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1 Dialysis Access. 2 Vascular System Internal Jugular Vein External Jugular Vein Brachlocephalic Vein Subclavian Vein Cephalic Vein Axillary Vein Brachial.

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Presentation on theme: "1 Dialysis Access. 2 Vascular System Internal Jugular Vein External Jugular Vein Brachlocephalic Vein Subclavian Vein Cephalic Vein Axillary Vein Brachial."— Presentation transcript:

1 1 Dialysis Access

2 2 Vascular System Internal Jugular Vein External Jugular Vein Brachlocephalic Vein Subclavian Vein Cephalic Vein Axillary Vein Brachial Vein Inferior Vena Cava Superior Vena Cava

3 3 What is Kidney Failure? Less than 10% kidney function Acute Chronic Sudden condition Often temporary Slower onset Not reversible

4 4 What causes Kidney Failure? Diabetes High blood pressure Inflammation Blockage Chronic infection Heriditary Other

5 5 How do you treat Kidney Failure? Kidney transplant Haemodialysis Continuous ambulatory peritoneal dialysis Automated peritoneal dialysis

6 6 What happens during a Haemodialysis Session? Cleaned blood back to the body Blood with waste to dialyser Access

7 7 Fistula Access Venous line Arterial line Vein Artery Vein Radial artery Fistula

8 8 Jugular Catheter

9 9 What is Peritoneal Dialysis? Used solution Tubing set New solution

10 10 Peritoneal Dialysis Catheter Catheter

11 11 What is CAPD? C ontinuous A mbulatory P eritoneal D ialysis Constant dialysis 24 hours a day You can walk around while it’s happening Peritoneal membrane works as a filter

12 12 CAPD exchange Drai n Fill Dwel l Used solution New solution Remove tubing set

13 13 8 French Single Lumen Catheter Acute haemodialysis low-cost 8 French Single Lumen choice of straight or curved extension, singles and kits, and radiopaque polyurethane Five outflow holes spiral near the tapered tip to help prevent occlusion against the vessel wall. rotatable suture wing facilitates suturin luer-lock adapter optimises connections. Priming volumes are conveniently printed on the extensions to aid in accurate heparinization. Recommended for acute hemodialysis

14 14 Quinton Haemodialysis Catheters Acute or Chronic haemodialysis single, double, or triple lumen catheters Mahurkar design = optimal flow UNIQUE silicone extensions unbreakable clamps Priming volumes printed on extensions choice of straight or curved extension, singles and kits Luer lock adapters Polyurethane acute Silicone chronic tapered atraumatic tip rotatable suture wing facilitates suturin luer-lock adapter optimises connections. subclavian, jugular, femoral placement Recommended for acute hemodialysis

15 15 8 French Single Lumen Catheter Recommended for acute hemodialysis Adaptable An optional, disposable Y-adapter lets you convert the single extension catheter to a dual. Percutaneous Insertion The catheter can be inserted percutaneously into the subclavian, femoral, or jugular vein. Catheter Kit 8 French Single Lumen Catheters are available in time-saving, cost-efficient Catheter Kits.

16 16 Mahurkar Dual Lumen Catheter 8, 10 or 11.5 Fr. diameter, curved or straight extensions Singles and Kits Patented Design Made of flexible polyurethane, Quick insertion patented double-D lumina = high flow rates (300 to 350ml/ min) tip design helps minimize recirculation. Rotatable Suture Wing helps stabilize the catheter enables the tip to be rotated after implant without removing sutures transparent angled away from the exit site Easy to see exit site Easy to clean area Recommended for acute hemodialysis & apheresis

17 17 Mahurkar Dual Lumen Catheter Imprinted Extensions catheter’s name Length priming volumes Optional Curved Extensions patented curved extensions (jugular placements) Catheter Kit time-saving cost-efficient convenient Recommended for acute hemodialysis & apheresis

18 18 PermCath Dual Lumen Catheter short- and long-term Efficient 2.5cm separation between the arterial lumen and the venous tip helps reduce recirculation Priming volumes are printed on the clear extensions. Comfortable silicone felt cuff anchors the catheter subcutaneously helps establish a natural infection barrier. Recommended for hemodialysis, apheresis & infusion

