Surgical Cut-Down Technique; References Requiring Modifications To The Above Techniques; Brachial Implantation Technique; Braunule Technique - B.Braun CELISTE Instrucciones De Uso

VII-3 Surgical Cut-down Technique
a) The skin is incised and the tissue dissected (Fig. 11, page 14).
b) The selected vessel is identified and tapes passed under it. The vessel is incised with a scalpel or with scissors (Fig. 12, page 14).
c) The previously flushed catheter is inserted into the vessel, using either a small vessel dilator or vein lifter (Fig. 13, page 14).
d) Follow from point e) - k) of the preceding paragraph: "Percutaneous Technique".
VII-4 References requiring modifications to the above techniques
VII-4-1 Brachial Implantation Technique
Brachial ports and catheters can be placed using either the Percutaneous or Surgical Cut-down Technique, see above.
Select the appropriate vein on the anterior aspect of the elbow, normally the Basilic or Cephalic vein.
The catheter length should be measured before insertion of the catheter into the vein.
Ensure that the access port is not placed over the mid-line of the selected vein. The port and catheter should be positioned above
the elbow on the internal surface of the arm.
VII-4-2 Braunule Technique
a) Puncture the vein with a needle percutaneously or through a skin incision.
b) Flush the catheter with sterile sodium chloride (NaCl) 0.9 %. Remove the stilette from the cannula, and insert the catheter
through the cannula to the desired position at the junction of the Superior Vena Cava and the right atrium.
c) Gently withdraw the cannula over the catheter.
d) Follow from point e) - k) above: "Percutaneous Technique".
VII-4-3 Valved catheter
Do not place the catheter over the guidewire, as this may cause damage to the valve.
The catheter must be tunnelled from the puncture point to the port pocket; the tunnelling rod must not be placed through the valve.
VII-4-4 Pre-connected catheter and port
The catheter should be measured and trimmed to the correct length before insertion in the vein.
The catheter must be tunnelled from the port pocket to the puncture point.
VIII - USE OF THE PORT AND CATHETER

VENOUS PORTS

Always verify that the port and catheter are functional by aspirating a few mL of blood into a syringe and injecting a few mL of
sterile sodium chloride (NaCl) 0.9% before attempting to start an infusion.
If aspiration of blood is not possible, attempt to inject a few mL of sterile sodium chloride (NaCl) 0.9% into the port.
Caution: If resistance to injection is noted, or if swelling occurs around the port or along the catheter, device malfunction should
be suspected. In this case, device integrity should be verified using X-ray and contrast media studies.
IX - MAINTENANCE OF THE PORT AND CATHETER
General recommendations:
• If sterile heparinized sodium chloride (NaCl) 0.9% is used the system should be rinsed first with sterile sodium chloride (NaCl) 0.9%
alone, as some drugs may react with heparin and result in blockage of the port/catheter due to the formation of precipitates.
• Always rinse the system between administration of different drugs. Special care should be taken with drugs which have a higher risk
of precipitation, with anti-coagulation agents, after blood sampling or after transfusion to reduce the risk of catheter occlusion.
• Failure to maintain the system may result in occlusion of the catheter.
IX-1 RINSING AND HEPARINIZATION
VENOUS PORTS
Rinsing of the access port is essential.
Rinse the port with 10-20 mL of sterile sodium chloride (NaCl) 0.9% after each use and every 4-6 weeks when no treatment is
being given.
IX-2 NEEDLE WITHDRAWAL
To avoid blood reflux into the catheter, always maintain positive pressure on the syringe during needle withdrawal (see Fig. 14, page 14).
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