Manual Part 2

95
Catheter placement
The Catheter is not designed to be tunneled subcutaneously. The Catheter
insertion should be at the extreme edges of the Pump pocket.
At a site not directly beneath the Pump, the layers of abdominal muscula-
ture are divided to expose the peritoneum. Concentric purse string sutures
are placed and the peritoneum is exposed with a 1 cm incision. The distal
tip of the Catheter is placed in the peritoneal space. The flange of the
Catheter is sutured firmly to the fascia of the abdominal musculature.
Sutures should only be placed on the reinforced flange of the Catheter.
Sutures must not be placed directly on the Catheter itself.
Never trim or cut the tip of the Catheter.
The implant site should be irrigated with an antibiotic solution. Inter-
rupted absorbable sutures should be used to approximate the subcutane-
ous tissues and the skin closed with a running subcuticular absorbable
suture. The wound is dressed using standard surgical technique. At the
end of the surgery, place an abdominal binder over the implant site. This
binder must be worn until the capsule has formed (about 1 month.) The
binder is recommended because it will obtain a better cosmetic result and
minimize the post operative swelling.
Post-operative management
Post-operative hospitalization
After implantation, the surgical incision should be inspected for any signs
of unusual swelling, tenderness, pain, or drainage. Potential post-opera-
tive complications include Pump pocket seroma, wound dehiscence,
wound infection, and catheter dislodgment.
Length of post-operative hospitalization depends upon how rapidly the
patient adjusts to the Pump and how quickly blood glucose levels
!
WARNING
Dmp9196021-011_c.book Page 95 Wednesday, April 3, 2002 5:04 PM