Patients

It is a change in the normal sequence of the heart’s electrical impulses causing an abnormal heart rhythm.

In order for the heart to do its work (to pump oxygen throughout the body), it needs an electrical impulse to generate the heart beat.  This electrical component is known as the cardiac conduction system. 

The electrical impulse begins its journey in the sinus node (SA node)—the heart’s natural pacemaker.  The sinus node is located in the upper right chamber of the heart, called the right atrium.  From the sinus node, the impulse travels down the conduction system causing the heart muscle to contract in an orderly sequence—the two upper chambers (right and left atria) are squeezing a little earlier than the two lower chambers (right and left ventricles).  This contraction pushes the blood through open the valves of the atria into the left and right ventricles.  As this impulse continues to travel downward, it reaches the AV node, slowing down the impulse to allow the right and left ventricles to fill with blood.  The impulse then continues across the ventricles causing them to contract and push blood from the right ventricle through the pulmonary valve to the lungs and from the left ventricle through the aortic valve to the rest of the body.

 

The sinus node gives off electrical impulses that normally make the heart beat
60-100 times per minute.  This is called sinus-rhythm.  In contrast, cardiac arrhythmia is a term for a group of conditions in which there is abnormal electrical activity in the heart. The heart beat may be too fast or too slow, and may be regular or irregular.

Arrhythmias can be defined into two broad categories:

1. Bradycardia
   A slow rhythm, (less than 60 beats/min), is a bradycardia. This may be caused by a slowed signal from the sinus node (termed sinus bradycardia), a pause in the normal activity of the sinus node (termed sinus arrest), or by blocking of the electrical impulse on its way from the atria to the ventricles (termed AV block or heart block).
Many bradycardias can be treated through the use of drugs or with the implantation of a pacemaker.
 
2. Tachycardia
   An abnormal or ‘irritable pacemaker’ outside of the sinus node causing an unusually fast heart rhythm to occur.  Tachycardias affect both the upper chambers (atria) and lower chambers (ventricular) of the heart.  These can be subdivided into two main areas:

Upper Chamber (atria)

• Atrial Flutter
  When a single electrical impulse circulates quickly through the atrium causing a fast but steady heartbeat.
• Atrial Fibrillation
  When electrical impulses in the upper chambers contract very quickly and irregularly.
• Supraventricular Tachycardia (SVT)
  When the fast heart rhythm (tachycardia) comes from the upper chambers of the heart.

Arrhythmias

• AV Nodal Re-entrant Tachycardia (AVNRT)
  A malfunction of the electrical impulses in the heart.  In most people, electrical impulses travel on a single pathway (AV node) but sometimes a second conducting pathway arises that confuses the electrical signal traveling throughout the heart (atria to the ventricles).
• AV Re-entrant Tachycardia (AVRT)
  An abnormal accessory pathway from the atria to the ventricle

Lower Chamber (ventricular)

• Ventricular Tachycardia
  When the fast heart rhythm (tachycardia) comes from the lower chambers of the heart.
• Ventricular Fibrillation
  When electrical impulses in the lower chambers contract in a rapid and disorganized fashion.

The treatment of arrhythmias may vary.  Electrophysiology testing makes it possible to study heart rhythm disturbances under controlled circumstances by using various procedures utilizing Intracadiac Access, Diagnostic and Mapping, and Therapeutic products, as well as an EP Recording System.  Bard Electrophysiology provides an array of product offerings that help to treat many of these conditions.

Intracardiac Access Products
These assist the placement of the catheter into the vein and up into the heart so that heart access is more easily achieved.

• Sheaths and needles
  • EZCROSS™ Introducer Kit 
  • SAFESHEATH™ Ultra Introducer
  • BARD® CHANNEL™ Steerable Sheath 
  • Split Sheath with Valve (SSV) 
  • TSX™ Transseptal Needle 
   

Temporary Pacing Electrodes
BARD offers a full line of electrodes for most temporary pacing needs.

• Temporary Pacing Electrodes

Diagnostic and Mapping Catheters
The diagnostic and mapping catheters allow the physician to locate where the irregular impulses are occurring.

• Advanced Mapping
  • ORBITER™ PV ™Catheter 
  • CONFORMA™ Bi-Directional Diagnostic Catheter 
  • BARD® 20-Pole Fixed Curve Specialty Catheter 
   
• Steerable 
  • RADIA™ XT Catheter 
  • EP•XT™ Catheter 
  • DYNAMIC TIP™ Catheter 
  • DYNAMIC  XT™ Catheter 
  • BARD® CS Assist Catheter 
   
• Fixed Curve
  • Woven Catheter 
  • WOVENFLEXIE™ Catheter 
  • VIKING™ Catheter 
  • VIKING SOFT TIP™ Catheter 
  • TANGO™ Catheter 
   
• Atrial Mapping
  • ORBITER™ Catheter 
  • ORIBITER ST™ Catheter  
  • RADIA™ Bidirectional Diagnostic Catheter 
   

Therapeutic Catheters
Therapeutic catheters allow the physician to treat the arrhythmia by placing the catheter into the patient’s vein and into the heart at the source of the abnormal electrical activity. Once the proper site is confirmed by the physician, an ablation catheter is used to deliver energy that destroys a small amount of heart tissue, ending the disturbance of electrical flow through the heart and restoring a healthy heart rhythm.

• Ablation products
  • SCORPION™ 2 Ablation Catheter  
  • STINGER™ Ablation Catheter 
   
• *Bard Electrophysiology does not have any ablation catheters approved in the U.S. for the ablation of atrial fibrillation.

EP Systems
A computerized software driven tool used to analyze and store the patient’s data to improve the patient’s assessment.

 

• EP Recording System
  • LabLink Data Interface 
  • LABSYSTEM PRO™ EP Recording System 
  • CLEARSIGN™ Amplifier 
  • EPLINK™ H.I.S. Interface 
  • EPLOGIX™ Mapping and Analysis Suite 
   
• Cardiac Stimulators
  • STIMCOR™ Integrate-able Stimulator 
  • STIMLAB™ Dual Touch Stimulator 
   

Related links
 

http://www.nhlbi.nih.gov/health/dci/Diseases/hhw/hhw_electrical.html
http://en.wikipedia.org/wiki/
http://www.texasheart.org/HIC/ProjH/images/flashheart.jpg

Vascular

Bard Electrophysiology Division 

While imaging tests like the mammogram and breast ultrasound can find a suspicious area, they cannot tell whether the area is cancer. A diagnosis of cancer is nearly always based on an expert looking at cell or tissue samples under a microscope. Not all lumps are malignant (cancerous). In fact, most tumors are benign (non-cancerous). A cancerous tumor is able to spread into surrounding tissues and even to distant parts of the body. A benign tumor cannot do this. 

A biopsy is the only way to tell for sure if a change is a benign breast condition or cancer. The procedure that takes a sample for this testing is called a biopsy, and the tissue sample is called a biopsy specimen. The testing process is sometimes referred to as pathology. A biopsy involves removing some cells from the suspicious area to look at under a microscope. A biopsy can be done using a needle or with surgery to remove part or all of the tumor. The type of biopsy depends on the size and location of the lump or area that has changed. The doctor will use the one best for you.  

