Thoratec Vectra Manual Del Usuario página 10

suture placement and bites. Elongation of suture holes or gaps between the graft and
host vessel could lead to anastomotic bleeding.
Thrombectomy
The Vectra VAG may be declotted as follows:
• Follow the catheter manufacturer's instructions regarding size, selection, and
balloon inflation, matching the balloon size to the inner diameter of the graft. Over-
inflation and excessive pulling may dilate or damage the graft.
• If devices such as Adherent Clot Catheter are used to declot the Vectra grafts, it is
important to match the catheter size to the internal diameter of the graft.
• If a longitudinal incision is used, place stay stitches at each end of the incision
before introducing the embolectomy catheter.
• If a transverse incision is used, no stay stitch is necessary and a horizontal mattress
suture technique will aid in closure.
Note: Do not place undue stress on the anastomosis or incision when placing or
removing the catheter.
Surgical Revision
If it is necessary to repair the Vectra graft with a surgical interposition bypass graft,
the use of a Vectra revision graft with uniform reinforcement is recommended. Two
types of revision grafts are available in either 5mm or 6mm diameters:
• 10-12 W.P.I. (4-5 W.P.C.) reinforcement for the portion of the grafts with the less
reinforced section, generally near the access sites.
• 24-32 W.P.I. (9.5-12.5 W.P.C.) for the portion of the graft with more densely
reinforced section, generally in the loop portion of graft.
Because of the monofilament reinforcement, only an end-to-end, not an end-to-
side, anastomosis of the revision graft to the implanted graft is recommended.
Cannulation
Note: The Vectra Vascular Access Graft may be punctured for vascular access within
24 hours after implant, providing no contraindications are present. (see #4 below)
Insert the blood access (dialysis) needle at a 45° angle with the bevel up until the graft
is penetrated. If the blood access needle is inserted such that the angle between the
needle axis and the graft is too small, tears in the wall of the graft can occur. If the
needle is inserted at a 90° angle, it increases the possibility of puncturing the far wall
of the graft, which may lead to hematoma formation.
For best results follow the established cannulation practices listed below:
1. Rotate Cannulation Sites. Repeated cannulation in the same area may lead to damage
of the graft wall and/or formation of hematoma or pseudoaneurysm. Needle puncture
sites should be equally spaced along the subcutaneous length of the graft.
2. Do not cannulate within the dialysis needle's length of the proximal or distal anas-
tomoses.
3. Strict adherence to aseptic technique is required to minimize infection.
4. As with all dialysis, do not cannulate if there are any signs of infection, bleeding,
swelling, edema, hematoma, or in the absence of a strong "thrill".
After needle withdrawal, use gentle, non-occlusive digital pressure to compress
the cannulation site to aid in hemostasis. The Vectra VAG seals quickly (1-5 min-
utes). Prolonged compression or use of stasis clamps may lead to clot formation,
restricting flow through the graft.
Please refer to the Vectra 7 Vital Intervention Principles (For Dialysis) brochure
#D028-1201 for additional information.
Vectra
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Vascular Access Graft