Cook Ultrathane Nephrostomy Set with Mac-Loc And Slip Coat

Features of Cook Ultrathane Nephrostomy Set

• Ultrathane nephrostomy catheter with Mac-Loc locking loop mechanism
• AQ hydrophilic coating on distal 5 cm, and radiopaque band at the base of the pigtail
• .038 inch (0.97 mm) diameter TFE-coated stainless steel Safe-T-J wire guide, 100 cm long
• .018 inch (0.46 mm) diameter stainless steel Cope mandril wire guide, 60 cm long
• Stainless steel rigid stylet
• 21 gage stainless steel thin-wall needle, 15 cm long
• Soft, low-profile catheter support with pull tie
• 6.3 French radiopaque polyethylene introducing catheter, 22 cm long
• Non-radiopaque polyethylene flexible stylet
• 14.0 French polyvinylchloride connecting tube, 30 cm long, with one-way stopcock

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How to use this Catheter?

1. Under fluoroscopic control, identify and anesthetize the skin site overlying the collecting system.
2. Introduce the 21-gage needle below the twelfth rib. Advance the needle in short steps toward the lower pole until the needle is seen moving with respiration. While the patient holds his or her breath, advance the needle no further than 3 cm. If urine is not aspirated, repeat the process at a slightly different angle until a calyx is punctured.
3. Thread the .018-inch (0.46 mm) diameter wire guide through the needle; maneuver the wire guide into the pelvis or proximal ureter. Remove the 21 gage needle and advance the 6.3 French introducing catheters with a 20 gage cannula over the wire guide into the calyx. Holding the cannula stationary, further advance the catheter to follow the wire guide into the pelvis and ureter.
4. Remove the wire guide and cannula. Decompress and irrigate the collecting system.
5. Align the curved tip of the Safe-T-J wire guide with the curve of the introducing catheter, then introduce the flexible tip of the wire guide into the catheter and advance it until the wire guide exits the side port of the introducing catheter. If the advancing wire guide encounters resistance, withdraw it slightly and then advance it with a slight rotary motion. When the Safe-T-J wire guide tip is within the renal pelvis, carefully withdraw the catheter. NOTE: Take care to avoid withdrawing the wire guide.
6. To facilitate passage of the nephrostomy catheter, dilate the musculofascial tract by progressing from the smallest to the largest dilator provided. NOTE: Prior to using, immerse the AQ catheter in sterile water or isotonic saline to allow the hydrophilic surface to absorb water and become lubricious. This will ease placement under standard conditions.
7. Pass the Ultrathane nephrostomy catheter over the external end of the wire guide; gradually advance the catheter into the collecting system. If it becomes difficult to advance the catheter, insert the 22 cm long stiffening cannula over the wire guide and into the catheter. Some lubricants may be helpful.
8. Confirm the position fluoroscopically, then hold the shaft of the catheter securely in position with one hand and withdraw the wire guide (and stiffening cannula, if used) with the other.
9. Lock the distal loop in place. NOTE: See the Mac-Loc locking loop mechanism instructions at the end of these instructions.
10. Attach the retention disc to the catheter shaft 1 to 2 cm from the skin surface and fix the retention disc in position by gluing or suturing. This will prevent the catheter from being accidentally displaced forward. 11. Use the connecting tube for attachment to standard urine drainage pouches. The optional stopcock may be used for intermittent patency checks.

Mac-Loc Locking Loop Mechanism

To Lock

1. Stabilize the Mac-Loc catheter hub assembly with one hand and pull back on the monofilament to form the distal catheter loop configuration (Fig. 1).
2. Push the locking cam lever down while maintaining traction on the monofilament until a distinct “snap” is felt. The catheter’s distal loop is now locked into position (Fig. 2).
3. Trim off the excess monofilament (Fig. 3).

To Unlock

1. While stabilizing the Mac-Loc catheter hub assembly with one hand, position the end of a small, sterile, straight, or curved forcep into the Mac-Loc release notch.
2. Pry upward until the locking cam lever is free (Fig. 4).
3. It is now possible to remove the catheter.

Precautions

• Periodic evaluation is advised; the catheter should not remain indwelling for more than four weeks.
• This device is intended for use by physicians trained and experienced in percutaneous access and placement of drainage catheters. Standard techniques should be employed.
• Do not forcefully advance any components during the removal or replacement of the catheter. Carefully remove the components if any resistance is encountered.