Thoratec Vectra Manual Del Usuario página 7

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Vectra Vascular Access Graft
Always create tunnels at appropriate depths that will allow easy visualization and pal-
pation of the Vectra VAG.
Care should be taken to push rather than pull the graft through the tunneler.
The Vectra VAG can be implanted using either a one-sheath or two-sheath technique
as described below.
One-sheath Technique:
1. Place the sheath over the rod and thread the tunneler tip onto the end of the tun-
neler rod to hold the sheath in place.
2. Make two (2) incisions for distal and proximal entries of the implant site.
3. Insert the fully assembled tunneler into one of the incisions to create a tunnel sub-
cutaneously between the distal and proximal incisions.
4. With the tip of the tunneler exposed, the tip is removed and the rod is pulled away,
leaving the sheath in place subcutaneously.
5. Insert the Vectra VAG into the subcutaneously placed sheath and gently push the
graft through using a rotating motion if necessary, while irrigating liberally with
sterile saline.
Do NOT pull the graft through the tunneler sheath. Do NOT twist the graft.
6. For a looped graft configuration, position graft to make sure the loop portion is
smooth and does not kink and that the more densely reinforced portion of the graft
is at the loop apex. The center of the apex is marked as pictured in Figure 4.
Do not attempt to reposition the graft after sheath removal.
7. When positioning of graft is complete, carefully remove the sheath, leaving the graft
in place subcutaneously.
8. Repeat steps 3 through 6 if using a looped graft configuration.
Two-sheath Technique for Looped Graft Position:
The following two-sheath technique has been successfully used with the Vectra VAG to
facilitate the final positioning of the graft once the tunneler sheaths are in place in the
subcutaneous tissue. (Figure 6)
This technique requires the use of a fully assembled tunneler and an extra sheath.
1. Place the sheath over the rod and thread the tunneler tip onto the end of the tun-
neler rod to hold the sheath in place.
2. Make two (2) incisions for distal and proximal entries of the implant site.
3. Insert the fully assembled tunneler into one of the incisions to create a tunnel sub-
cutaneously between the distal and proximal incisions. (Figure 7)
Figure 6. Two-sheath implantation technique
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