Why Use a Closed-Flush Blood Sampling System?

A critically ill patient may enter the ICU because of organ failure, extreme dehydration, Sepsis, or some other complicated issue. In all of these conditions, a quick response is best for a positive patient outcome. Invasive hemodynamic monitoring allows a healthcare provider to access real-time information about the patient’s cardiac health. Additionally, blood samples are a routine and vital process to assess the patient’s lung function and perfusion. Multiple blood samples per day is not uncommon in the ICU; however, providers may be unaware of the inherent risks of drawing blood.

Each time a blood sample is drawn, the potential for contamination and blood discard is present. The CDC has made recommendations for improving blood sampling, including the use of a pressure monitoring system with a closed-flush (continuous-flush) sampling system. This type of system can help prevent air-borne contaminants from entering the blood stream. In a study comparing bacterial contamination in arterial lines, the results stated: “There was less microbial contamination of intraluminal fluid when BCS [a blood conservation system] was used for arterial catheterization.”1 Another study, measuring hemoglobin and hematocrit counts of critically ill patients having multiple blood samples drawn, indicated that the use of a closed blood sampling system was able to minimize blood count value changes.2

Merit Medical is proud to offer a portfolio of critical care products including invasive hemodynamic monitoring sets. The MeritransDTXPlus® with Safedraw® closed arterial sampling helps minimize the risk of infection and unnecessary exposure with a simple, closed, in-line arterial sampling system. Unlike other pressure monitoring systems, the EasyVent™ closed zero port allows clinicians to maintain a closed system when priming or zeroing the transducer (not opening the system to the ambient environment reduces patient risk and enhances overall safety).

A new critical care catalog and a brochure are available showing Merit’s critical care portfolio.

  1. Oto J, Nakataki E, Hata M, Tsunano Y, Okuda N, Imanaka H, Nishimura M. (2012 Aug). Comparison of bacterial contamination of blood conservation system and stopcock system arterial sampling lines used in critically ill patients. Am J Infect Control, 40(6):530-4. doi: 10.1016/j.ajic.2011.08.006. Epub2011 Nov 3.
  2. Rezende E, Ferez MA, Silva Junior JM, Oliveira AM, Viana RA, Mendes CL, Toledo Dde O, Ribeiro Neto MC, Setoyama TA. (2010 Mar). Closed system for blood sampling and transfusion in critically ill patients. Rev Bras Ter Intensiva,  22(1):5-10.

SwiftNINJA® Successfully Embolizes Post-EVAR Type II Endoleaks Using Transarterial Iliolumbar Approach

Endovascular aneurysm repair (EVAR) has been linked to the formation of type II endoleaks. The transarterial iliolumbar approach to repair this complication is occasionally difficult and associated with a lower technical success rate due to the anatomical features of the area.

However, earlier this year Dr. Yunosuke Nishihara of Saga-Ken Medical Centre Koseikan in Saga, Japan, discussed two cases in which the SwiftNINJA® Steerable Microcatheter successfully embolized type II endoleaks using the iliolumbar artery approach after attempts employing other microcatheters and conventional catheterization techniques had failed.

Case 1: A 68-year-old female patient

  • EVAR was performed in January 2014, immediately followed by a persistent type II endoleak and increased diameter of the aneurysm.
  • Transfemoral transarterial embolization was attempted in March 2015 but failed because selection of the iliolumbar artery and beyond was not possible.
  • At follow up, the aneurysm size was 15 mm greater than the previous year. Transarterial iliolumbar embolization using the SwiftNINJA was performed in March 2016.
  • The SwiftNINJA was articulated to cannulate a strong angle bifurcation. Locking and unlocking the tip of the SwiftNINJA at an angle along the bifurcation allowed for easy vessel selection and advancing of the guidewire.
  • After exchanging the catheter, the tip of the selective microcatheter was guided into the aneurysm sac; the endoleak cavity and feeding artery were embolized.
  • After embolization, no blood flow into the endoleak cavity was observed. 

Case 2: A 78-year-old male patient

  • EVAR was performed in January 2014, immediately followed by a persistent type II endoleak.
  • The aneurysm size was 8 mm greater than the previous year and the patient was admitted in March 2016 to undergo embolization via the transarterial iliolumbar approach using the SwiftNINJA.
  • The SwiftNINJA was the primary microcatheter used to cannulate the aneurysm and was guided to the bifurcation without a guidewire.
  • A guidewire was then successfully placed into the aneurysms feeding vessel and the SwiftNINJA was induced successfully.
  • After exchanging the catheter, the tip of the selective microcatheter was guided into the endoleak cavity.
  • The endoleak cavity was embolized and coil embolization was performed successfully on suspected feeding and/or outflow vessels.

