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.
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