19 19 PermCath Dual Lumen Catheter Choice of Insertion Sites jugular, subclavian, or femoral vein. 40cm and 45cm catheters permit access to the right atrium from the patient’s left side. They are particularl useful for larger patients, when the right side is thrombosed, or for a thoracic approach. Catheter Kit patented Oval Pull-Apart TM sheath/dilator Oval Pull-Apart TM Introducer Set conforms to catheter shape = reduces risk of air embolism during insertion. Recommended for hemodialysis, apheresis & infusion

20 20 PermCath Dual Lumen Catheter Oval Pull-Apart Introducer Extra Oval Pull-Apart sheath/dilators are available. Catheter Repair Kit Catheter Repair Kits eliminate the need to replace a catheter due to external damage. Repair Kits are available in all PermCath sizes. Recommended for hemodialysis, apheresis & infusion

21 21 Mahurkar 13.5 Fr Cuffed Catheter Efficient 2.5 cm separation between the arterial lumen and the venous tip helps reduce recirculation Priming volumes are printed on the clear extensions. Choice of Insertion Sites jugular, subclavian or femoral vein. 40cm, 45cm and 50cm catheters permit access to the right atrium from the patient’s left side. useful for larger patients, when the right side is thrombosed, or for a thoracic approach. Recommended for hemodialysis

22 22 Mahurkar 13.5 Fr Cuffed Catheter Comfortable silicone rubber, the catheter does not abrade the skin at the exit site or interfere with patient mobility. The flexible silicone suture wings anchor the catheter while tissue ingrowth occurs. A felt cuff anchors the catheter subcutaneously and helps establish a natural infection barrier Catheter Kit The catheters are available in time-saving, cost-efficient Kits. They contain the basic items needed for percutaneous insertion and a convenient tunnelling stylet. Catheter Repair Kits Catheter Repair Kits eliminate the need to replace catheters, due to external damage. Repair Kits are available in all catheter lengths. Recommended for hemodialysis

23 23 MAHURKAR Acute Triple Lumen Catheter Recommended for hemodialysis, apheresis and infusion Safety Soft Atraumatic Tip designed to reduce vessel trauma during insertion Laser Cut Arterial Slot reduces positional occlusion, maintains high flows and retains heparin lock Imprinted Primimg Volumes on catheter extensions quickly identify heparin loading volumes Straight Infusion Lumen differentiates it from the dialysis ports to prevent accitental infusion of heparin or Urokinase

24 24 MAHURKAR Acute Triple Lumen Catheter Recommended for hemodialysis, apheresis and infusion Ease of use 180° Curved Extensions help stabilize the catheter and aid in patient comfort Rotatable Suture Wings enable the tip to be rotated after implantation and stabilize the catheter Selection The 12 Fr. Mahurkar Acute Triple Lumen Catheter is available in four lengths: 13 cm, 16 cm, 20 cm and 24 cm to accommodate varying body types and insertion sites Catheters are available individually or in kits

25 25 MAHURKAR Acute Triple Lumen Catheter Recommended for hemodialysis, apheresis and infusion

26 26 Tenckhoff Peritoneal Catheters Broad Selection Choose from a variety of catheter lengths and cuff placements, or choose Quinton’s Universal Tenckhoff- a unique catheter that can be trimmed to fit most patient sizes. Quinton offers the Tenckhoff in four cuff configurations: two attached cuffs - one subcutaneous and one preperitoneal, one attached cuff - in either the subcutaneous or preperitoneal position, and two loose cuffs - catheter can be customized to fit the needs of the patient. Cost-Efficient For your convenience, Quinton packages Tenckhoff catheters one per carton, enabling you to stock multiple configurations at minimal cost. Catheters are also available in time-saving, cost-efficient Kits. They contain the basic items needed for percutaneous insertion, featuring the Pull-Apart TM sheath/dilator and tunnelling stylet. Recommended for peritoneal dialysis or intraperitoneal chemotherapy

