How Supplied - COOK Medical Blue Rhino G2-Multi Instrucciones De Uso

14. Advance the Blue Rhino G2-Multi dilator and the guiding catheter as a unit over the wire guide, while
maintaining wire guide position. (Fig. 11) NOTE: Align the proximal end of the guiding catheter at the mark
on the proximal portion of the wire guide. (Fig. 1) This will ensure that the distal end of the guiding catheter is
properly positioned back on the wire guide, preventing possible trauma to the posterior tracheal wall during
subsequent manipulations. NOTE: Bronchoscopic guidance may also prevent possible trauma to the posterior
tracheal wall.
15. Begin to dilate the tracheal access site by advancing the guiding catheter and Blue Rhino G2-Multi dilator
into the trachea. To properly align the dilator on the wire guide/guiding catheter assembly, position the
proximal end of the dilator at the single positioning mark on the guiding catheter. This will ensure that
the distal tip of the dilator is properly positioned at the safety ridge on the guiding catheter to prevent
possible trauma to the posterior tracheal wall during introduction. While maintaining the visual reference
points and positioning relationships of the wire guide, guiding catheter and dilator, advance them as a unit to
the skin level mark on the Blue Rhino G2-Multi dilator. (Fig. 11) NOTE: Proper positioning and alignment may
help minimize complications (e.g., stenosis).
16. Advance and pull back the dilating assembly several times to effectively dilate the tracheal access site.
NOTE: The wire guide must always lead the dilator and the guiding catheter assembly to prevent possible
trauma to the posterior tracheal wall during dilation. Care should be taken to keep the guiding catheter assembly
properly aligned with the mark on the proximal portion of the wire guide. This will ensure that the tip of the
guiding catheter assembly does not advance beyond the distal tip of the wire guide within the trachea.
17. Remove the Blue Rhino G2-Multi dilator, leaving the wire guide/guiding catheter assembly in position.
Respiratory air leak through the tracheostomy stoma should be noted to confirm intratracheal location of
the wire guide and guiding catheter.
18. Advance the tracheostomy tube (loaded on the dilator) over the wire guide/guiding catheter assembly to the
safety ridge of the guiding catheter, then advance wire guide, guiding catheter, loading dilator and tracheostomy
tube as a unit into trachea. (Fig. 12)
NOTE: The assembly should be directed perpendicular to the axis of the trachea during insertion for uniform
dilation between tracheal cartilages. Once the tracheostomy tube is within the tracheal lumen, the assembly may
be directed caudad. NOTE: Proper positioning and alignment may help minimize complications (e.g., stenosis).
19. Advance the tracheostomy tube to its flange. Remove the dilator, guiding catheter and wire guide, leaving
the tracheostomy tube in place. (Fig. 13) NOTE: At this point, the bronchoscope may be inserted into the
tracheostomy tube to confirm correct placement. NOTE: If using a dual cannula tracheostomy tube, insert the
inner cannula at this point.
20. Inflate the tracheostomy tube balloon cuff. Connect the tracheostomy tube to the ventilator. Confirm position of
the tracheostomy tube via standard methods (e.g., capnography, breath sounds, etc.).
21. Deflate and remove the endotracheal tube.
22. Perform suction to determine if any significant bleeding or possible obstruction exists that has not been noted
to this point.
23. If necessary, one suture may be taken at the bottom of the initial incision.
Post-Placement
Follow hospital protocol for post-tracheostomy care and maintenance.

HOW SUPPLIED

Supplied sterilized by ethylene oxide gas in peel-open packages. Intended for one-time use. Sterile if package is
unopened and undamaged. Do not use the product if there is doubt as to whether the product is sterile. Store in a
dark, dry, cool place. Avoid extended exposure to light. Upon removal from package, inspect the product to ensure
no damage has occurred.
REFERENCES
These instructions for use are based on experience from physicians and (or) their published literature. Refer to your
local Cook sales representative for information on available literature.
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