COOK Vital-Port Instrucciones De Uso página 6

WARNING
• Introduction of the catheter into the subclavian vein (Fig. 2, reference A) using standard percutaneous techniques
may subject the catheter to periodic compression forces within the narrow costoclavicular space between the clavicle
(Fig. 2, reference B) and first rib (Fig. 2, reference C). Reported complications from repeated subclavian compression
include catheter pinch-off syndrome, catheter fracture, and catheter shear followed by embolization of the distal portion.
The likelihood of catheter occlusion and damage can be greatly reduced by choosing an access site lateral to the clavicle
(preferably at or lateral to the midclavicular line) (Fig. 2, reference D) and prior to the vein entering the thorax at the
costoclavicular space.
RECOMMENDED: Central Venous Catheter introduced at or lateral to mid-clavicular line (Fig. 2, reference E).
AVOIDED: Central Venous Catheter introduced medial to costoclavicular space (Fig. 2, reference F).
For additional information and references on this subject, a booklet entitled Understanding and Avoiding Subclavian
Compression of Central Venous Catheters is available from Cook.
Catheter Placement
For percutaneous access:
a. Choose an appropriately sized introduction system and attach the introducer needle to a syringe.
b. Introduce the needle into the desired vessel, gently aspirating during introduction.
c. Remove the syringe from the needle, being sure to cover the needle opening to prevent air embolism.
d. Insert the wire guide into the needle using wire guide straightener if included.
e. Advance the wire guide to the appropriate position. Confirm position using radiographic technology.
f. Remove the needle and straightener.
g. Advance the introducer dilator/sheath over the wire guide.
h. Remove the dilator. WARNING: Prevent air embolism by applying finger pressure over the opening of the
introducer sheath.
i. Insert the catheter into the sheath. Position the distal end of the catheter at the desired location using appropriate
imaging technologies (Fig. 3)
j. Peel away the sheath while withdrawing from the vessel.
k. Verify correct catheter tip placement using fluoroscopy or other appropriate imaging technology.
For cutdown access:
a. Make a small incision to expose the entry vessel of choice.
b. Isolate and stabilize the vessel. Perform vessel incision.
c. Introduce the catheter and advance the tip to the desired location. (Fig. 3)
d. Verify correct catheter tip position using fluoroscopy or other appropriate imaging technology.
Pre-Attached Catheter Models
1. Prior to catheter placement select the site for the port pocket.
2. Make an incision at the edge of the desired anatomic location for the port pocket.
3. Create the subcutaneous pocket using blunt dissection
4. Measure the catheter length. Provide enough slack to allow for body movement.
5. Trim the excess catheter by cutting the distal end squarely.
6. Verify that the port chamber(s) and catheter are filled with heparinized saline (100 IU/mL).
7. Gain access to the vascular system and place the catheter using either percutaneous or cutdown approach as
described above. Use a standard tunneling device when required.
8. Secure port body in the subcutaneous pocket.
Detached Catheter Models
1. Verify that the catheter is filled with heparinized saline (100 IU/mL).
2. Gain access to the vascular system using standard percutaneous techniques or surgical cutdown.
3. Make an incision at the edge of the desired anatomic location for the port pocket.
4. Create the subcutaneous pocket using blunt dissection
5. Position the distal end of the catheter in the vessel at the desired location. Advance the catheter from the selected
access vessel back to the port pocket. Use a standard tunneling device when required.
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