A biopsy is done when other tests show that you might have breast cancer. A biopsy involves removing some tissue from the suspicious area to look at under a microscope. A biopsy can be done using a needle or with surgery to remove part or all of the tumor. The type of biopsy depends on the size and location of the lump or area that has changed. The doctor will decide which one is best for you. 

Fine needle aspiration biopsy (FNAB): For this test, a very thin, hollow needle is used to pull out fluid or cells from the lump. Your doctor might use ultrasound to guide the needle into the lump. 

Core needle biopsy: A core needle biopsy (CNB) is much like an FNAB. A slightly larger, hollow needle is used to withdraw small cylinders (or cores) of tissue from the abnormal area in the breast. The BARD® MAX-CORE® Disposal Core Biopsy Instrument is an example of a biopsy core needle.  CNB is most often done with local anesthesia (you are awake but your breast is numbed) in the doctor's office. The needle is put in multiple times to get the samples, or cores. This is more invasive and takes longer than an FNAB, but it is more likely to give a definite result because more tissue is taken to be looked at. 

Vacuum-assisted needle biopsy: BARD is the world leader in biopsy innovations.  BARD’s newest innovation, ENCOR ENSPIRE® Breast Biopsy System, transforms the breast biopsy experience for the physician, the patient, and the practice with smart features like a sleek, streamlined console, palm-sized handpiece, and an intuitive touch screen interface. It offers features such as in-breast adaptability, pre-programmed sampling, real-time visual confirmation of needle activity, and quick and easy set-up. 

The FINESSE® Ultra Breast Biopsy System is a self-contained, vacuum-assisted, ultrasound-guided breast biopsy system with SIMS Technology – the ability to acquire multiple samples with a single probe insertion.  With sampling cycle time just 10 seconds, the FINESSE® Ultra Breast Biopsy System acquires large, high-quality, contiguous tissue samples rapidly from a single insertion.  The 10 gauge and 14 gauge probe options offer flexibility to choose the right probe for each patient . The FINESSE® Ultra Breast Biopsy System provides compassionate control of the patient experience, confident control of sample quality, and efficient control of the biopsy procedure. 

BARD’s VACORA® Breast Biopsy System obtains large, high-quality, contiguous tissue samples under ultrasound, stereotactic x-ray and MR image guidance. 

Following a breast biopsy, a breast tissue marker may be placed to help locate the site for future reference.  During a breast biopsy procedure most of the lesion may have been removed and could potentially be difficult to locate after the biopsy.  Therefore, it has become standard practice for a physician to place a breast tissue marker at the site of the biopsy for future reference.  Marking the site also helps to ensure that the correct area was biopsied.  

Breast tissue markers are made of materials that will show up on your follow-up mammogram.  The markers have been tested and proven to be safe and effective.  

BARD also offers localization wires, as well as core needle biopsy systems for lung, liver, breast, and prostate biopsies.  

Surgical (excisional) biopsy: A surgical biopsy is used to remove all or part of the lump so it can be looked at under the microscope. An excisional biopsy removes the entire mass or abnormal area, as well as a surrounding margin of normal-looking breast tissue. In rare cases, this type of biopsy can be done in the doctor's office, but it is more often done in the hospital's outpatient department under a local anesthesia (where you are awake, but your breast is numb). During an excisional breast biopsy the surgeon may use a procedure called wire localization if there is a small lump that is hard to find by touch or if an area looks suspicious on the x-ray but cannot be felt. After the area is numbed with local anesthetic, a thin, hollow needle is put into the breast using imaging to guide the needle to the suspicious area. A thin wire is put in through the center of the needle. A small hook at the end of the wire keeps it in place. The hollow needle is then removed, and the surgeon uses the wire as a guide to the abnormal area to be removed. BARD offers a wide variety of localization wires including: ULTRAWIRE®, CHESBROUGH®, GHIATAS® and DUALOK® Breast Localization Wires.  

Because BARD develops biopsy related devices, we are especially knowledgeable about these technologies, but we do not suggest that any one is, or is not, the best option for you.  Only a physician with knowledge of a patient’s unique case and condition can recommend appropriate treatment options. 

Related links 

American Cancer Society
A nationwide, community-based, voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service.
Toll-free number:1-800-ACS-2345 (1-800-227-2345)
Web site: www.cancer.org 

Susan G. Komen for The Cure
An international not-for-profit organization dedicated to eradicating breast cancer as a life-threatening disease by advancing research, education, screening, and treatment.
Toll-free number: 1-877-GO KOMEN (1-877-465-6636)
Web site: www.komen.org 

American College of Radiology
A professional society that focuses on the practice of radiology, safety, and quality standards.
Toll-free number: 1-800-227-5463
Web site: www.acr.org 

National Breast Cancer Coalition
An organization that advocates for public policy related to breast cancer issues.
Toll-free number: 1-800-622-2838
Web site: www.stopbreastcancer.org 

National Cancer Institute
Toll-free information line for questions about cancer.
Toll-free number: 1-800-4-CANCER (1-800-422-6237)
Web site: www.cancer.gov 

Bard links
Vacuum Assisted Breast Biopsy Patient Information Brochures – English & Spanish
Breast Tissue Marker Patient Information Brochure  - English & Spanish 

FINESSE® ULtra Breast Biopsy System 
VACORA® Vacuum Assisted Biopsy System
ENCORE® Breast Biopsy System
ENCORE ENSPIRE® Breast Biopsy System
ULTRACLIP® Dual Trigger Breast Tissue Markers
ULTRACLIP® Breast Tissue Markers
ULTRAWIRE® Breast Localization Device
GHIATAS® Beaded Breast Localization Wire
DUALOK® Breast Lesion Localization Wire
CHESBROUGH® Breast Localization Wire
MAX-CORE® Disposable Core Biopsy Instrument
MONOPTY® Disposable Core Biopsy Instrument
MAGNUM® Reusable Core Biopsy Instrument
BIOPTY-CUT® Disposable Core Biopsy Needles
TRUGUIDE® Coaxial Biopsy Needle
VACU-CUT® Disposable Aspiration Biopsy Needles
OSTYCUT® Disposable Bone Biopsy Needle
GEL MARK ULTRA™ Breast Tissue Markers
SENOMARK® Breast Tissue Markers
STARCHMARK® Breast Tissue Markers 

Oncology

Bard Biopsy Systems 

A vascular access device is used to provide intravenous (IV) medicines into the blood vessels of a patient, and to draw blood samples. When access to the blood vessels is needed for a longer period of time, or the medicines that are needed might damage the smaller vessels of the hand or wrist, a special catheter called a central venous catheter may be used. Central venous catheters can be inserted into a vein in the upper arm, leg, neck or chest, and are threaded through the veins until the opening of the catheter is in one of the large veins near the patient’s heart. These types of catheters can be used easily and repeatedly over a long period of time, without repeated needle-sticks.

Peripherally inserted central catheters (PICC) (say “pick”) can stay in your system for up to a year.  The catheter is used to give you medications or to get blood samples.  You do not need surgery to have the PICC catheter put in your arm.

The PICC catheter lets your doctors and nurses give you medications without repeated needle sticks in your arm. Some PICC catheters are also power injectable. This means they can be used to inject contrast media into your vessels for diagnostic studies like CT scans.

PICCs also help protect veins from being exposed to irritating substances such as high or low pH medications. 

