Chapters Transcript Video Catheter Placement using the Pristine ™ Long-Term Hemodialysis Catheter Duration: 6:48 minutes My name is Doctor Sheker Kikesh. I am an interventional nephrologist. I will be describing in this video detailed steps on placing the pristine long term hemodialysis catheter. Open the kit as shown. The kit contains an introducer needle, catheter caps, spring tip guide wire. dilators. At Tumblr. And dressing. And the pristine antigrade catheter. The catheter and all dilators need to be flushed. Administer local anesthesia to the insertion site, exit site, and the path for the subcutaneous tunnel. For safety and success, it is standard of care to gain vascular access on the real-time ultrasound. The insertion site on the neck in relation to the clavicle is vital. Once Venus access is obtained, insert the guide wire and advance as far as appropriate. Verify correct positioning using fluoroscopy. Using an 11 blade, the insertion site incision is slightly enlarged. A 2nd incision is then made at the desired exit site of the catheter. The tundler assembly and insertion are very straightforward and easy. Pinch the white tip distill lumen together to slide the tundler sheath over the compressed tip. And then the tunneling process is no different from any other antigrade hemodialysis catheter. The cuff should be positioned approximately midway between the exit site and the Venus entry site, at a minimum of 2 centimeters from the Venus entry site. Serial dilatation over the guide wire is performed under fluoroscopic guidance. The piloway sheath is advanced over the wire again under fluoroscopy into the central vessels. The inner dilator and wire are simultaneously removed. Place your finger over the orifice of the sheath to minimize blood loss and the risk of aspiration. The white-tipped distal lumen needs to be pinched together again before inserting through the valved peel away sheath. The catheter is advanced into the sheath, which is then pulled apart and removed as the catheter is pushed fully into the vessel. The tip must be properly positioned in the right atrium. The catheter's red lure must be toward the lateral side of the patient. This will ensure that the catheter's Y tip orients into the proper AP orientation. Perform an aspiration test with a 20 mL syringe to each port. If you encounter any resistance, most of the time it is correctable by adjusting the catheter tip, positioned properly in the right atrium. Each lumen should be flushed with sterile saline. And locked with heparin in the amount indicated. Finally, the venotomy is closed. And the catheter secured at the exit site. Some suture the wings to the skin below, but it makes skin care. An alternative is to secure it by placing a stitch on either side of the exit site, which also helps in improving hemostasis. And then tying to the wings. This allows dressing to be placed between the catheter and the skin from the exit site onward. Published January 10, 2025 Created by Related Presenters Shaker Qaqish, MD Interventional Nephrologist