Despite the complexities surrounding the transarterial iliolumbar approach, the author noted that the SwiftNINJA improved the selectivity of target vessels and provided enough support for guidewire introduction into acute bifurcating vessels to not allow catheter kickback. These device advantages can lead to other patient and clinician benefits.


“When this useful device [is] appropriately used, we can expect the reduction of operation time, X-ray exposure and the amount of contrast medium used.”

SwiftNINJA® Steerable Microcatheter

Merit Medical’s SwiftNINJA® Steerable Microcatheter is the single most advanced and only 180-degree articulating microcatheter on the market. Able to navigate difficult vasculature, the SwiftNINJA offers unparalleled performance by utilizing three main advantages: speed, control, and delivery.

To learn more about the SwiftNINJA, please click here:

https://www.merit.com/interventional-oncology-spine/accessories/microcatheters/swiftninja-steerable-microcatheter/

REFERENCE

Nishihara, Y. (2017). Embolization of post-EVAR type II endoleaks using SwiftNINJA® [White paper]. Sumitomo Bakelite Co., LTD., Tokyo, Japan: Medical Products Business Division.

Dr. Yunosuke Nishihara received payment from Sumitomo Bakelite Co., Ltd. for the performance of this study.

NextGenRadial programs and products from Merit Medical

In a press release issued last week, Merit Medical announced its Advanced ThinkRadial Program for Interventional Cardiologists (IC’s), with a curriculum focused on complex interventions accessed via the radial artery. The course will be co-proctored by Interventional Cardiologist Dr. Sandeep Nathan (University of Chicago) and special guest of honor, Dr. Ferdinand Kiemeneij (Tergooi Hospital in Blaricum, The Netherlands), the Father of Transradial Intervention. This course is unique because it focuses on moving IC’s with radial experience to the next level of radial interventions. It will include advanced case presentations, hands-on experiences, and a special presentation by Dr. Kiemeneij about left distal transradial access, the Next Generation of the Radial technique.

Merit is very fortunate to have Dr. Nathan and Dr. Kiemeneij co-proctor the upcoming Advanced Course for Interventional Cardiologists, which will be held October 13-14, 2017 at the Merit Medical Education Center in Salt Lake City, Utah. Dr. Kiemeneij will also co-proctor a total of five courses in 2018 at both the Merit Education Centers in Salt Lake City, Utah and in Maastricht, Netherlands.

Fully committed to the radial approach, Merit offers a full portfolio of radial products, from set-up and access to hemostasis, as well as the ThinkRadial Education Program. Dr. Kiemeneij recently tweeted about using the PreludeEASE for left distal transradial access, a next gen radial entry site in the hand. Read more about his statement in the press release or on twitter.

For more information about Merit Medical and the Next Generation of radial products and programs, visit Merit.com/NextGenRadial.

HeRO Graft Dramatically Reduces Infection Among Catheter-Dependent Patients

Approximately 80% of patients starting hemodialysis use tunneled dialysis catheters, while 25% of all prevalent patients have one placed as a bridge to permanent vascular access, or because all other options for permanent access have failed.1 And yet, catheter dependency still poses the risk of infection. Current research is now pointing to an alternative to catheter use among access-challenged hemodialysis patients: permanent subcutaneous arteriovenous graft devices. Data has shown that the HeRO™ (Hemodialysis Reliable Outflow) Graft is the only clinically proven permanent subcutaneous arteriovenous graft to reduce the risk of vascular access-related infections by 69% when compared to tunneled catheters.2

Unlike other graft devices, HeRO Graft technology improves long-term hemodialysis by way of a Venous Outflow component that’s placed in the right atrium, which then attaches to an adjacent ePTFE hemodialysis graft via a proprietary titanium connector. This mechanism allows for blood to return from an artery back to the heart, bypassing central venous occlusions—a common complication seen among catheter-dependent long-term dialysis patients.

