CareFusion PleurX 50-7050 Manual Del Usuario página 6

General Guidelines
1. The procedure for pleural placement can be
performed using local anesthetic and sedation.
However, depending on patient needs, it may be
performed using alternative approaches to
anesthesia or sedation.
2. Use of image guidance may aid in the accuracy
and safety of catheter placement. Care should be
taken to identify and avoid contact with
vasculature near the guidewire insertion site.
3. Guidewire insertion site selection should be
based upon patient anatomy and presentation
with consideration given to any possible
adhesions or loculated pockets of fluid.
4. Consideration should be given to the patient's
ease of access in determining the location of the
catheter exit site.
5. The fenestrated end of the catheter may be cut
shorter depending on an individual patient's
anatomy. Note: Leave at least one fenestration
present on the catheter.
6. When using the drainage line, it may be used to
drain at a suction level of -60 cm H
as long as it takes to drain 1,000 ml of fluid from
the chest per day. The volume of fluid removed
should be based on the individual patient's status
and the risks for over draining, including
re-expansion pulmonary edema in the chest.
Suggested Placement Procedure
Tunneled
portion of
catheter
External portion
of catheter
(3)
Proper medical and surgical procedures are the
responsibility of the physician. The appropriateness
of any procedure must be based upon the needs of
the patient. Figure (3) illustrates the placement of
the PleurX™ Pleural Catheter, as described in the
following procedure.
1. Position the patient appropriately to access the
desired guidewire insertion site.
2. Identify the appropriate intercostal space for
guidewire placement. The guidewire is typically
placed in the sixth or seventh intercostal space.
Ultrasound can be used to confirm the guidewire
insertion site.
3. Identify the location of the catheter exit site,
4. Surgically prep the patient.
5. Drape and anesthetize the planned insertion and
Caution: Care must be taken when inserting the
needle to avoid puncturing or lacerating the lung or
liver.
6. Insert the guidewire introducer with needle,
7. Ensure free aspiration of pleural fluid, then
8. Insert the guidewire through the introducer,
Caution: Do not allow the guidewire to inadvertently
advance totally within the patient. Ensure that the
guidewire exits the proximal end of the needle,
dilator, or sheath prior to and during placement of
each component.
O or less for
2
9. Remove the introducer, leaving the guidewire in
Caution: Damage to the guidewire may result if
withdrawn through the needle.
10.Make a 1 cm incision at the guidewire insertion
11.Make a second 1-2 cm incision approximately
Note: A smaller incision may provide better security
of the catheter.
Note: Take care to ensure that the tunnel track has
been anesthetized.
12.The fenestrated end of the catheter may be cut
First Incision:
Guidewire
insertion site
Second
Incision:
Catheter
exit site
13.Attach the fenestrated end of the catheter onto
Caution: Exercise care when handling the catheter to
prevent it from coming into contact with surfaces
such as drapes or towels. Silicone rubber is highly
electrostatic and attracts airborne particles and
surface contaminates.
Caution: Use smooth surface instruments when
handling the catheter. Possible cuts or tears can
occur if smooth surface instruments are not used.
2
which is usually approximately 5 cm from the
guidewire insertion site.
tunneling sites.
attached to a syringe, through the desired
intercostal space and just over the lower rib.
remove the needle and syringe, leaving the
guidewire introducer in place.
advancing it well into the pleural cavity.
place.
site.
5 cm from the guidewire insertion site. This
incision will be the catheter exit site. Consider
the patient's ease of access in determining its
location. (Figure 3)
shorter depending on an individual patient's
anatomy. If desired, cut a portion of the
fenestrated end of the catheter by using a scalpel
to make a straight cut between fenestrations.
Leave at least one (1) fenestration on the
catheter.
the tunneler.