27 27 Tenckhoff Peritoneal Catheters Complete System Each Tenckhoff catheter comes with an adapter, cap, and clamp. The Ultem ® adapter forms a tight closure with standard CAPD transfer sets and eliminates the need for expensive titanium adapters. In Addition Quinton makes Curled Peritoneal Catheters, Peritoneal Catheter Kits, and catheter accessories. Catheter Repair Kit The Peri-Patch ® and Peritoneal Catheter Repair Kits provide the components for fast, convenient Tenckhoff repair. Unlike polyurethane catheters, the silicone-rubber Tenckhoff can be extended or repaired, thereby eliminating the need for costly replacement due to external damage. To calculate the internal volume of the catheter, multiply.058 by the length of the catheter. Recommended for peritoneal dialysis or intraperitoneal chemotherapy

28 28 Tenckhoff Peritoneal Catheters Recommended for peritoneal dialysis or intraperitoneal chemotherapy

29 29 Curl Cath Peritoneal Catheters Features The Curl Cath Catheter, a modified Tenckhoff, is suitable for acute or chronic peritoneal dialysis and intraperitoneal chemotherapy. It can be inserted either percutaneously or surgically. The additional mass of the Curl Cath keeps the catheter low in the pelvic gutter, resulting in fewer dislodgements and less catheter migration. The catheter’s curled tubing and numerous inflow/outflow holes diffuse dialysate gently into the patient. The Curl Cath is made of translucent, medical-grade silicone rubber with a radiopaque stripe. It has a 4.9mm OD., and a 2.6mm ID., and comes in adult or pediatric lengths. Unlike polyurethane catheters, the Curl Cath can be extended or repaired if necessary, eliminating the need for costly catheter replacement due to external damage. Recommended for peritoneal dialysis or intraperitoneal chemotherapy

30 30 Curl Cath Peritoneal Catheters Felt cuffs anchor the catheter subcutaneously and help establish a natural infection barrier through tissue ingrowth. To meet the varying needs of patient and physician, Quinton offers four cuff configurations: two attached cuffs - one subcutaneous and one preperitoneal, one attached cuff - in the preperitoneal position, and two loose cuffs - the clinician can customize cuff placement on the catheter to meet the needs of the patient. The adapter provides a tight closure with standard CAPD transfer sets and eliminates the need for expensive titanium adapters. Curl Cath Catheters are also available in convenient Kits, which provide the necessary components for inserting the catheter by modified Seldinger technique. Each Kit features a Pull-Apart TM Introducer and Peritoneal Catheter Tunnelling Stylet. Accessories Quinton offers a full line of accessory items for Curl Cath catheters, including repair kits, and stylets. See our Peritoneal Catheter Accessories and Peri-Patch ® data sheets for ancillary and replacement components. Recommended for peritoneal dialysis or intraperitoneal chemotherapy

31 31 Swan Neck Peritoneal Catheters Swan Neck Specialty Peritoneal Catheters give you the options and features you need to simplify access for peritoneal dialysis. Broad Selection Choose from a Variety of Catheter Options: Tenckhoff Curl Cath Missouri (Available in Tenckhoff and Curl Cath) Oreopoulos-Zellerman or Toronto Western (Available in Tenckhoff and Missouri) Presternal (Available in Curl Cath) Some are available in pediatric Recommended for peritoneal dialysis

32 32 Swan Neck Peritoneal Catheters Recommended for peritoneal dialysis

33 33 Swan Neck Peritoneal Catheters Recommended for peritoneal dialysis

34 34 Swan Neck Peritoneal Catheters Recommended for peritoneal dialysis

35 35 Swan Neck Peritoneal Catheters Recommended for peritoneal dialysis

36 36 Swan Neck Peritoneal Catheters Recommended for peritoneal dialysis

37 37 Peritoneal Catheter Kit Recommended for percutaneous placement of Peritoneal Catheters

