterile saline or

sterile water, and insert it into the catheter.

• do not use any other lubricant.

• do not use a twisting motion to force the catheter onto the

connector.

• push the connector into the catheter with a single forward

motion.

2. advance the catheter completely to the raised Shoulder

ridge of the connector. The catheter tubing must completely

pass over the Tapered Tip and to the raised Shoulder ridge, but

not beyond that onto the Finger Grip. See diagram.

3. pull carefully on the connector and catheter to test the

strength of the connection.

4. attach either the cap (e), or a dialysis transfer set, to the

threaded luer (d).

catheter cleaning and care

all Flex-Neck peritoneal dialysis catheters are made of silicone.

exit-site cleaning agents that are compatible with silicone cathe-

ters therefore may be acceptable for use on Flex-Neck peritoneal

dialysis catheters. Such cleaning agents include:

• electrolytically-produced sodium hypochlorite solutions (i.e.,

exSept plus®)

• Normal (sterile) saline

cleaning agents that are non-irritating, non-toxic, anti-bacterial,

and in liquid form are generally recommended.

The following cleaning agents are not compatible with silicone

catheters, and are not recommended for use with Flex-Neck

peritoneal dialysis catheters:

• acetone or acetone-based products

• povidone-iodine or iodine-based products

merit medical Systems, does not provide specific recommenda-

tions or protocols for exit-site care and cleaning, whether by the

healthcare professional or by the patient. appropriate exit-site

and catheter care treatment protocols should be individualized

for each patient, and established by the patient’s physician(s),

nurse(s), dialysis center(s), and/or other relevant dialysis health-

care professionals.

exSept plus is a registered trademark of alcavis hdc, llc or one

of its affiliates.

references

crabtree Jh. construction and use of stencils in planning for

peritoneal dialysis catheter implantation. perit dial Int. 2003

Jul-aug;23(4):395-8.

crabtree Jh. Selected best demonstrated practices in peritoneal

dialysis access. kidney Int. 2006;70:S27-S37.

crabtree Jh, Burchette rJ, Siddiqi Na. optimal peritoneal dialysis

catheter type and exit site location: an anthropometric analysis.

aSaIo J. 2005 Nov-dec;51(6):743-7.

Gokal r, alexander S, ash S, et al. peritoneal catheters and

exit-site practices toward optimum peritoneal access: 1998

update. perit dial Int. 1998 Jan-Feb;18(1):11-33.

Gokal r, ash Sr, helfrich GB, et al. peritoneal catheters and

exit-site practices: toward optimum peritoneal access. perit dial

Int. 1993;13(1):29-39.

Twardowski ZJ. peritoneal catheter placement and manage-

ment. In Suki WN, massry SG, eds. Therapy of renal disease

and related disorders. 3rd ed. Boston, ma: kluwer academic

press;1997:953-79.