Taewoong Niti-S Nagi Stent Manual Del Usuario página 5

A. Stent Size Determination
a) The stent length and diameter should be determined by the doctor after endoscopic
and/or fluoroscopic inspection of the lesion.
b) The length and diameter of the stent should be chosen in a way that both walls of
the created transmural drainage remain tightly together, thus preventing any
migration.
B. Stent Deployment Preparation
A. Fluoroscopic Procedure
Fluoroscopic procedure has not been established yet.
B. Endoscopic Procedure
a) Under endoscopic guidance, insert an endoscope until reaching the lesion. Then
introduce a needle through the working channel of the endoscope. Advance the
needle until reaching the lesion and puncture it.
b) After puncture of the lesion, insert a guide wire through the needle and advance it
across the lesion. Remove the needle slowly and carefully.
c) After needle removal, insert a dilating device such as a needle knife and/or
balloon catheter along the guide wire until reaching across the lesion and dilate it.
d) After dilating, remove carefully a dilating device
e) Remove the stylet from the distal end of the introducer.
f) Ensure that the valve of Y-connector connecting the inner sheath and outer sheath
is locked by rotation proximal valve end in a clockwise direction to prevent
premature stent deployment.
g) Flush the inner lumen of introducer system.
C. Stent Deployment Procedure
PRECUATION: Do not twist introducer system or employ a boring motion during the
deployment as this may affect positioning and ultimate function of stent.
a) Under the fluoroscope and/or endoscopic guidance, position the introducer system
b) Once the introducer system is in the correct position for deployment, unlock the
proximal valve of the Y-connector by turning the valve more than twice in an anti-
clockwise direction.
c) To begin stent deployment, immobilize the hub in one hand and grasp the Y-
connector with the other hand. Gently slide the Y-connector back along the pusher
towards the hub
d) Under EUS and/or fluoroscopic guidance, deploy the distal flare of the stent, and
then deploy the proximal flare of the stent under endoscopic guidance while
making sure that the stent connects both walls together.
CAUTION Do not push forward or pull backward on the hub with the stent partially
deployed. The hub must be securely immobilized. Inadvertent movement of the hub
may cause misalignment of the stent and possible damage.
D. After Stent Deployment
a) Examine the stent fluoroscopically and/or endoscopically to confirm expansion.
b) Carefully remove the introducer system, guidewire and endoscope from the
patient. If excessive resistance is felt during removal, wait 3~5 minutes to allow
further stent expansion. (Place the inner sheath back into the outer sheath as the
original state prior to removal.)
c) Balloon dilatation inside the stent can be performed if judged necessary.
11. Perform Routine Post-implant Procedures

Assess the good position of the stent and effective drainage. A Stent may require
up to 1 to 3 days to expand fully.

Doctor's experience and discretion can determine the appropriate drug regimen
for each patient.

After implantation, patient should remain on a soft diet until otherwise determined
Figure 3
Figure 4