Bringing Solutions to Vascular Medicine ML2303 Rev A 10/10

1. Basic access Anatomy 2. Basics of Ultrasound 3. Smart Needle

3 main access sites

1. Femoral 2. Radial 3. Brachial

Femoral

1. Advantages a. More comfortable for Dr.

b. Bigger Artery or vein c. Less chance for Spasm 2. Disadvantages a. PVD b. Anatomical variances c. Can lie deep in the leg d. Complications tend to be worse

Femoral Head

N A V

Radial/Brachial

1. Advantages a. Great for the patient b. Much more superficial 2. Disadvantages a. Awkward b. Spasm

Ultrasound

Two Types 1. Doppler 2. Duplex

Doppler

•

Uses sound which can be heard and seen as an M-mode Image 1. Arterial 2. Venous

Arterial

Venous

Duplex

•

Uses Gray scale and color to calculate and create a picture on the screen

Duplex

Continuous auditory feedback to aid in locating vascular structures

Description

• Vascular access device for arteries and veins using percutaneous doppler (sound) guidance • Components: – Reusable monitor that amplifies audible, vascular sounds and acts as a speaker – Single-use needle with an inner detachable probe (stylet) that acts as a microphone

Basic Concept

• Detect veins and arteries by the sound of flowing blood • Artery sound will be pulsatile (whoosh, whoosh) • Vein sound will be more constant (“windy” or static) • Needle should be directed toward desired sound (artery or vein)

Components

Monitor -- battery powered (reusable) Needle -- contains the Doppler probe stylet (disposable) Additional items required: Syringe & sterile saline

Monitor

• “Speaker” for transmitting sound • Uses continuous wave doppler • Operates using 6 standard AA alkaline batteries (provides 20 hours of “on time”) • Can be used on or off the sterile field

Simple Monitor Mechanics

Three simple controls: – On/off button – Mute button – Volume control (1-5)

Doppler Probe

Needles

• Needles consist of a doppler probe at the end of a stylet that is housed within the standard sized needle • Stylet connects to monitor via cable attachment • Needles and connection are proprietary – no other needle works • Needles are single use Tip of needle

3 Types of Needles

1. Bare Needle – Regular Length – Extended Length 2. IV Assembly Sheathed Needles 3. Catheterization Sets

1. Bare Needles

• Standard percutaneous entry needle with probe stylet inside • Available in 18, 20, and 22 gauge sizes with differing lengths

2. I.V. Assembly Sheathed Needles

• Two Components: – Needle with doppler probe stylet – I.V. catheter available in polyurethane or Teflon • Available in I.V. catheter sizes 20, 22, 24 gauge (10 to a box)

3. Catheterization Sets

• Three Components: – Needle with doppler probe stylet – Polyurethane or Teflon coated catheter – Positive Placement Spring-wire guide • Available only in 20 gauge catheter size (10 to a box)

Clinical Use

• Used to assist during difficult arterial or venous access cases • Used to aid in the access of small vessels

Procedure Set-Up

1.

Attach cable from needle to monitor

• Monitor can be placed on or off the sterile field during the procedure • If used on the sterile field, enclosed sterile bag goes over the monitor

Use in Sterile Field

Testing

2.

Test needle by dipping in saline (Audible signal should be heard)

Flushing the Needle

3.

Attach saline syringe and flush the needle (VERY important)

Puncture

4. Insert tip of the SmartNeedle into tissue at a 45 degree angle and inject a small amount of saline to clear any air bubbles

Clinical Procedure

5. Move needle in a circular motion listening for appropriate audible doppler sound 6. Puncture when appropriate audible sound is heard NOTE: Bleedback often will be absent until doppler probe stylet is removed from needle

Clinical Procedure

7. Withdraw the probe stylet, leaving the needle in place

Troubleshooting

• Signal is absent when monitor is turned on?

– Check “mute” button – Replace batteries – Was it dropped?

– If unable to correct, contact VSI customer service

Troubleshooting

• No sound?

Air bubble may be on tip.

Solution = inject saline through needle to expel any air bubbles • Signal disappears?

Needle may have compressed the vessel.

Solution = pull back needle slowly

Benefits

1. Quicker vessel access in difficult femoral cases = improved procedure room efficiency and quicker turnaround 2. Minimize the “pin cushion” effect, which can cause trauma to surrounding structures 3. More secure access in challenging patients (small vessels, large patients) where visual ultrasound is challenged

Continuous auditory feedback to aid in locating vascular structures

Use of the SmartNeedle devices are indicated when blood flow must be detected for percutaneous vessel cannulation. The vessel must be of a caliber which would normally be punctured with a needle and/or catheter of this size or larger.

CAUTION: Federal law (U.S.A.) restricts these devices to sale by or on the order of a physician. Please see the appropriate product Instructions for Use for a complete listing of the indications, contraindications, warnings and precautions.

SmartNeedle is a trademark of Vascular Solutions, Inc. ©2010 Vascular Solutions, Inc. All rights reserved.