TROUBLESHOOTING

COMMON MISTAKES

 
 

Antegrade IR Platform

Common Mistake

Solution

The Front Base is not correctly positioned under the mattress, causing the table to be incorrectly aligned to the patient and femoral access site.

The Front Base should be inserted underneath the mattress at a horizontal position, near the patient’s knees. Slide it upwards to it is sitting underneath the patient’s shoulders for optimal platform placement.

The legs are not correctly aligned within the recesses, causing the legs to not be locked in place during the procedure. 

Ensure the legs are placed fully within the recesses. Push the blue locking clip in until it is engaged, and the leg is secure.

The platform is uneven or not correctly positioned towards the femoral access site, causing equipment to not sit evenly on the platform surface and unalignment towards the access site.

Ensure that the Antegrade IR Platform is planarly positioned towards the femoral access site by adjusting the legs to create an even work surface. If you require the platform to be closer or further away from the patient for optimum placement, slide the full Antegrade IR Platform to the correct position. The ideal placement is usually where the table is aligned to the patient’s forehead and the narrow area is over the patient’s shoulder.

The blue locking collars are not twisted tight, resulting in movement of the platform height during the procedure.

After adjusting the platform height, twist the blue collar clockwise firmly to lock the leg.  This will allow the legs and platform to stay fixed for the remainder of the procedure.

The legs are not completely tightened in the height-adjustment process, causing product instability during the procedure.

Once the Antegrade IR Platform is at the appropriate height, twist the blue collar clockwise tightly to lock the leg.  This will allow the leg and platform to stay fixed for the remainder of the procedure.

A patient is restless during the procedure, increasing the chance of the patient reaching out and disrupting the femoral access site.

Using the ArmSure in conjunction with the Antegrade IR Platform ensures that patient is secure, preventing them from reaching out and disrupting the femoral access site.

The Drape is unsupported when positioned over the patient’s face, causing discomfort.

Using the Drape Support in the cut away area of the Antegrade IR Platform creates a spacious environment underneath the drape, increasing patient comfort.

ArmSure

 

Common Mistake

Solution

The daggerboard is not pushed fully underneath the mattress, causing product instability.

To ensure correct patient positioning and product security throughout the procedure, push the Arm Support daggerboard firmly to the edge of the mattress.

The Arm Support is not inserted underneath the table at an appropriate position, causing difficulty when positioning the patient.

Ensure the Arm Support is placed underneath the mattress, so the patients’ hand does not hang below the Arm Support surface and is fully supported.

The straps are not installed at the correct orientation and the strap cannot be locked in place.

Ensure the straps are installed at the correct orientation so that the stoppers can secure the strap in place. If the strap is flipped, the stopper cannot connect with the bracket.

A strap is not placed behind the patient’s elbow, causing the patient to pull their arm out towards the back of the Arm Support.

The Arm Support has multiple strap positioning options. Place one strap around the patient’s elbow and another around the forearm to provide complete arm security throughout the duration of the procedure.

Not enough straps are used for thin, fragile or restless patients, meaning patients are able to get out from the Arm Support.

Ensure an acceptable number of straps are used during the procedure to ensure patients are secure. The ArmSure is packaged with 10 straps, and extras are available to purchase separately.

X-ray Shield

 

Common Mistake

Solution

The IR Shield is not placed centred within the slot of the ArmSure Support, causing weight imbalance and the product to fall out.

Do not slide the IR shield too far either side of the arm support. This will cause a weight imbalance and the shield will fall off.

Drape Support

 

Common Mistake

Solution

The daggerboard is not pushed fully underneath the mattress, causing product instability.

To ensure product security throughout the procedure, push the daggerboard fully underneath the mattress and ensure the product is stable before the draping process.

The clinician does not hold onto the clear support surface when releasing the locking leg, causing the clear support surface to suddenly drop and risks landing on the patient.

When releasing the locking leg, hold the support surface and move it into the desired position. Twist the locking mechanism to ensure it is secure for the duration of the procedure.

The clinician catches their fingers in the articulating joints located at the base and top of the locking leg.

When manipulating the locking leg, ensure fingers are clear of the articulating joints to prevent any catching.

 

Retrograde IR Platform

Common Mistake

Solution

The Retrograde IR Platform is not correctly aligned with the femoral access site, increasing the risk for drape sagging.

Ensure the IR Platform is optimally positioned to be mid-way along the patient’s thigh. This will provide a planar surface allowing an easy transition from the patient to the site of access.

The locking clips are not fully secure if they aren’t correctly pushed in. This may cause the platform to dislodge during the procedure, or the Extension to come away from the platform.

