Merit Medical Embedding Tool - Manual (Page 3)

EmbEddINg INSTRUCTIONS
STEP 1: PREPaRaTION
1. during the Pd catheter implantation procedure, implant
and tunnel the catheter according to hospital protocol
or product instructions for Use, with the superficial cuff
3.0 cm from the future exit-site (primary exit-site). the
exit-site incision should be about 1.5 cm long (equal to
three catheter widths).
2. mark the desired track of the portion of the catheter
to be embedded. the embedding track can be made
wherever there is suitable space. the path of the
subcutaneous embedding track should be straight or
curvilinear in order to facilitate subsequent catheter
retrieval.
NOTE:
a. if using a flex-neck Classic or arC™ catheter, or an
Exxtended catheter with an upper abdomen exit-site,
the shape of the embedding track should form a gentle
curvilinear turn back toward the midline.
b. if using a flex-neck Exxtended
Catheter with an upper chest
exit-site, a straight subcutaneous
embedding track down the torso
may be used.
3. determine that the external length
of the catheter to be embedded
fits the patient’s anatomy. trim
the external catheter length, if
necessary.
NOTE: if the external part of the
catheter is trimmed, make sure that
the cut is perpendicular to the catheter tube, and that the
face of the cut is smooth.
5. disassemble the titanium Plug from the Cap. do not
discard the Cap.
6. thread the Plug onto the plastic handle. be careful not
to cross-thread the Plug and handle threads.
STEP 2: EmbEddINg
1. lay the external (subcutaneous) part of the catheter
to be embedded on the patient’s abdomen to assure
proper placement.
2. mark a location on the patient’s abdomen to indicate the
end of the embedding track which also will become the
temporary secondary exit-site.
NOTE: allow for the extra length of the Plug and Cap. this
is typically 1.0 – 2.0 cm.
3. make an incision, approximately 0.5 – 0.7 cm, with a #11
blade at the secondary exit-site.
4. insert the tip of the handle, with the Plug attached,
through the secondary exit-site and through the middle
of the subcutaneous tissue toward the primary exit-site.
5. advance the handle until the entire titanium Plug is
visible.
6. dry the Plug thoroughly.
7. infuse heparin or equivalent into the catheter, as per
standard protocol.
8. insert the Plug into the catheter so that the end of the
catheter is next to (touching) the shoulder of the Plug.
NOTE:
• do not detach or separate the Plug from the handle.
• a correctly positioned catheter and Plug should form a
relatively smooth and continuous surface from catheter
to Plug.
9. secure the catheter to the Plug with a permanent, non-
absorbable suture.
10. retract the handle and catheter through the
subcutaneous tissue until the Plug is visible at (external
to) the secondary exit-site.
CaUTION: do not twist or kink the catheter.
11. hold the catheter and Plug stationary.
12. separate the handle and the Plug by rotating the
handle counter-clockwise.
CaUTION: do not twist the catheter or the Plug.
13. Verify that the catheter is not twisted by making sure
that the radiopaque stripe is consistently positioned
from the subcutaneous cuff to the end where the plug is
inserted.
14. thread the titanium Cap onto the Plug and tighten
firmly. there should be no gaps between the Cap and
Plug when completely fastened.
15. insert the Plug, with the Cap attached, and catheter into
the subcutaneous tissue.
NOTE:
• if necessary, use forceps to push the Plug into the
subcutaneous tissue.
• if necessary, use a second set of forceps at the primary
exit-site to retract the catheter into the subcutaneous
tissue.
• if the catheter (with Plug attached) seems to be too
close to the secondary exit-site, enlarge the secondary
exit-site incision and position the Plug deeper into the
subcutaneous tissue, or trim off additional length of the
catheter and reinsert the Plug.
CaUTION:
• do not retract the catheter more than 2.0 cm back
through the primary exit-site.
• do not dislodge or reposition the superficial
subcutaneous cuff.
16. Carefully verify that:
• the catheter is not kinked or twisted.
• the subcutaneous cuff is in the proper location relative
to the future primary exit-site.
• the embedding track forms a straight or curvilinear
path that will facilitate pulling the catheter from the
subcutaneous path during the retrieval procedure.
17. Close the original catheter insertion incision, as well
as the primary and secondary exit-site incisions, as per
normal hospital protocol.
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