Implantation Techniques; Occlusion; Infection; Central Venous Implantation Techniques - B.Braun CELISTE Instrucciones De Uso

VI-6 IMPLANTATION TECHNIQUES
Precautions:
• To prevent shearing of the guidewire never withdraw the J guidewire through the Seldinger needle.
• Remove the guidewire and the dilator together. Do not remove the guidewire through the dilator as this may result in the
guidewire unravelling.
• It is recommended that sterile NaCl 0.9% (with or without heparin according to local protocols) be used to flush the port and
catheter during implantation (Fig. 3, page 14) to reduce the risk of thrombosis.
• During implantation ensure that the catheter is not damaged by unguarded forceps, suture needle or other sharp instruments.
• If using the Celsite® Concept
square indicated on the silicone to reduce the risk of port flip.
VI-7 OCCLUSION
Precaution: Always use a syringe equal to or greater than 10 mL volume when rinsing the port to avoid generating excessive
pressures in case of occlusion of the system.
Warning: In case of obstruction of the system never try to clear the blockage using a fluid under high pressure which carries the
risk of catheter fracture and migration.
• According to local protocols, and under medical supervision, 70% alcohol may be used to aid the unblocking of silicone cathe-
ters when the blockage is due to lipid deposits. The use of alcohol with Polyurethane (PUR) catheters is not recommended.
• According to local protocols, and under medical supervision, Hydrochloric acid (HCl) 0.1 mol/L may be used to aid the unblocking
of both silicone and PUR catheters when the blockage is due to mineral deposits.
VI-8 INFECTION
Warning: In case of infection, if appropriate, treat with antibiotic drugs. If this fails, or is not appropriate, the catheter and port
should be removed.
VII CENTRAL VENOUS IMPLANTATION TECHNIQUES
VII-1 Venous catheters
a) Precaution: The catheter tip should always be positioned in the Superior Vena Cava at the entrance to the right atrium (see
Fig. 1, page 14). A radiograph should be taken to verify catheter position and exclude hemothorax or pneumothorax.
b) Warning: Particular attention should be paid when the catheter is to be implanted via the subclavian route. It is recommended
that the catheter be inserted outside the costoclavicular space (see Fig. 2, page 14). Catheter ruptures have been observed with
the subclavian route, the associated risk of extravasation of the infused drugs and embolisation of the distal extremity may have
serious consequences. This is due to rupture of the catheter secondary to the catheter being pinched in the costoclavicular space
(Pinch-Off syndrome). It is necessary to pay particular attention to catheters used for long periods or for ambulatory patients
rather than short term catheters. Catheter rupture can occur with silicone and polyurethane catheters.
The following clinical signs may suggest catheter pinching:
• The patient needs to lift the arm to permit infusion.
• Intermittent malfunction of the catheter, such as difficulty with aspiration or infusion.
• Subclavicular pain or swelling during infusion.
• Palpitations or chest discomfort may indicate catheter fracture.
Remove any subclavian catheter which presents any of the signs of catheter Pinch-Off.
A radiograph with contrast injection may be useful to detect catheter abnormalities at the costoclavicular level.
VII-2 Percutaneous Technique
a) Insert the Seldinger needle into the chosen vein; verify the position by observing blood reflux (Fig. 4, page 14).
b) Insert the J guidewire into the vein, when the correct position is reached, withdraw the needle (Fig. 5, page 14).
c) Thread the assembled dilator and peelable sheath over the guidewire using a twisting motion to pass through the skin planes
(Fig. 6, page 14).
d) Remove the dilator and guidewire from the vein and insert the catheter through the peelable sheath (Fig. 7, page 14) to the desi-
red position at the junction of the Superior Vena Cava and the right atrium (Fig. 1, page 14). Check catheter tip position using
fluoroscopy.
e) Prepare the port pocket at the chosen site, the port should lie approximately 1/2 - 1 cm below the skin surface away from the
injection site. Cut the luer connector from the catheter and attach to the tunnelling rod (Fig. 8, page 14).
f) Tunnel the catheter from the puncture point to the port pocket (Fig. 9, page 14); ensure there is no kinking of the catheter. Cut
the excess catheter (at right-angles) prior to connecting to the port.
g) Catheter port/connection: Slide the connection ring over the catheter, firmly push the catheter onto the exit cannula ensuring
the catheter covers the length of the exit cannula, slide the connection ring over the catheter and exit cannula. The connection
ring should be in contact with the port (Fig. 10, page 14).
h) Confirm catheter connection by gently pulling on the catheter.
i) Insert the port into the port pocket, paying attention not to kink the catheter.
j) Confirm catheter patency (by ensuring that both aspiration and injection are possible), taking care that the skin incision is not
at the injection site.
k) It is possible to fix the access port to the fascia with sutures.
TM
Access Ports (with silicone inserts) it is recommended that the suture be placed within the
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