When the legs and extension are correctly positioned into place, ensure the locking clips have been fully pushed in and are engaged. This will provide platform security throughout the procedure.

The Front Base is not correctly positioned under the mattress, causing the table to be incorrectly aligned to the patient and femoral access site.

The Front Base should be inserted underneath the mattress at a horizontal position, near the patient’s knees. Slide it upwards to it is sitting underneath the patient’s thigh for optimal platform placement.

The blue locking collars are not twisted tight, resulting in movement of the platform height during the procedure.

After adjusting the platform height, twist the blue collar clockwise firmly to lock the leg.  This will allow the leg and platform to stay fixed for the remainder of the procedure.

The legs are not correctly aligned within the recesses, causing the legs to not be locked in place during the procedure. 

Ensure the legs are placed fully within the recesses. Push the blue locking clip in until it is engaged, and the leg is secure.

The legs are not completely tightened in the height-adjustment process, causing product instability during the procedure.

Once the Retrograde IR Platform is at the appropriate height, twist the blue collar clockwise tightly to lock the leg.  This will allow the leg and platform to stay fixed for the remainder of the procedure.

A patient is restless during the procedure, increasing the chance of the patient reaching out and disrupting the femoral access site.

Using the ArmSure in conjunction with the Retrograde IR Platform ensures that patient is secure, preventing them from reaching out and disrupting the femoral access site.

IR System | STARBoard

 

Common Mistake

Solution

The shoulder joint screw is not adjusted for the correct approach, consequently meaning the STARBoard either moves too freely and swings out or is too firm and cannot be easily manoeuvred.

The tension of this screw is adjusted to different settings depending on what arm approach you're doing. When you do a left arm approach you need it free to pivot when carrying out puncture. Then when you attach Left arm support you would then tighten the shoulder screw to prevent left arm support from pivoting away from the patient.

If the wrist pivot screw is not adjusted, rotation of the STARBoard handle for hyper extension can be difficult. If it is too tight, it is difficult to rotate and flex the handle downwards. If it is too loose, the handle will move too freely.

The wrist pivot screw needs to be adjusted for ease of manoeuvrability when adjusting the STARBoard handle for hyper extension of the wrist. If the wrist pivot is too loose, the handle will move too freely and if it is too tight, it will be difficult to adjust the handle.

If the STARBoard is placed on the lab table incorrectly, it greatly affects other components of the STARSystem and patient set up.

 

Correct table placement of the daggerboard is essential to the function of the STARSystem.

The daggerboard should be positioned between the shoulder and the elbow. Optimum placement is dependent on the height of the patient.

Taller Patient Placement

The optimal position for taller patients is between the shoulder and mid-arm, often closer to the shoulder.

Shorter Patient Placement

The optimal position for shorter patients is between the mid-arm and elbow, often closer to the elbow. 

If the slider arm is not adjusted once the patient has been positioned in the arm rest, it will cause discomfort for the patient and make hyper-extension difficult.

Adjust the slider arm to suit the individual patient once they have been positioned in the arm rest. The patient should not be strained to reach the handle and should have a comfortable grip.

 

Ensure the daggerbaord is correctly positioned in relation to the height of the patient and that the armrest has movement available on the slider arm.

Hyper-extension is attempted without correctly placing the patient’s wrist in and turning it. This makes hyper-extension difficult to complete and causes patient discomfort.

Complete the correct steps to achieve hyper-extension by getting the patient to grip the STARBoard handle before rotating and hyper-extending the patient’s wrist for hyper-extension.

IR Shield

 

Common Mistake

Solution

The daggerboard is not pushed fully underneath the mattress, causing product instability.

To ensure product security throughout the procedure, push the daggerboard fully underneath the mattress, so the IR Shield slot is firmly against the mattress.

The IR Shield is not placed centred within the slot, causing weight imbalance and the product to fall out.

Do not slide the IR shield too far either side of the arm support. This will cause a weight imbalance and the shield will fall off.

Extension Tray

 

Common Mistake

Solution

The Extension Tray is not fully clipped on, causing instability during the procedure

Ensure the extension tray is fully clipped on and stable before draping the patient. This will ensure complete stability during the procedure

Overhead Arm Support

 

Common Mistake

Solution

The daggerboard is not pushed fully underneath the mattress, causing product instability.

To ensure product security throughout the procedure, push the daggerboard fully underneath the mattress.

The release clip is not fully engaged, resulting in the locking leg not being completely secure to the daggerboard.

Ensure the release clip is fully engaged and gently pull on the locking leg assembly to test that it is secure.

Placing the Overhead Arm Support wings on in the wrong direction, meaning that the device is not correctly set up for the procedure.   

