Merit Medical ProGuide Chronic Dialysis Catheter - Manual (Page 6)

CAUTION: Avoid damage to the catheter by using a slight twisting motion.
CAUTION: To avoid damage to the catheter tip, keep the tunneler straight and do not pull it out at an
angle.
CAUTION: Inspect catheter tip for damage before proceeding with procedure.
12. Remove the stylet label and tighten down the luer lock nut of the stylet to the blue venous luer lock
connection.
13. Thread the distal tip of the stylet with the catheter over the proximal tip of the guide wire until the
guide wire exits the venous luer connection.
14. While maintaining guide wire position in the vein, advance catheter to the junction of the superior vena
cava and right atrium to ensure optimal blood flow.
PRECAUTION: To help minimize catheter kinking, it may be necessary to advance in small steps by
grasping the catheter close to the skin.
15. Remove the stylet and guide wire from the venous lumen.
16. Press the small remaining catheter loop (“knuckle”) gently into the subcutaneous pocket created at the
venous entry site.
WARNING: Catheters should be implanted carefully to avoid any sharp or acute angles which could
compromise the flow of blood or occlude the opening of the catheter lumens.
PRECAUTION: For optimal product performance do not insert any portion of the cuff into the vein.
17. Make any adjustments to the catheter insertion depth and tip position under fluoroscopy.
18. Attach syringes to both extensions and open the clamps. Confirm correct placement and catheter
function by aspirating blood from both lumens. Flush each lumen with heparinized saline (priming
volume is printed on the extension tubing clamp). Blood should aspirate easily.
PRECAUTION: If either lumen exhibits excessive resistance to blood aspiration, the catheter may need
to be rotated or repositioned to obtain adequate blood flow.
PRECAUTION: To maintain patency, a heparin lock must be created in both lumens.
PRECAUTION: It is recommended that the “venous” lumen be oriented cephalad (toward the head).
19. Clamp the extensions immediately after flushing.
20. Remove the syringes and replace with injection caps.
CAUTION: Avoid air embolism by keeping extension tubing clamped at all times when not in use and by
aspirating then irrigating the catheter prior to each use.
21. Correctly position the cuff and tunneled portion of the catheter.
22. Confirm proper tip placement with fluoroscopy. The distal “venous” tip should be positioned at the
junction of the superior vena cava and right atrium or into the right atrium for optimal blood flow.
WARNING: Failure to verify catheter placement with fluoroscopy may result in serious trauma or fatal
complications.
SECUREMENT AND DRESSING
1. Suture the pocket created for the small remaining catheter loop (“knuckle”) at the venous entry site.
2. If necessary, suture the catheter exit site.
3. Suture the catheter to the skin with the suture wing.
WARNING: Do not suture through any part of the catheter. If sutures are used to secure the catheter,
make sure they do not occlude or cut the catheter. Catheter tubing may tear when subjected to
excessive force or rough edges.
PRECAUTION: The catheter must be secured / sutured for the entire duration of implantation.
4. Apply transparent site dressing to catheter exit site and the tunneled insertion site using standard
institutional protocol.
WARNING: Do not use sharp instruments near the extension tubing or catheter body.
WARNING: Do not use scissors to remove dressing.
WARNING: Alcohol or alcohol-containing antiseptics may be used to clean the catheter/skin site;
however, care should be taken to avoid prolonged or excessive contact with the solution(s).
WARNING: Acetone and PEG-containing ointments can cause failure of this device and should not be
used with polyurethane catheters.
5. Record the catheter length and catheter lot number on the patient’s chart. Note in the chart that Acetone
and PEG-containing ointments should not be used with this device.
SITE CARE
1. Clean the skin around the catheter.
WARNING: Use of ointments/creams at the wound site is not recommended.
2. Cover the exit site with occlusive dressing and leave extensions, clamps, and caps exposed for access by
dialysis team.
3. Wound dressings must be kept clean and dry.
CAUTION: Patients must not swim or soak the dressing unless instructed by a physician.
PRECAUTION: If profuse perspiration or accidental wetting compromises adhesion of the dressing, the
medical and nursing staff must change the dressing under sterile conditions.
CATHETER REMOVAL
As with all invasive procedures, the physician will assess the anatomical and physiological needs of the
patient to determine the most appropriate catheter removal technique. The white implantable retention
cuff facilitates tissue ingrowth, therefore the catheter must be surgically removed.
WARNING - Only a physician familiar with the appropriate removal techniques should attempt to
remove an implanted chronic dialysis catheter.
CAUTION: Always review institutional protocol, potential complications and their treatment, warnings
and precautions prior to catheter removal.
CAUTION STATEMENTS REGARDING HEMODIALYSIS TREATMENT
• Hemodialysis should be performed under a physician’s instruction using approved institutional protocol.
• The heparin solution must be removed from each lumen prior to treatment to avoid systemic
heparinization of the patient. Aspiration should be based on institutional protocol.
• Before dialysis begins, all connections to the catheter and extracorporeal circuits should be
examined carefully.
• Accessories and components used in conjunction with this catheter should incorporate luer-lock
adapters.
• Frequent visual inspection should be conducted to detect leaks and to minimize blood loss
or air embolism.
• Repeated over-tightening of blood lines, syringes and caps will reduce connector life and could lead to
potential connector failure.
• If a leak in the catheter tubing or hub occurs, or if a connector separates from any component during
insertion or use, clamp the catheter and take all necessary steps and precautions to prevent blood loss
or air embolism.
• To minimize the risk of air embolism, keep the catheter clamped at all times when not attached to a