Patients with the following medical conditions often receive a PICC line because of the treatments they require:

• AIDS
   
•  Intestinal Obstruction
   
• Cellulitis
   
•  CHF
   
• COPD
   
• Crohn’s Disease
• Cystic Fibrosis
   
• Endocarditis
• Hypermesis
• Lyme Disease
   
• Mastectomy
   
• Osteomyelitis
   
• Septic Arthritis
   
• Septicemia
   
• Short Bowel Syndrome
• Transplants
   
• Oncology Patients
• Wound Infections

Potential Patient Benefits
 

• Reduced number of needle-sticks required for successful placement
• Reduced risk of vascular access related complications
• Increased patient safety and comfort
• Increased patient confidence in care received

Potential Patient Risks
 

• Bleeding
• Catheter embolism: Air in the catheter or bloodstream
• Venous thrombosis: Swelling of neck and arm on side of catheter insertion
• Risk normally associated with local or general anesthesia, surgery and post-operative recovery
• Phlebitis: Swelling at exit site
• Infection: Redness or swelling in conjunction with fever

A peripherally inserted central catheter (PICC) is essentially a tube that is inserted into your vein and gives clinicians the ability to deliver medications and fluids directly to your heart.  The catheter is usually inserted in the cephalic, basilic, or brachial vein – all of these are found within your upper arm.  As these veins move closer to your heart, they get increasingly bigger.  The catheter gets pushed through these veins until they reach one of the largest vessels in your body, the superior vena cava.

You might notice more than one catheter “leg” coming out of your arm where the PICC has been placed.  These legs are called lumens and enable your nurse or doctor to administer different treatments at the same time.  PICCs have also evolved in the past few years to enable clinicians to power-inject fluids.  If a doctor decides you should get a CT scan, the CT Technologist can use the PICC that’s already in your arm to administer contrast media.  Generally, contrast media needs to be pushed through your veins at higher pressures.  Technological advancements have made it possible for your PICC to accommodate these high-pressure injections.  This helps reduce your chances of having to get “stuck” by a needle again for another catheter. 

Please consult with you healthcare provider to determine if a PICC is right for you.

Related links
www.bardaccess.com
www.powerpicc.com
www.powerpiccsolo.com
www.veins4life.com 

BARD links
PICC Care & Maintenance
POWERPICC Patient Guide
POWERPICC Solo Patient Guide - English & Spanish 

QUESTION: How will I know that everything is Okay with my PICC line?
ANSWER: When you look at the catheter and insertion site, and you don’t see anything unusual, be confident that there are no problems. Some patients experience an increased redness around the insertion site about two weeks after the catheter has been inserted. This can be a normal part of the healing process. The redness of normal healing is NOT accompanied by pain, and goes away in 24-48 hours. Your doctor or nurse may suggest that you apply a warm compress several times daily until the redness is gone. There should not be any drainage around the catheter at this time. You will also know that everything is okay if you can flush your catheter freely.

During the time you have the catheter, your doctor or nurse may have you take your temperature every day and may request that you make other periodic observations. This will be another way of making sure everything is okay.

QUESTION: How will I know if something is wrong?
ANSWER: If you experience problems with the flushing procedure, you may have a clotting problem that requires immediate attention by your doctor or nurse.

A low grade temperature and a feeling of general fatigue/weakness that lasts for more than 24 hours may mean the beginning of an infection. If a child becomes less active for no apparent reason for longer than usual, an infection may be starting even though there is no increase in temperature.

If you have a fever with a temperature higher than 100° F, call your doctor or nurse immediately. Contact your doctor or nurse as soon as you suspect that something is wrong.

QUESTION: Can I bathe?
ANSWER: You should ask your doctor this question. The answer will depend on your general health and general risk of infection.  It will also depend on how long you have had the catheter in place. The doctor may allow you to bathe as long as you do not get the catheter dressing wet or damp.

QUESTION: How long can the catheter stay in place?
ANSWER: Your doctor is the best source for this answer. The catheter is designed to stay in place for long periods of time, but each patient situation is unique. The answer depends on what the catheter is used for, your general health, and the care and attention paid to the procedures.
 

The better care you take of your catheter, the longer you may be without complications.

QUESTION: How soon after a catheter is placed can it be used?
ANSWER: A catheter can be used as soon as placement is confirmed and the inserting physician writes an order for the catheter use.

QUESTION: Can catheters be used in the Radiology Department with the Power Injector?
ANSWER: POWERPICC, POWERPICC SOLO*, POWERGROSHONG, POWERLINE and POWERHOHN Catheters by Bard Access Systems can be used for injection of contrast media up to 5 ml/second up to 300 psi.  These catheters are easily distinguished from other non-indicated catheters by the distinctive purple color used on the catheter.

QUESTION: What is the recommended dwell time for catheters?
ANSWER: PICCs: Peripherally Inserted Central Catheters (PICCs) are recommended for short (under 30-days) and long-term (greater than 30-days) use.  The optimal time interval for removal is unknown; however, most practitioners believe a PICC should not remain indwelling past one year. 

For information on BARD PICC products that can be used to give you special fluids, medications, blood products, or to take blood samples for testing go to:
www.bardaccess.com
www.powerpicc.com
www.powerpiccsolo.com 

Oncology

Bard Access Systems   

Deep Vein Thrombosis (DVT) is the formation of a blood clot ("thrombus") in a deep vein.  DVT commonly affects the leg veins (such as the femoral vein or the popliteal vein) or the deep veins of the pelvis (occasionally the veins of the arm are affected). The most serious complication of a DVT is that the clot could dislodge and travel to the lungs, which is called a pulmonary embolism (PE). A late complication of DVT is chronic venous insufficiency, which can present itself as edema (abnormal amount of fluid under the skin), pain or discomfort and skin problems. 

Several medical conditions can lead to DVT, such as compression of the veins, physical trauma, cancer, infections, certain inflammatory diseases and specific conditions such as stroke, heart failure or nephrotic syndrome (damaged kidneys which leak large amounts of protein into the urine).

Risk FactorsDecreased flow rate of the blood, damage to the blood vessel wall and an increased tendency of the blood to clot (hypercoagulability).  DVT is a medical emergency, if present in the lower extremity, there is a 9% chance of the clot dislodging and killing the patient. 

Other factors which can increase a person's risk for DVT include surgery, hospitalization, immobilization (such as when orthopedic casts are used, or during long-haul flights leading to economy class syndrome), smoking, obesity, age, certain drugs (such as estrogen treatment) and inborn tendencies to form clots known as thrombophilia (for example, in carriers of factor V Leiden). Women have an increased risk during pregnancy and within 6 weeks after giving birth.

A DVT can occur without symptoms, but in many cases the affected extremity will be painful, swollen, red, warm and the veins near the surface of the skin may be engorged.   

The most commonly used tests for the diagnosis of DVT are a blood test called D-dimer and doppler ultrasound of the affected veins. Anticoagulants such as warfarin are the primary treatment option for patients with DVT to prevent further buildup and formation of new clots.  In severe cases, the physician may recommend thrombolysis, which is the use of an intravenous medication that dissolves clots, or thrombolectomy in which the clot is extracted through a small incision.

