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Dialysis Access

Dialysis Access. Vascular System. Internal Jugular Vein. External Jugular Vein. Superior Vena Cava. Brachlocephalic Vein. Subclavian Vein. Cephalic Vein. Axillary Vein. Brachial Vein. Inferior Vena Cava. What is Kidney Failure?. Less than 10% kidney function. Acute. Sudden condition.

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Dialysis Access

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  1. DialysisAccess

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

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

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

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

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

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

  8. Jugular Catheter

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

  10. Peritoneal Dialysis Catheter Catheter

  11. What is CAPD? Constant dialysis 24 hours a day Continuous Ambulatory Peritoneal Dialysis You can walk around while it’s happening Peritoneal membrane works as a filter

  12. CAPD exchange Dwell Drain Fill Remove tubing set New solution Used solution

  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. 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. 8 French Single Lumen Catheter 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. Recommended for acute hemodialysis

  16. Mahurkar Dual Lumen Catheter • 8, 10 or 11.5Fr. 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. 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. 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. 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-ApartTMsheath/dilator Oval Pull-ApartTM Introducer Set conforms to catheter shape = reduces risk of air embolism during insertion. Recommended for hemodialysis, apheresis & infusion

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

  24. MAHURKAR Acute Triple Lumen Catheter • 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 Recommended for hemodialysis, apheresis and infusion

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

  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-ApartTM sheath/dilator and tunnelling stylet. Recommended for peritoneal dialysis or intraperitoneal chemotherapy

  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. Tenckhoff Peritoneal Catheters Recommended for peritoneal dialysis or intraperitoneal chemotherapy

  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. Curl Cath Peritoneal Catheters • Felt cuffs anchor the catheter subcutaneously and help establish a natural infection barrierthrough tissue ingrowth. To meet the varying needs of patient and physician, Quintonoffers 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 Seldingertechnique. Each Kit features a Pull-ApartTM 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. 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. Swan Neck Peritoneal Catheters Recommended for peritoneal dialysis

  33. Swan Neck Peritoneal Catheters Recommended for peritoneal dialysis

  34. Swan Neck Peritoneal Catheters Recommended for peritoneal dialysis

  35. Swan Neck Peritoneal Catheters Recommended for peritoneal dialysis

  36. Swan Neck Peritoneal Catheters Recommended for peritoneal dialysis

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

  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. 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. Peritoneal Catheter Kit 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) Recommended for percutaneous placement of Peritoneal Catheters

  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. 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. 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® PeritonealCatheters. It forms a tight closure with standard CAPD transfer sets and eliminates theneed 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. 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. 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-ApartTM 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. Single Lumen Right Atrial Catheter Catheter Repair Kit Catheter Repair Kits eliminate the need to replace a catheter due to external damage. Recommended for long term infusion and blood sampling

  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 immunosuppressed, thrombocytopenic patients needing: • chemotherapy, • total parenteral nutrition, • blood sampling, or • blood product administration. Recommended for long term infusion and blood sampling

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

  50. 3.9 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-ApartTM 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 bloodor air in the tube, in-line clamps, and color-coded, luer-lock adapters. The larger1 .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

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