Trusted in Action: Onyx™ Liquid Embolic System by MEDTRONIC

Medtronic - Onyx™ LES with Apollo™ Delivery Micro Catheter

1.    Shake Onyx™ LES Vials

- Place vials on mixer

- Shake for a minimum of 20 min at setting 8

- Maintain shaking of vials until ready to use

2.    Place micro catheter

Confirm micro catheter placement by performing super selective contrast injection

3.    Flush with saline & prime with DMSO

- Flush all contrast from micro catheter with 10mL of saline

- Aspirate DMSO into the yellow DMSO 1mLsyringe

- Inject DMSO to sufficiently fill dead space of delivery micro catheter

4.    Aspirate Onyx™ LES

- Remove prepared Onyx™ LES vial from shaker

- Fill white ev3 1 ml syringe with the Onyx™ LES through an 18- or 20-gauge needle

- As soon as the DMSO has been injected into the catheter dead space, remove the DMSO syringe, hold the catheter hub in a vertical position, and overfill and wash the lure hub with the balance of the DMSO

- Immediately connect the Onyx™ LES syringe to the hub, making sure there is no air 

5.    Begin injecting Onyx™ LES

- Inject Onyx™ LES at a slow, steady rate of 0.16ml/min. 

- Do not exceed 0.3mL/min

- Begin fluoroscopic imaging just prior to displacing micro catheter dead space

- Watch for reflux

6.    Reinjection pressure after wait time

Limit wait time between injections to less than 2 minutes

7.    Confirm desired embolization

- Inject Onyx™ LES until desired filling is achieved

- Perform contrast run to confirm embolization

- Assess results based on treatment plan

- Deliver vasodilators as necessary

- Apply gentle, incremental traction to microcatheter

- Tighten RHV to maintain traction

- Slightly aspirate syringe and completely withdraw microcatheter

- Assess risk of spasm or vessel damage

- Release and apply intermittent traction as necessary

- Monitor tip release

- Detachable tip catheters such as Apollo™ Onyx™ delivery micro catheter may or may not detach on retrieval

TIP & TRICKS

1.    Use only thumb pressure to inject the recommended rate of 0.16 mL/min. Do not exceed 0.3 ml/min injection rate. Animal studies have shown that rapid injection of DMSO into the vasculature may lead to vasospasm and/or angionecrosis. Using palm of hand to advance plunger may result in catheter rupture due to over pressurization in the event of catheter occlusion.

2.    Use only the EV3 1 ml syringe to inject DMSO and the Onyx™ LES. Other syringes may not be compatible with DMSO.