Related links
www.filterfacts.com/
www.vdf.org
http://www.outcomes-umassmed.org/dvt/  

QUESTION: What is pulmonary embolism and what causes it?
ANSWER: Pulmonary embolism is the condition that results when a blood clot forms, usually in the deep veins of the thighs, pelvis or lower leg, and becomes loosened, traveling upward from the legs in the bloodstream. If the blood clot is left untreated, there is a possibility that the clot may move up into the arteries that carry blood to the lungs. If this occurs, it could lead to decreased blood flow to the lungs and may cause lung damage or death.

QUESTION: What types of treatment are used for pulmonary embolism?
ANSWER: The most common treatment is a group of medications called anticoagulants or “blood thinners.” However, there are some patients who, for a variety of medical reasons, cannot take anticoagulants. For these individuals, a vena cava filter may offer an effective preventive option to limit clot movement in the lungs.

QUESTION: What is a vena cava filter?
ANSWER: A vena cava filter is an expandable metal device specially designed to trap blood clots before they reach the lungs.  The filter is placed in the inferior vena cava (IVC) – the large vein that carries blood from the lower extremities back to the heart and lungs – and remains in place to trap clots before they move further up toward the lungs. 

QUESTION: How will the filter be inserted?
ANSWER: Your physician will insert the filter through either the right or left femoral vein in the upper thigh.  To make the procedure as easy as possible, the filter is inserted inside a small plastic tube called a catheter.  Once inserted, the filter expands to its predetermined shape and is held in place against the vena cava walls.

QUESTION: How long does the procedure usually take?
ANSWER: Although it varies depending upon the individual patient and the specific circumstances, the implantation of the filter generally takes less than an hour.

QUESTION: Will I experience discomfort during and after the procedure?
ANSWER: Local anesthesia, plus a mild sedative that might be taken before the procedure, will normally result in little to no discomfort while the filter is being implanted.

QUESTION: How long will it take to fully recover?
ANSWER: Recovery from the procedure should be rapid, although the specific length of time will vary from patient to patient, depending upon factors such as age, general state of health, etc.

AFTER THE PROCEDUREQUESTION: How long will the filter last and can the filter be removed?
ANSWER: The ECLIPSE™ Filter is designed to be a permanent implant. However, the filter can be removed when your physician determines that you no longer need it.

QUESTION: Can the filter become clogged?
ANSWER: In the great majority of cases, the answer is “no.” Once a clot becomes entrapped in the filter, the normal flow of your blood through the vena cava and the filter will usually dissolve a trapped clot as the blood flows over it.

QUESTION: Under what circumstances should I contact the doctor right away?
ANSWER: You should contact your physician right away if you experience any of the following:

• Sudden onset of chest pain accompanied by shortness of breath
• Swelling in both legs
• Unexplained pain in the abdomen or back
• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden severe headache with no known cause
• Unexplained fever

QUESTION: What are the risks associated with implantable filters?
ANSWER: As with all implantable devices there are some risks associated with vena cava filters. You should discuss the possible adverse effects of this procedure and the filter with your physician. Potential risks include the following:

• Any procedure where the skin is penetrated carries a risk of infection.
• The filter could accidentally be implanted in the wrong place, move from its initial implantation site, or poke or tear through the vessel wall.
• The events above may lead to pain, bleeding, injury to a nearby organ, or make it difficult or impossible to remove the filter (should your doctor wish to remove it).
• Blood clots could continue to recur and possibly obstruct the filter and vena cava, causing swelling in the legs.
• The entire filter or pieces of the filter may break loose and travel to the heart or lungs, causing injury or death. You may need to have additional surgery to retrieve the filter or pieces if they break loose.
• Even with a filter it is possible to experience a recurrent pulmonary embolism due to clot material passing through the small openings in the filter.

REMOVAL PROCEDUREQUESTION: Can the filter be removed?
ANSWER: Depending on the type of filter you receive, the filter may be able to be removed when your physician determines that you no longer need it.

QUESTION: How will the filter be removed?
ANSWER: Your physician will remove the filter through either the right or left internal jugular vein (see anatomic illustration in the section “The Implant Procedure”). He/she will insert a small tube called a catheter. Through the catheter, a grasping device will be advanced to the filter. The filter will be grasped, and then pulled into the catheter. Your physician will then remove the entire system together.

QUESTION: How long does the retrieval procedure take?
ANSWER: Although it varies depending upon the individual patient and the specific circumstances, the retrieval of the filter generally takes less than an hour.

QUESTION: Will I experience discomfort during and after the procedure?
ANSWER: As with the implant procedure, local anesthesia, helped by a mild sedative given before the procedure, will normally result in little to no discomfort while the filter is being removed. Afterwards, you may experience mild soreness in your neck for a few days. This is normal and will disappear. You will be left with a small scar on your neck at the puncture site.

QUESTION: How long will it take to fully recover from the removal procedure?
ANSWER: Recovery from the removal procedure should be rapid, although the specific length of time will vary from patient to patient, depending upon factors such as age, general state of health, etc. Typically, you will be discharged several (2-3) hours after the procedure.

RESUMING YOUR NORMAL LIFESTYLEQUESTION: Should I restrict my activities after the filter implantation or removal procedure?
ANSWER: The implantation or removal of a vena cava filter is not necessarily a reason to restrict your normal activity level; however, each patient is unique and there may be other medical reasons for doing so. Be sure to discuss with your doctor what level of activity is most appropriate for you following the procedure.

For more frequently asked questions click here.  

ECLIPSE™ Vena Cava Filter
Simon NITINOL® Filter    

For more information on these products click here.

Vascular

Bard Peripheral Vascular 

www.filterfacts.com/www.outcomes-umassmed.org/dvt/ 

End Stage Renal Disease (ESRD) is the 5th stage of Chronic Kidney Disease (CKD) classified as a progressive loss of renal function over a period of months or years. Recent professional guidelines classify the severity of chronic kidney disease in five stages, with Stage 1 being the mildest and usually causing few symptoms and Stage 5 being a severe illness with poor life expectancy if untreated.

Often, CKD is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. CKD may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis. Higher levels of creatinine indicate a falling filtration rate and as a result a decreased capability of the kidneys to excrete waste products.

The most common causes of CKD are diabetes and hypertension. Together, these cause approximately two-thirds of all cases.

Risk Factors
If untreated, Stage 5 CKD is a severe illness with poor life expectancy. A kidney transplant is an arduous journey from finding a donor, your body accepting the new kidney, the longevity of the transplanted kidney and the continuous care of the transplanted kidney. Hemodialysis carries certain risk factors that are dependant on the individual patients overall health and the type of dialysis chosen.

Symptoms
Initially it is without specific symptoms, but by Stage 5 it is established kidney failure. 

The goal of therapy is to slow down or halt the otherwise relentless progression of CKD to stage 5. When one reaches Stage 5 CKD, renal replacement therapy is required, in the form of either dialysis or a transplant.

Dialysis is a process which simulates the actions of the kidneys by removing wastes from the blood stream. There are two types of dialysis – peritoneal dialysis and hemodialysis.

Peritoneal dialysis involves a catheter that is implanted into an area in your abdomen called the peritoneal cavity. The peritoneal cavity is filled via the catheter with a solution which slowly draws the wastes out of the blood stream while filtering them through the peritoneal membrane. The fluid is then drained and replaced through the same catheter and the process is started over again.