38 38 Peritoneal Catheter Kit Percutaneous Insertion The Peritoneal Catheter Kit provides an ideal alternative to catheter placement by laparotomy. Each Kit features a Pull-Apart Introducer used to insert the catheter percutaneously using modified Seldinger technique. This technique involves a smaller incision, helping to minimize the risk of post-operative dialysate leakage, and often enabling the catheter to be used sooner. In general, percutaneous insertion means faster insertion and greater patient comfort. Recommended for percutaneous placement of Peritoneal Catheters

39 39 Peritoneal Catheter Kit Convenience Cost-efficient Kits simplify inventory and save staff time required for assembling supplies needed for catheter insertion. Each Kit contains the following components: peritoneal catheter, BetaCap adapter, cap and clamp, 1 6Fr. Pull-Apart sheath/dilator, 18 gage introducer needle, J/straight guide wire, 10cc syringe, #11 scalpel, tunnelling stylet, and gauze sponges. Recommended for percutaneous placement of Peritoneal Catheters

40 40 Complete System Each catheter comes with a Beta-Cap adapter, cap, and clamp. The Ultem adapter forms a tight closure with standard CAPD transfer sets. Choices variety of lengths (42, 57, 60 and 62cm) styles (straight, curled, and universal) cuffed positions (single, dual, preperitoneal, or subcutaneous) styles (straight or curled, universal and straight or curled Swan Neck) catheter stencils (Available for Swan Neck) Peritoneal Catheter Kit Recommended for percutaneous placement of Peritoneal Catheters

41 41 Peri-Patch Repair Kit The Peri-Patch ® Repair Kit contains: 15cm silicone rubber catheter extension (2.6mm ID., 4.9mm CD.) with double-barbed connector; Beta-Cap ® adapter, cap, and clamp; medical-grade silicone adhesive, Type A; and glue mold. The hinged glue mold with locking ring is approximately 5cm long. Used with the adhesive, the mold forms a permanent silicone seal over the connection between the indwelling catheter and the extension. NOTE: To be repaired, the indwelling catheter needs to have at least 3cm external tubing at the exit site. All components, including silicone adhesive are supplied sterile. Kits are double packaged; the inner package can be placed directly on a sterile field. Due to the expiration date, the adhesive is packaged separately in a sterile pouch. Recommended for lengthening and repair of the external portion of Peritoneal Catheters

42 42 Peritoneal Catheter Accessories Peritoneal Catheter Straightening Stylet The stainless steel stylet is 62cm long, helping to keep the catheter straight and manoeuvrable during insertion into the peritoneum. Peritoneal Tunnelling Stylet The Stylet penetrates tissue cleanly, creating a subcutaneous tunnel with minimal bleeding and tissue trauma. As the stylet dilates the tissue, the practitioner simultaneously pulls the catheter through the tunnel. Made of pliable stainless steel, it can be bent to create a customized, curved tunnel. The stylet is 5Fr. x 23cm (9”). Felt Cuffs Felt Cuffs enable the practitioner to custom fit Quinton ® Peritoneal Catheters. They anchor the catheter and help establish a natural infection barrier. Each cuff is one centimetre long. Tyco Healtcare offers top quality accessories for its peritoneal catheters

43 43 Peritoneal Catheter Accessories Medical Grade Silicone Adhesive Type A The sterile adhesive is used to bond felt cuffs to the catheter. It is also used with Quinton ® Repair Kits to extend or repair catheters. Injection Sealing Caps Caps provide self-sealing injection sites for administering medications. Beta-Cap ® Adapter The Beta-Cap adapter is made of Ultem ® resin and can be used with all Quinton ® Peritoneal Catheters. It forms a tight closure with standard CAPD transfer sets and eliminates the need for expensive titanium adapters. Beta-Cap ® Clamp The Beta-Cap Clamp is compatible with all Quinton ® Peritoneal Catheters. Tyco Healtcare offers top quality accessories for its peritoneal catheters

