Instruction Manual

Finalizing Catheter Placement
Merit Medical Systems, Inc. provides three options for tunneling
the catheter through the skin exit-site location. The technique
for creating the exit-site will vary according to the particular
tool selected to perform this function. A plastic retrograde
Tunnelor® Tool , plastic antegrade Faller Trocar, and stainless
steel antegrade Faller Trocar are sold separately.
1. The exit-site should be approximately 3-4 cm distal to the
exit site cu if possible.
NOTE: For reduced infection and optimal placement, the cathe-
ter should have a gentle, curved downward-facing exit-site
WARNING: Check catheter at primary site and exit-site to ensure
the catheter is not twisted or kinked.
2. After the catheter has been tunneled to the exit-site, verify
catheter patency by infusing and draining a minimum of 1.0 L of
sterile saline.
3. Attach the Catheter Connector and Cap, or alternatively,
a connector and transfer set. See below, “Catheter Connector
Instruction” for details.
4. Close the primary and secondary incision sites, appropriate
to the implantation technique used.
NOTE:
a. Do not suture the exit-site.
b. Do not use anchoring stitches to secure the catheter to the
skin. Instead, use sterile adhesive strips to immobilize the
catheter on the skin adjacent to the exit-site.
c. Apply appropriate dressings to all incision sites and to the
catheter itself.
Supplemental Information
• Urgent or supportive dialysis can begin immediately with re-
duced volumes (1 liter maximum) and the patient in a supine
position. If possible, the abdomen should be continuously
dry (nocturnally) for 8-12 hours within each 24 hour period
after catheter placement for the rst full week of dialysis. If
the patient assumes an upright position, there should be no
uid in the abdomen for the rst 7 days or until the catheter
sites are healed.
• Catheter immobilization is important to allow for proper
tissue in-growth.
• The catheter should be ushed with heparinized saline with-
in 24 to 72 hours and a minimum of every 7 days thereafter.
SECTION E
CATHETER CONNECTOR INSTRUCTION
A Plastic Connector is included with each Flex-Neck Peritoneal
Dialysis Catheter. A two-piece Titanium Connector for Flex-Neck
Adult, Adolescent, and Pediatric Peritoneal Dialysis Catheters is
available separately from Merit Medical.
After successful implantation of the Flex-Neck Peritoneal Dialysis
Catheter, attach a Merit Peritoneal Dialysis (PD) Catheter Con-
nector to the catheter.
Each catheter kit contains one Connector and one Cap.
• Tapered Tip (A) A
• Raised Shoulder Ridge (B)
• Finger Grip (C)
C
B
• Threaded Luer (D)
D
• Cap (E) E
1. Wet the Tapered Tip (A) of the Connector with sterile saline or
sterile water, and insert it into the catheter.
• Do not use any other lubricant.
• Do not use a twisting motion to force the catheter onto the
Connector.
• Push the Connector into the catheter with a single forward
motion.
2. Advance the catheter completely to the Raised Shoulder
Ridge of the Connector. The catheter tubing must completely
pass over the Tapered Tip and to the Raised Shoulder Ridge, but
not beyond that onto the Finger Grip. See diagram.
3. Pull carefully on the Connector and catheter to test the
strength of the connection.
4. Attach either the Cap (E), or a dialysis transfer set, to the
threaded Luer (D).
Catheter Cleaning and Care
All Flex-Neck Peritoneal Dialysis Catheters are made of silicone.
Exit-site cleaning agents that are compatible with silicone cathe-
ters therefore may be acceptable for use on Flex-Neck Peritoneal
Dialysis Catheters. Such cleaning agents include:
• Electrolytically-produced sodium hypochlorite solutions (i.e.,
ExSept Plus®)
• Normal (sterile) saline
Cleaning agents that are non-irritating, non-toxic, anti-bacterial,
and in liquid form are generally recommended.
The following cleaning agents are not compatible with silicone
catheters, and are not recommended for use with Flex-Neck
Peritoneal Dialysis catheters:
• Acetone or acetone-based products
• Povidone-iodine or iodine-based products
Merit Medical Systems, does not provide specic recommenda-
tions or protocols for exit-site care and cleaning, whether by the
healthcare professional or by the patient. Appropriate exit-site
and catheter care treatment protocols should be individualized
for each patient, and established by the patient’s physician(s),
nurse(s), dialysis center(s), and/or other relevant dialysis health-
care professionals.
ExSept Plus is a registered trademark of Alcavis HDC, LLC or one
of its aliates.
Copyright © Merit Medical Systems, Inc. All rights reserved.
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ASAIO J. 2005 Nov-Dec;51(6):743-7.
Gokal R, Alexander S, Ash S, et al. Peritoneal catheters and
exit-site practices toward optimum peritoneal access: 1998
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Twardowski ZJ. Peritoneal catheter placement and manage-
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