In hemodialysis, the blood is filtered through an artificial kidney which cleans the blood and restores the proper levels of certain chemicals such as sodium, potassium and bicarbonate. To get your blood into the artificial kidney, your doctor must create a “vascular access”, a high-flow conduit needed for effective hemodialysis, by joining an artery to a vein to create a larger vessel (fistula), or the insertion of an ePTFE graft. Additionally, an access may be created by the insertion of a catheter into a vein in your neck. This type of treatment is usually temporary, but may be used for long-term treatment if no other options are available. 

Related links
www.kidney.org
www.vasamd.org
www.aakp.org 

BARD links
FLAIR® Endovascular Stent Graft Patient Information Brochure  

QUESTION: What is dialysis?
ANSWER: Dialysis is a process which simulates the action of the kidneys by removing waste from the blood stream.

QUESTION: What are the types of dialysis?
ANSWER: There are two types of dialysis – peritoneal dialysis and hemodialysis.

Peritoneal dialysis involves a catheter which is inserted into an area in your abdomen called the peritoneal cavity. The peritoneal cavity is filled via the catheter with a solution which slowly draws the wastes out of the blood stream while filtering them through the peritoneal membrane. The fluid is then drained and replaced through the same catheter and the process is started over again.

In hemodialysis, the blood is filtered through an artificial kidney which cleans the blood and restores the proper levels of certain chemicals such as sodium, potassium and bicarbonate. To get your blood into the artificial kidney, your doctor will need to create an “access” into your blood vessels. This is done by minor surgery to your arm or leg which will involve either the joining of an artery to a vein to create a larger vessel (fistula), or the insertion of an ePTFE graft. Occasionally, an access may be created by the insertion of a small catheter into a large vein in your neck. This type of treatment is usually temporary, but may be used for long-term treatment.

Hemodialysis Access Grafts    

• VENAFLO® II Vascular Graft    
• VECTRA® Vascular Access Graft  
• FLAIR® Endovascular Stent Graft (available in the U.S. only)
• CONQUEST® PTA Dilatation Catheter  
• ATLAS® PTA Dilatation Catheter   

For more information on these products click here.

Vascular

Bard Peripheral Vascular 

According to the National Center for Health Statistics, some five million Americans have a hernia. Yet, only about 750,000 Americans seek treatment each year.

A hernia is a protrusion of an organ or tissue through an abnormal opening in the body. Most hernias occur when a piece of intestine slips through a weakness in the abdominal wall, creating a bulge you can see and feel. Hernias can develop in the groin (inguinal hernia), around the navel (umbilical hernia), or any place where you may have had a surgical incision (ventral hernia). Some hernias are present at birth; others develop slowly over a period of months or years. Hernias can also come on quite suddenly.

Think of a hernia as a bulge in a tire. The outer wall of the tire is like your abdominal wall. The inner tube of the tire is like your intestines. Most of the time, the outer wall of the tire is strong enough to hold the inner tube, but if the wall weakens, a bulge may occur. This is just like the way a hernia may form in a weakness in the abdominal wall. 

A hernia will not get better on its own. If a hernia is not repaired, it could become incarcerated (trapped) or strangulated. Strangulation is dangerous because a loop of intestine can get caught in the hernia and cut off blood supply to the tissue and is treated as a medical emergency.  If a man has a strangulated hernia, the chance of damage to the testicle increases.

These days, many hernia repairs are typically performed:

• in an outpatient setting at a hospital or at an ambulatory surgery center
• using local or epidural anesthesia instead of general anesthesia
• through small incisions
• within 45 minutes
• without the need for pain medication
• with patients going home a few hours after surgery
• with patients returning to normal activities within a few days  

Related links
Hernia Resource Center 

If it’s above the belt, you may have a ventral or Abdominal Hernia. 

If it's along the incision line from a previous surgery, you may have an Incisional Hernia. 

If it's around your belly button, you may have an Umbilical Hernia. 

If it's below the belt, you may have a groin or Inguinal Hernia. 

If it's near the top of your leg, you may have a Femoral Hernia. 

If you experience gastric reflux, you may have a Hiatal or Paraesophageal Hernia.  

QUESTION: What is a hernia?
ANSWER: A hernia is a protrusion of an organ or tissue through an abnormal opening in the body. Most hernias occur when a piece of intestine slips through a weakness in the abdominal wall, creating a bulge you can see and feel. Hernias can develop around the navel, in the groin, or any place where you may have had a surgical incision. Some hernias are present at birth; others develop slowly over a period of months or years. Hernias can also come on quite suddenly.

QUESTION: Who gets hernias?
ANSWER: According to the National Center for Health Statistics, approximately five million Americans have hernias. Hernias in the groin area (inguinal hernias) are most common in men, primarily because of the unsupported space left in the groin after the testicles descend into the scrotum during development. Hernias in the femoral area, at the top of the thigh, occur most often in women. They commonly result from pregnancy and childbirth. Children can also suffer from hernias. Some people also develop hernias at the site of previous surgical incisions, or in the area of the navel.

QUESTION: What are the symptoms of a hernia?
ANSWER: A hernia can often be both seen and felt. You may notice it as a lump in your abdomen or groin that may or may not disappear when you lay down or press on it. You may also be aware of a dull aching sensation that becomes more pronounced when you are active. The bulge may get bigger over time.

QUESTION: What causes a hernia?
ANSWER: It is not uncommon for someone to be born with a weakness in their abdominal wall. The weakness can also occur over time or from a previous surgical incision. Pressure from organs or tissue pushing on the weakness can cause a hernia. Age, smoking and obesity can also contribute to weakened tissue.

For a list of frequently asked questions about hernias and hernia repair click here . 

• Inguinal Hernia Repair
  BARD PERFIX™Plug
  BARD KUGEL™ Hernia Patch
  BARD MK™† Hernia Patch
  BARD 3DMAX™ Mesh
  BARD SOFT MESH
  BARD Mesh
  BARD VISILEX™ Mesh  

• Ventral Hernia Repair
  BARD VENTRIO™ Hernia Patch
  BARD COMPOSIX® L/P Mesh
  BARD COMPOSIX® E/X Mesh
  BARD CK™† Patch
  BARD DULEX* Mesh
  BARD VENTRALEX* Patch
  BARD SEPRAMESH™ IP Composite 

        † BARD* Modified Kugel* Patch

• Biologic Implants
  BARD XENMATRIX® Surgical Graft
  BARD COLLAMEND™ FM Implant
  BARD™ ALLOMAX™ Surgical Graft 
• Specialty Hernia Repair
  BARD CRURASOFT™ Patch
  BARD CK™ Parastomal Patch 
• Fixation
  BARD SORBAFIX™ Absorbable Fixation System                                       
  Davol PERMASORB™ Disposable Fixation Device 

For information on BARD hernia repair products click here.

Surgical Specialties

Davol 

Hernia Resource Center  

Kidney stones are very common, and can be a highly painful urologic disorder. In fact, it's estimated that 10% of the U.S. population will suffer from kidney stones at some point in their lives. Luckily, about 80% of kidney stones will pass out of the body without any need for medical intervention within 48 hours. But even if medical intervention is necessary, there are several proven treatment options that are highly successful in managing and treating stone disease. 

QUESTION:  What causes kidney stones?
ANSWERS:  Doctors do not always know what causes a stone to form. It seems that some people are just susceptible to having stones—and those who are might increase their risk by eating certain foods, or by not drinking enough water.