44 44 Single Lumen Right Atrial Catheter Advantages Single Lumen Right Atrial Catheters provide long-term vascular access with minimal trauma to the system. Made of soft, biocompatible silicone rubber, these radiopaque catheters are ideal for immunosuppressed, thrombocytopenic patients needing: chemotherapy, total parenteral nutrition, blood sampling, or blood product administration. Recommended for long term infusion and blood sampling

45 45 Single Lumen Right Atrial Catheter Features reinforced tubing to protect the catheter when clamping felt cuff to anchor the catheter subcutaneously and help establish a natural infection barrier range of sizes catheter name and priming volume are imprinted on extensions for easy identification can be inserted percutaneously using a Pull-Apart TM sheath/dilator or surgically implanted in-line clamp and luer-lock adapter atraumatic tunnelling stylet designed to minimize bleeding in the tunnel tract Recommended for long term infusion and blood sampling

46 46 Single Lumen Right Atrial Catheter Recommended for long term infusion and blood sampling Catheter Repair Kit Catheter Repair Kits eliminate the need to replace a catheter due to external damage.

47 47 Raaf Dual Lumen Right Atrial Catheter Advantages Single Lumen Right Atrial Catheters provide long-term vascular access with minimal trauma to the system. Made of soft, biocompatible silicone rubber, these radiopaque catheters are ideal for immuno suppressed, thrombocytopenic patients needing: chemotherapy, total parenteral nutrition, blood sampling, or blood product administration. Recommended for long term infusion and blood sampling

48 48 Raaf Dual Lumen Right Atrial Catheter Features reinforced tubing to protect the catheter when clamping felt cuff to anchor the catheter subcutaneously and help establish a natural infection barrier range of sizes catheter name and priming volume are imprinted on extensions for easy identification can be inserted percutaneously using a Pull-Apart TM sheath/dilator or surgically implanted in-line clamp and luer-lock adapter atraumatic tunnelling stylet designed to minimize bleeding in the tunnel tract Recommended for long term infusion and blood sampling

49 49 Raaf Dual Lumen Right Atrial Catheter Recommended for long term infusion and blood sampling Catheter Repair Kit Catheter Repair Kits eliminate the need to replace a catheter due to external damage.

50 mm Triple Lumen Catheter Minimal Trauma Made of biocompatible, soft silicone rubber, the catheter minimizes internal trauma, making it ideal for immunosuppressed, thrombocytopenic patients. Percutaneous Insertion The catheter can be surgically implanted, or it can be introduced percutaneously through a 1 2Fr. Pull-Apart TM Introducer. A felt cuff anchors the catheter subcutaneously and helps create a natural infection barrier. Extras For your convenience, the catheter has clear extensions to enable you to see blood or air in the tube, in-line clamps, and color-coded, luer-lock adapters. The larger 1.2mm lumen, used for blood products, is conveniently identified by its red adapter. Recommended for chemotherapy, stem cell infusion, parenteral nutrition, incompatible therapeutic agents, blood sampling and transfusions

51 mm Triple Lumen Catheter Recommended for chemotherapy, stem cell infusion, parenteral nutrition, incompatible therapeutic agents, blood sampling and transfusions Catheter Repair Kit The Catheter Repair Kit eliminates the need to replace a catheter due to external damage.

52 52 Welcome to the Tyco test 1.What material are Acute Mahurkar Catheters made from? 2.What material are Permcath Catheters made from? 3.What are the extensions made of? 4.What material do our competitors use for the extensions? 5.Which catheters need a tunnel? 6.Which substance is used for priming? 7.Which substance is used for anti-clotting? 8.Please state the three major placements in the body for HD catheters? 9.List the name of three competitors in your market

53 53 Welcome to the Tyco test continued 10.Quinton configurations on extensions: How many and their names? 11.How many cuffs on a PD catheter? 12.Which are the two major insertion methods of a HD catheter? 13.Describe the Seldinger technique in point form (step by step). 14.Where should the tip of the Permcath catheter be placed? 15.Which Quinton catheter has suture wings? 16.What is the special benefit of the Quinton suture wing? 17.Where should the tip of a Mahurkar catheter be placed? 18.What are DOQI guidelines?

54 54 Your happy boss?


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