Ensure the wings are placed on the daggerboard so they are in the correct orientation when placed on the table. The wings should face out in the same direction as the daggerboard.

The straps are not installed at the correct orientation and the strap cannot be locked in place.

Ensure the straps are installed at the correct orientation so that the stoppers can secure the strap in place. If the strap is flipped, the stopper cannot connect with the bracket.

Patient tubing is not secure and is in the way during the procedure

The Overhead Arm Support strap can be positioned to contain extra patient tubes. With the extra strap length that is left over after securing the patient, twist and insert the strap into the bracket further down the wing, around the tubing. This will ensure it is contained and secure throughout the remainder of the procedure.

The locking leg is not correctly locked, so when a patient rests on it, it is not secure.

Once the Overhead Arm Support is at the desired height, rotate the locking mechanism vertically. This will lock the height of the Overhead Arm Support for the remainder of the procedure.

STARSystem | STARBoard

 

Common Mistake

Solution

The shoulder joint screw is not adjusted for the correct approach, consequently meaning the STARBoard either moves too freely and swings out or is too firm and cannot be easily manoeuvred.

The tension of this screw is adjusted to different settings depending on what arm approach you're doing. When you do a left arm approach you need it free to pivot when carrying out puncture. Then when you attach Left arm support you would then tighten the shoulder screw to prevent left arm support from pivoting away from the patient.

If the wrist pivot screw is not adjusted, rotation of the STARBoard handle for hyper extension can be difficult. If it is too tight, it is difficult to rotate and flex the handle downwards. If it is too loose, the handle will move too freely.

The wrist pivot screw needs to be adjusted for ease of manoeuvrability when adjusting the STARBoard handle for hyper extension of the wrist. If the wrist pivot is too loose, the handle will move too freely and if it is too tight, it will be difficult to adjust the handle.

If the STARBoard is placed on the lab table incorrectly, it greatly affects other components of the STARSystem and patient set up.

 

Correct table placement of the daggerboard is essential to the function of the STARSystem.

The daggerboard should be positioned between the shoulder and the elbow. Optimum placement is dependent on the height of the patient.

Taller Patient Placement

The optimal position for taller patients is between the shoulder and mid-arm, often closer to the shoulder.

Shorter Patient Placement

The optimal position for shorter patients is between the mid-arm and elbow, often closer to the elbow. 

If the slider arm is not adjusted once the patient has been positioned in the arm rest, it will cause discomfort for the patient and make hyper-extension difficult.

Adjust the slider arm to suit the individual patient once they have been positioned in the arm rest. The patient should not be strained to reach the handle and should have a comfortable grip.

 

Ensure the daggerbaord is correctly positioned in relation to the height of the patient and that the armrest has movement available on the slider arm.

Hyper-extension is attempted without correctly placing the patient’s wrist in and turning it. This makes hyper-extension difficult to complete and causes patient discomfort.

Complete the correct steps to achieve hyper-extension by getting the patient to grip the STARBoard handle before rotating and hyper-extending the patient’s wrist for hyper-extension.

STARSystem | STARTable

 

Common Mistake

Solution

The shield is incorrectly positioned to the patient causing the STARTable to provide insufficient scatter radiation protection.

The shield should be approximately positioned to align with the patient’s elbow. Some adjustment will be required to find the optimum position of the shield between the clinician and the radiation source.

The STARTable shelf and shield is not positioned correctly in relation to the patient. 

The shelf can be moved along the shield by sliding it across. This allows the clinician to fine tune the position of the work surface relative to the STARBoard (or wrist) whilst maintaining the optimum position of the shield between them and the radiation source. It may be necessary to adjust the position of the shield slightly at this point also. The shelf can then be adjusted after the sterile drape is applied should further adjustment be required.

The STARTable daggerboard is pushed underneath the mattress with force applied at the top, meaning excessive force is required to correctly position the shield.

Push the STARTable daggerboard underneath the mattress at base of the shield. This will ensure ease of placement and no requirement for using excessive force.

Storing STARTable Shield upright will result in uneven weight distribution causing the shield to topple over and possibly dropping on the ground.

After use, store the STARTable resting on the spigots to ensure even weight distribution of the device and safe storage of the product.

The STARTable is removed by pulling the curved top section of the shield or the end. This will make STARTable shield removal difficult.

Correctly remove the STARTable before the patient is removed from the imaging table by holding the shield near the base of the shield, with two hands. This will ensure there is no extra stress on the vertical shielding and that the patient can safely be removed from the table with no intrusions.

STARSystem | STARSupport

 

Common Mistake

Solution

The STARBoard has not been set-up correctly for the STARSupport, making it difficult for patient positioning.