A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and metabolic disorders such as hyperparathyroidism are also linked to stone formation.

Certain intestinal disorders can increase the risk, as can taking certain medications, like protease inhibitors. Even taking diuretics or calcium-based antacids can increase the risk of forming stones.

National Kidney and Urologic Diseases Information Clearinghouse:
Kidney Stones in Adults jul04 

QUESTION:  What are the symptoms of kidney stones?
ANSWER:  Sometimes, urinary stones cause no symptoms at all. But often, urinary stones can cause pain—possibly severe— as well as blood in the urine, nausea or vomiting, the need to urinate more often, or burning during urination. If you’re experiencing any of these symptoms, you should contact your doctor for evaluation. And if fever and chills accompany any of these symptoms, contact a doctor immediately, as you may have an infection.

National Kidney and Urologic Diseases Information Clearinghouse:
Kidney Stones in Adults jul04 

Urology Care Foundation:
Kidney and Ureteral Stones 

QUESTION:  What is a ureteral stent and what can I expect if I need one?
ANSWER:  A ureteral stent helps keep the passage from kidney to bladder open so urine can flow unobstructed out of the body. If there is an obstruction, and urine is allowed to build up, serious kidney complications could result. The stent itself is a thin, hollow tube with two coiled ends; one end sits in the kidney and one end sits in the bladder, and the tube itself lies throughout the length of the ureter. Ureteral stents are placed surgically, and are necessary if there’s a chance of obstruction from either a stone or a stone fragment, a narrowing (stricture) of the ureter due to scarring, or a swelling of the ureter following surgery.

If you do need a stent, you can expect to be able to carry on your usual daily activities, including work and sports. Occasionally, there are side effects to having stents in place. These could include back pain, blood in the urine, and an increased risk of urinary tract infections. The length of time you will have your stent in will be determined by your physician, but typically is only for a couple of days.

Your doctor can give you more information about ureteral stents, their risks, and their benefits.  And for more information, click here to access a complete patient guide to ureteral stents.

References:
National Kidney and Urologic Diseases Information Clearinghouse:
Kidney Stones in Adults jul04 

Joshi, H.B. et. al. Having a Ureteric Stent: What to Expect and How to Manage. Southmead Hospital, Westbury-on-trym: Bristol, 2000.

QUESTION:  How can I find a doctor who treats urinary stones?
ANSWER:  Your primary care physician can refer you to a urologist who can help treat your urinary stones.

QUESTION:  How are kidney stones or ureteral stones diagnosed?
ANSWER:  Occasionally, "silent" stones—those that do not cause symptoms—are found on x-rays taken during a general health exam.  More often, symptoms of urinary stones will cause your doctor to scan your urinary system using a special x-ray test called an IVP (intravenous pyelogram) or a CAT scan. Blood and urine tests help detect any bleeding as well as any abnormal substances that might promote stone formation. The results of all these tests help determine the proper treatment.

Urology Care Foundation:
Kidney and Ureteral Stones 

QUESTION:  How are kidney stones or ureteral stones treated?
ANSWER:  Fortunately, surgery is not usually necessary. In fact, 80% of all urinary stones can pass through the urinary system with plenty of water to help move the stone along. Often, you can stay home during this process, drinking fluids and taking pain medication as needed.
If medical intervention is necessary, however, several treatment options offer excellent outcomes.

WebMD:
Kidney Stones: Treatment Overview jul04 

Urology Care Foundation:
Kidney and Ureteral Stones 

QUESTION:  How can I prevent kidney or ureteral stones?
ANSWER:  Drinking more liquids—preferably water—can help prevent stones, as can avoiding certain types of foods, depending on the type of stone you may have. For some people, certain medications may be necessary to help prevent more stones from forming. Your doctor may prescribe certain dietary changes, drinking more water, or becoming more physically active.

If you've had more than one kidney stone, you are likely to form another; so prevention is very important. Your doctor will order laboratory tests, including urine and blood tests, and analysis of the stone itself—all of which will help him or her determine the cause of your stones and how you can prevent them.

National Kidney and Urologic Diseases Information Clearinghouse:
Kidney Stones in Adults jul04 

For a list of frequently asked questions about pelvic kidney stones click here.

This site is not intended as a substitute for professional medical care.  Only your physician can diagnose and appropriately treat your systems. 

GuidewiresUreteral CathetersStone Removal Baskets
Ureteral Stents 

Urological

Bard Medical Division 

Questions to Ask Your Doctor
www.WebMD.com 

Throughout a lifetime, women's bodies undergo tremendous stress, including pregnancy, childbirth, strenuous exercise, and gynecologic surgeries. All of these stresses—accumulated over the years—can weaken the natural support structure of the pelvis, which can cause the pelvic organs to shift from their natural, intended position and/or to protrude into or outside of the vaginal canal. It's actually not an uncommon problem, and it can affect women of many ages and health circumstances.

Different types of organs protruding into the vaginal canal cause different types of prolapse. These include:

• Bladder (Cystocele)
• Small bowel (Enterocele)
• Rectum (Rectocele)
• Vagina (Vaginal vault), which can happen after hysterectomies.  

Some women who have prolapse experience no symptoms, and therefore don't require treatment. For many, however, Pelvic Reconstructive Surgery is required to repair the prolapse and restore a better quality of life.

Pelvic reconstruction is a surgical procedure to repair prolapse and relieve its symptoms. It’s often performed vaginally, and it involves the use of an implant to reinforce the strength of your weakened tissues.

Your doctor can give you more information about treatments for POP, their risks, and their benefits. 

BARD links
Pelvic Reconstruction Patient e-Brochure
Glossary
Questions to Ask Your Doctor
Pelvic Organ Prolapse Overview 

QUESTION: What is pelvic reconstruction?
ANSWER: Pelvic Reconstruction is a surgical procedure to repair prolapse and relieve its symptoms. It’s often performed vaginally, and it involves the use of an implant to reinforce the strength of your weakened tissues. It’s a safe and effective procedure, and is highly successful in correcting the problems associated with prolapse, and in helping restore a better quality of life.

QUESTION: Who performs pelvic reconstruction?
ANSWER: Gynecologists, uro-gynecologists, or urologists are all surgeons who specialize in pelvic reconstruction.

QUESTION: What are some of the symptoms of pelvic organ prolapse?
ANSWER: The symptoms of pelvic organ prolapse can range from mild to debilitating. They include:

• A feeling of pelvic pressure, or feeling as if something is actually falling out of the vagina
• A low backache
• Painful intercourse
• Urinary incontinence
• Difficulty with bowel movements
• Feeling of fullness in the vagina

For a list of frequently asked questions about pelvic organ prolapse click here 

This site is not intended as a substitute for professional medical care.  Only your physician can diagnose and appropriately treat your systems. 

PELVITEC® Mesh 

For information on BARD products that treat pelvic organ prolapse click here.  

Urological

Bard Medical Division 

Questions to Ask Your Doctor
www.WebMD.com 

Peripheral Artery Disease (PAD) is a circulatory disease which is characterized by narrowing of the arteries in the arms and legs due to the build up of cholesterol and scar tissue, often called plaque. This build up of plaque is commonly referred to as atherosclerosis. Additionally, PAD can be caused by blood clots that lodge in the arteries and restrict blood flow. As the flow of blood is reduced, the amount of oxygen and nutrients reaching the recipient tissue is also reduced. Often times, people with PAD will experience varying degrees of pain depending on how advanced their atherosclerosis has become, however, many people have no symptoms at all. If left untreated, the progression of PAD and resultant reduction in blood flow can lead to amputation in some patients.

