Necessary remedial action must be taken prior to resuming the infusion procedure. In the rare event of a leak, the catheter should be clamped immediately.Failureto clamp extensions when not in use may lead to air embolism.The heparin solution must be aspirated out of all lumens immediately prior to using the catheter to prevent systemicheparinization ofthe patient.Accessories and components used in conjunction with this catheter should incorporate luer-lock adapters.Note: Athreepound (13.3 Newton) forceon the plunger ofa3ml syringe generates pressure in excess of 30 psi (206 kPa) whereas the same three pound (13.3 Newton) force on the plunger ofalOml syringe generates lessthan 15 psi (103 kPa) ofpressure. The use ofalOmlor larger syringe is recommended because smaller syringes generate more pressure than larger syringes. To avoid damage to vessels and viscus, infusion pressures should not exceed 25 psi (172 kPa).To prevent air embolism and/or blood loss, place thumb over the exposed orifice of the sheath introducer.Catheters should be implanted carefully to avoid any sharp or acute angles which could compromise the opening of the catheter lumens.Repeated clamping near or on the luer lock connectors may cause tubing fatigue and possible disconnection. Extensions may develop cuts or tears if subjected to excessive pulling or contact with rough edges. Close all clamps only in the center of the extension legs.Cardiac arrhythmias may result if the guidewire is allowed to pass into the right atrium.Chlorhexidine patches are the preferred alternative. Acetone and PEG-containing ointments can cause failure ofthis device and should not be used with polyurethane catheters.The catheter should not be inserted into the subclavian vein medially, because such placement may cause compression ofthe catheter between thefirst rib and clavicle which can lead to damage or fracture and embolization of the catheter.1 Fluoroscopic or radiographic confirmation of catheter tip placement should be helpful in demonstrating that the catheter is not being pinched by the first rib and clavicle.1 Percutaneous insertion of the catheter should be made into the axillary-subclavian vein at thejunction ofthe outer and mid-thirds of the clavicle lateral to the thoracic outlet.Local tissue factors will prevent proper device stabilization and/or access.Previous episodes of venous thrombosis or vascular surgical procedures at the prospective placement site.Past irradiation ofprospective insertion site.Severe chronic obstructive lung disease exists (percutaneous subclavian placement only).The patient is known or is suspected to be allergic to materials contained in this device.The patient'sbody size is insufficient to accommodate the size of the implanted device.The presence of device related infection, bacteremia, or septicemia is known or suspected.Contraindications This device is contraindicated whenever: The Hickman® TriFusion® catheter incorporates three large, equal size lumens appropriate for apheresis procedures. fluids, blood products, drugs, and parenteral nutrition solutions, as well as blood withdrawal. All Hickman® TriFusion® Catheters are designed for apheresis, and the administration of I.V.
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