When the HeRO Graft was compared to tunneled dialysis catheter use, access-related bacteremia rates were significantly lower (0.7 events/ 1000 days). Reported infection only occurred during the bridging period when a catheter was implanted prior to a HeRO Graft being used.2

In an effort to circumvent the 2-4 week bridging period and avoid this risk of infection, Merit launched the Super HeRO™ Adapter in 2016. Made with the same HeRO Graft technology, the Super HeRO Adapter has the advantage of wide range graft compatibility. In this instance, by connecting the Super HeRO Adapter to a compatible early cannulation graft, a patient can be implanted today and dialyzed the next, virtually eliminating the risk of access-related infection due to a bridging catheter.

The Super HeRO Adapter is also designed for long-term, access-challenged hemodialysis patients who still have a working Venous Outflow component but need a new graft. Available through the HeRO Ally™ Revision Kit, this option provides clinicians with the tools they need to replace an old graft with a compatible graft of their choice.

In addition, eliminating risks associated with vascular access infection can lead to healthcare cost-savings. A US healthcare model for provision of dialysis access predicted that in comparison to catheters, implementing HeRO technology could result in an average of 23% annual savings—with infection observed as one of the primary determinants of cost.3

In order to meet the diverse needs of patients, dialysis technology is continuously evolving. By taking advantage of innovative tools, clinicians can improve the dialysis experience for catheter-dependent patients, offering them better treatment and a new outlook on life.

As an option to help improve patient care and save on healthcare related costs, Merit Medical offers an in-depth, hands-on training course – THINK ACCESS – that covers techniques for HeRO graft implantation. To be considered for an upcoming THINK ACCESS course, visit the link below to sign-up.

https://www.merit.com/education/course_dates/#Hero

  1. Clin J Am Soc Nephrol. 2011;6: 2247-52.
  2. J Vasc Surg. 2009;50: 600-607.
  3. J Surg Res. 2012;177: 165-171.

SwiftNINJA® Steerable Microcatheter Should be Your “Work Horse” Device, New Case Report Suggests

In the May 2017 issue of Radiology Case Reports, Hinrichs, Marquardt, Wacker, and Meyer reviewed two potential solutions to successfully coil embolize patients with hepatointestinal collateral (HIC) vessels precluding radioembolization. The second solution presented is to use the SwiftNINJA® Steerable Microcatheter as a “work horse” device in appropriate situations, as opposed to a “problem-solving” device, as it is sometimes considered.

  • In the second case, a 59-year-old male is presented who suffers from bilobar multifocal hepatocellular carcinoma (HCC).
  • After coil embolization was performed on the right gastric artery, cystic artery and gastroduodenal artery, an angiogram revealed a small, reverse-curved HIC.
  • Radioembolization was determined to be contraindicated in the patient after catheterization of the HIC using regular microcatheters was unsuccessful.
  • After introduction to the SwiftNINJA Steerable Microcatheter®, the patient was brought back four weeks later.
  • The patient’s HIC was then accessed by positioning the SwiftNINJA® catheter tip near the origin and repeating inflection until the catheter tip hooked into the feeder. Once the SwiftNINJA® was locked in an inflected configuration, a 2-mm pushable straight coil was advanced.
  • Radioembolization was performed successfully 20 days later.

The authors note that given the numerous regular microcatheters that were used initially in the case without success, in appropriate cases it is more cost-effective to use the SwiftNINJA® first as a “work horse” device, rather than a “problem-solving” device.

“The [SwiftNINJA®] represents a new device class and has the potential to expand the armamentarium of interventional radiology in oncology patients and might be of high value in this and numerous other endovascular interventions.”

http://www.sciencedirect.com/science/article/pii/S1930043317301206

SwiftNINJA® Steerable Microcatheter

Merit Medical’s SwiftNINJA® Steerable Microcatheter is the single most advanced and only 180-degree articulating microcatheter on the market. Able to navigate difficult vasculature, the SwiftNINJA® offers unparalleled performance by utilizing three main advantages: speed, control, delivery.

To learn more about the SwiftNINJA®, please click here:

https://www.merit.com/interventional-oncology-spine/accessories/microcatheters/swiftninja-steerable-microcatheter/

REFERENCE

Hinrichs, J. B, Marquardt, S., Wacker, F. K, & Meyer, B. C. (2017). Coil embolization of reversed-curve hepatointestinal collaterals in radioembolization: potential solutions for a challenging task. Radiol Case Rep, http://dx.doi.org/10.1016/j.radcr.2017.04.006