The most common symptom of PAD is intermittent claudication which is leg pain that occurs when walking or exercising and it disappears when the person stops the activity. Numbness and tingling in the lower leg, coldness in the lower legs and feet, and non-healing ulcers on the legs and feet are also common signs of PAD. Many people simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor. As a result, PAD is extremely under diagnosed. It is estimated that only 15% of patients that need intervention are receiving it.

Prevalence
PAD affects 8 to 12 Million Americans.
PAD is most common in men and women aver age 50.
PAD affects 14-33 percent of Americans age 70 and older. 

The treatment of PAD varies widely depending on several factors such as:

• How progressed the disease is
• Which section of the arterial system is affected
• Additional co-morbidities such as diabetes
• The overall health of the patient

The primary goal in treating PAD is to restore proper blood flow and to prevent limb loss in patients with advanced stages of PAD.  Today, physicians have many options at their disposal to accomplish these objectives.  Your physician will determine which option is best for you.   

Related links
www.padcoalition.org
www.vasamd.org
www.vdf.org 

QUESTION: What are the risk factors for PAD?
ANSWER: The most common risk factors for PAD are: Genetics; High Blood Pressure; Smoking; Cholesterol; Diabetes; Inactive lifestyle.

QUESTION: What is the most common symptom of PAD?
ANSWER: The most common symptom of PAD is claudication which is leg pain that occurs when walking or exercising and it disappears when the person stops the activity; numbness and tingling in the lower leg; coldness in the lower legs and feet; non-healing ulcers on the legs and feet. 

DORADO® PTA Catheter  
RIVAL® PTA Dilatation Catheter
LIFESTENT® Vascular Stent
E-LUMINEXX® Vascular Stent
DISTAFLO® Mini-Cuff Bypass Graft  
VASCUTRAK® Dilatation Catheter   

The physician may choose to use an angioplasty balloon catheter such as the DORADO® PTA Catheter to dilate the lesion (plaque).  The catheter is inserted through a small incision in the groin and guided under x-ray to the exact location of the lesion, at which point, the catheter is inflated with a saline solution mixture to a precise diameter.  The catheter is then deflated, the artery is again examined and the physician will then determine if further intervention is necessary. 

Another option that may be considered is a self-expanding stent such as the LIFESTENT® Vascular Stent or the E-LUMINEXX® Vascular Stent.  These self-expanding stents are often delivered through the same small incision which was used for the angioplasty balloon.  Once they have been deployed at the site of the lesion, they exert a constant gentle outward force on the artery which helps to keep the artery open and restore proper blood flow.

Occasionally, a physician may encounter an occlusion (blockage) in the artery that they are unable to treat through an endovascular approach (minimally invasive options which are typically delivered through small catheters in the vasculature).  Depending on the analysis of the physician and their medical specialty, you may be referred to a surgeon to receive a bypass graft.   The two most common types of bypass grafts are autologous vein, which is native vein that is taken from the patient’s body, or ePTFE bypass grafts such as the DISTAFLO® Mini-Cuff Bypass Graft. 

Because BARD develops peripheral vascular devices, we are especially knowledgeable about those technologies but we do not suggest that any one is, or is not, the best option for you.  Only a physician with knowledge of a patient’s unique case and condition can recommend appropriate treatment options.

For more information on these products click here.

Vascular

Bard Peripheral Vascular 

A vascular access device is used to provide intravenous (IV) medicines into the blood vessels of a patient, and to draw blood samples. When access to the blood vessels is needed for a longer period of time, or the medicines that are needed might damage the smaller vessels of the hand or wrist, a special catheter called a central venous catheter may be used. Central venous catheters can be inserted into a vein in the upper arm, leg, neck or chest, and are threaded through the veins until the opening of the catheter is in one of the large veins near the patient’s heart. These types of catheters can be used easily and repeatedly over a long period of time, without repeated needle-sticks.

Ultrasound systems provide nurses and doctors with the ability to visualize anatomy and track the progress of Peripheral Inserted Central Catheters (PICCs), Central Venous Catheters (CVCs), or Peripheral Intravenous Line (PIVs) as they are placed.

Ultrasound assisted vascular access provides a safe and efficient means of obtaining vascular access.

Once central catheters are placed the location of the tip is typically confirmed with a chest x-ray before the catheter may be used for treatment. To enhance the placement of PICCs, BARD developed the SHERLOCK® II Tip Location System to provide clinicians with real-time catheter direction, location, and orientation. It operates by detecting the slight magnetic field generated by the pre-loaded stylet in Bard Access Systems’ PICC kits marked with   

Together, this system:

• Provides audible and visual signals that indicate location of tip position with an accuracy of 1 cm. 
• Displays the direction in which the catheter tip is pointing, increasing clinician confidence that the catheter is properly positioned.
• Helps reduce risks associated with “blind” catheter placement by following the position of the catheter tip.

Any PICC kit from Bard Access Systems labeled with “TLS” (Tip Location System) and marked with  may be used with the system. The system accommodates all placement techniques, is completely portable, and is the first tip location in the world that is compatible with an ultrasound system.

Please consult with your healthcare provider for more information.

Vascular Access devices let your doctors and nurses give you medications without repeated needle sticks in your arm.

Potential Patient Benefits

• Reduced number of needle-sticks required for successful placement 
• Increased patient safety and comfort

Potential Patient Risks

• Bleeding 
• Catheter embolism: Air in the catheter or bloodstream 
• Venous thrombosis: Swelling of neck and arm on side of catheter insertion 
• Risk normally associated with local or general anesthesia, surgery and post-operative recovery 
• Phlebitis: Swelling at exit site 
• Infection: Redness or swelling in conjunction with fever

Related links
www.bardaccess.com
www.powerpicc.com 
www.powerpiccsolo.com  

BARD links 
SITE~RITE* Ultrasound System - The SITE~RITE® Ultrasound System provides ultrasound guidance for placement of needles and catheters in vascular structures.

SHERLOCK* Tip Location System- The SHERLOCK* Tip Location System displays real-time catheter tip direction, location and orientation.  

Bard Access Systems 
Site~Rite Ultrasound System and Sherlock Tip Location System may help reduce your risk of the following hazards associated with multiple puncture attempts and blind insertion techniques:

Vascular Access Hazards Table 

According to the American Cancer Society, prostate cancer is the most common form of cancer in adult males. Not surprisingly, it is the second leading cause of cancer-related deaths in men, trailing only lung cancer in its deadliness. If you are an adult male, you have a one-in-six chance of developing prostate cancer during your lifetime.

Prostate cancer usually affects men over 65 and is rarely seen in men under 40. The disease occurs in African-American males at a higher rate than others. Public awareness of prostate cancer is more important than ever considering that the number of men aged 50 or over in the U.S. will have increased by some 30% from 1995 to 2005.

In its early stages, prostate cancer shows no symptoms. Once they appear, symptoms include weak or interrupted urine flow, difficulty controlling urination, frequent urination, especially at night, painful urination, blood in the urine, and persistent lower back or pelvic pain.