Once the STARSupport has been clipped onto the STARBoard, move the armrest in towards the patient and tighten the pivot screw. This will ensure that the STARSupport will not swing out away from the patient during the procedure.

The STARSupport is not unlocked, meaning you cannot freely adjust the height and angle of the arm support post.

Unlock the STARSupport by releasing the blue leaver. This will allow full movement of the arm support post.

The STARBoard Shoulder Joint is not tightened, causing the STARBoard and left arm to rotate out during the procedure.

It is important to tighten the shoulder joint screw of the STARBoard once the STARSupport has been correctly positioned. This will ensure that that the STARBoard will not rotate away from the patient and the STARSupport will be securely supporting the patient’s left arm for the duration of the procedure.

Attempting to the clip the STARSupport onto the STARBoard when it is locked, causing difficulty.

Ensure the STARSupport is unlocked before clipping it onto the STARBoard for ease of placement.

STARSupport is clipped onto the STARBoard by positioning the outer clip first, resulting in difficulty with the device placement.

Begin with positioning the inner clip first and then click back the STARSupport in position on the slider arm. 

The STARSupport is not positioned on the STARBoard correctly, affecting patient positioning.

The STARSupport should be clipped close to the pivot point, near the daggerboard so that the blue cup is positioned on the patient’s upper arm (above the elbow).

The STARSupport is placed upside down, causing discomfort for the patient.

Follow the diagram on the STARSupport to ensure the soft blue cup is positioned correctly to the orientation of the patient.

The STARSupport is not locked after adjustments have been made, causing it to end up incorrectly situated when positioning the patient.

Once adjustments have been made and the STARSupport is correctly positioned to support the patients left arm, close the lever to lock the STARSupport lever.

Lower Leg Support

 

Common Mistake

Solution

The Table Straps have not been placed correctly, making it difficult to secure the Lower Leg Support.

Ensure the straps are placed horizontally, approximately 500 mm apart so that they are the correct distance and orientation to attach onto the Lower Leg Support easily.

 

Ensure the Table Straps are flat on the table and are not twisted. 

The Lower Leg Support has been correctly positioned, but there is still movement of the device. 

Ensure there is adequate tension on the straps after the Lower Leg Support has been correctly positioned. Tighten if necessary.

The Table Strap Buckle has been positioned on the same side of the table as the working leg, causing interference and difficulty of securing the Table Straps.

The Table Strap Buckle sits on the opposite side of the leg that you are working on.

 

If you are working on the left, the Table Strap Buckle sits on the right side of the table. If you are working on the right, the Table Strap Buckle sits on the left side of the table.

 

Avoid placing the Table Strap Buckle directly beneath the opposing leg. If necessary, add additional padding underneath the leg.

The Foot Plate is not fully engaged in the Footplate Slot, causing incorrect positioning and instability of the foot.

Push the Foot Plate firmly into the Foot Plate Slot at the correct orientation, ensuring complete engagement.

The Leg Pad is not placed correctly on the Lower Leg Support, causing hard edges to be exposed.

The Leg Pad needs to be placed centrally on the Lower Leg Support, ensuring there are no exposed hard edges.

 

 

The Leg Pad ledge should be placed so it is overlapping the Foot Plate. 

 

 

Ensure the Leg Pad is correctly fastened to the Lower Leg Support by the Hook and Loop strapping.

The patient’s sole is not pushed up firmly against the Foot Plate, making it difficult to fasten to the Foot Strap correctly.

The patient’s sole should be positioned firmly against the Foot Plate.

 

Additional padding can be placed under the patient’s knee if required.

The Leg and Foot Straps are fastened the wrong way around, causing patient discomfort.

To fasten the Hook and Loop Strapping, stick the loop side onto the hook side, as indicated as the ‘Patient Side’. 

The patient’s leg does not feel completely secure after strapping.

Additional straps can be used if required. Ensure the Leg Straps are at a comfortable pressure around the patient’s leg, but tight enough to provide immobilisation. 

The Foot Plate is not positioned at the correct orientation for imaging or access.

The Foot Plate can be reversed by simply removing it from the slot and re-inserting it at the opposite orientation.

 

If required, the Foot Plate can be completely removed for access to the sole or back of the heel when considering Dorsiflexion or Sole/Posterior Tibial Artery access.

Physical Address

Adept Medical Ltd
2-6 McDonald Street
Morningside
Auckland 1025
New Zealand

Postal Address

PO Box 10075
Dominion Road
Auckland 1446
New Zealand

Telephones

Telephone: +64 9 815 2999
Facsimile: +64 9 846 6976

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