Because symptoms are silent early on, around 20% of prostate cancers are detected after the disease has spread beyond the prostate gland into other tissues or organs, which dramatically impacts a patient's long-term survival. If the cancer is caught while still in the prostate gland, it can be effectively treated.

For more information about prostate cancer and how it is diagnosed, click here. 

The ideal treatment for prostate cancer stops the disease in its tracks and eradicates it without disturbing the patient's quality of life. The information provided on this site is not intended as a substitute for professional medical care. It is up to you and your physician to choose the best combination of treatments to best address your situation.
 

The most common treatments are:

• Watchful Waiting
• Surgery
• External Beam Radiation
• Hormone Therapy
• Cryotheraphy
• Brachytherapy

For more information about the benefits and risks involved with various prostate cancer treatment options, download the brochure here. 

BARD links
Prostate Cancer Treatment Brochure
Glossary
Questions to Ask Your Doctor
Prostate Seed Implantation Instruction Sheet 

Prostate Cancer Treatment Information and Answers Online Brochure
Frequently Asked Questions About Brachytherapy 

Brachytherapy is a powerful modern treatment for prostate cancer that can help preserve a patient's quality of life. The brachytherapy procedure involves the surgical implantation of radioactive seeds into the prostate gland. Between 60 and 120 seeds are delivered into the prostate through hollow needles under ultrasound visualization, an extremely accurate way of guiding placement. The radioactivity kills the tumor cells.

Brachytherapy is associated with a lower incidence of impotence and incontinence compared to prostate surgery. Even though prostate cancer is the second leading cause of cancer-related death in men after lung cancer, if the cancer is detected early enough, the 5-year survival rate for men is almost 100%. 

Source (Brachytherapy Seeds) 
Needles 
Equipment SourceLink™ Delivery System  
Simetry™ Brachytherapy Program 
IsoSleeve™ Source Delivery System 

For more information on these products click here.

Urology

Bard Medical Division 

The American Cancer Society 
National Cancer Institute
University of Pennsylvania
Bard Medical Division  

Pulmonary embolism is the condition that results when a blood clot forms, usually in the deep veins of the thighs or pelvis (DVT), and becomes loosened, traveling upward from the legs to the lungs. If this occurs, the normal functioning of the lungs may be impaired, and there exists a significant risk of death.

The most common causes of blood clots that become pulmonary emboli are trauma, surgery, cancer, or hereditary conditions. Any risk factor for DVT also increases the risk that the venous clot will dislodge and migrate to the lung circulation, which is fatal in up to 9% of all DVTs. 

The most common treatment is a group of medications called anticoagulants or “blood thinners.” However, there are some patients who, for a variety of medical reasons, cannot take anticoagulants, or in whom the anticoagulants are ineffective.

For these individuals, a vena cava filter, such as the BARD ECLIPSE™ Vena Cava Filter, can be used to reduce the risk of pulmonary embolism.  A vena cava filter is an expandable metal device designed to trap blood clots before they reach the lungs. 

As with all implantable devices there are some risks associated with vena cava filters.  You should discuss the possible adverse effects of this procedure and the filter with your physician.  Potential risks include the following:

Related links
www.filterfacts.com/
www.vascularweb.org
www.vdf.org 

QUESTION: What is deep vein thrombosis (DVT)?
ANSWER: Deep Vein Thrombosis (DVT) is the formation of a blood clot ("thrombus") in a deep vein.   DVT commonly affects the leg veins (such as the femoral vein or the popliteal vein) or the deep veins of the pelvis (occasionally the veins of the arm are affected).

QUESTION: What medical conditions can lead to DVT?
ANSWER: Several medical conditions can lead to DVT, such as compression of the veins, physical trauma, cancer, infections, and specific conditions such as stroke, heart failure, or damaged kidney function.

QUESTION: What other factors can increase a person's risk for DVT?
ANSWER: Other factors which can increase a person's risk for DVT, include surgery, hospitalization, immobilization (such as when orthopedic casts are used, or during long-haul flights leading to economy class syndrome), smoking, obesity, age, certain drugs (such as estrogen treatment) and inborn tendencies to form clots known as thrombophilia (for example, in carriers of factor V Leiden). Women have an increased risk during pregnancy and within 6 weeks after giving birth.

QUESTION: What are the symptoms of DVT?
ANSWER: A DVT can occur without symptoms, but in many cases the affected extremity will be painful, swollen, red, warm and the veins close to the surface of the skin may be engorged. 

QUESTION: What is a vena cava filter?
ANSWER: A vena cava filter is an expandable metal device specially designed to trap blood clots before they reach the lungs.  The filter is placed in the inferior vena cava (IVC) – the large vein that carries blood from the lower extremities back to the heart and lungs – and remains in place to trap clots before they move further up toward the lungs. 

QUESTION: How will the filter be inserted?
ANSWER: Your physician will insert the filter through either the right or left femoral vein in the upper thigh.  To make the procedure as easy as possible, the filter is inserted inside a small plastic tube called a catheter.  Once inserted, the filter expands to its predetermined shape and is held in place against the vena cava walls.

QUESTION: How long does the procedure usually take?
ANSWER: Although it varies depending upon the individual patient and the specific circumstances, the Implantation of the filter generally takes less than an hour.

QUESTION: Will I experience discomfort during and after the procedure?
ANSWER: Local anesthesia, plus a mild sedative that might be taken before the procedure, will normally result in little to no discomfort while the filter is being implanted.

QUESTION: How long will it take to fully recover?
ANSWER: Recovery from the procedure should be rapid, although the specific length of time will vary from patient to patient, depending upon factors such as age, general state of health, etc.

AFTER THE PROCEDUREQUESTION: How long will the filter last and can the filter be removed?
ANSWER: The ECLIPSE™ Filter is designed to be a permanent implant. However, the filter can be removed when your physician determines that you no longer need it.

QUESTION: Can the filter become clogged?
ANSWER: In the great majority of cases, the answer is “no.” Once a clot becomes entrapped in the filter, the normal flow of your blood through the vena cava and the filter will
usually dissolve a trapped clot as the blood flows over it.

QUESTION: Under what circumstances should I contact the doctor right away?
ANSWER: You should contact your physician right away if you experience any of the following:

• Sudden onset of chest pain accompanied by shortness of breath
• Swelling in both legs
• Unexplained pain in the abdomen or back
• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden severe headache with no known cause
• Unexplained fever

QUESTION: What are the risks associated with implantable filters?
ANSWER: As with all implantable devices there are some risks associated with vena cava filters. You should discuss the possible adverse effects of this procedure and the filter with your physician. Potential risks include the following:

• Any procedure where the skin is penetrated carries a risk of infection.
• The filter could accidentally be implanted in the wrong place, move from its initial implantation site, or poke or tear through the vessel wall.
• The events above may lead to pain, bleeding, injury to a nearby organ, or make it difficult or impossible to remove the filter (should your doctor wish to remove it).
•  Blood clots could continue to recur and possibly obstruct the filter and vena cava, causing swelling in the legs.
• The entire filter or pieces of the filter may break loose and travel to the heart or lungs, causing injury or death. You may need to have additional surgery to retrieve the filter or pieces if they break loose.
• Even with a filter it is possible to experience a recurrent pulmonary embolism due to clot material passing through the small openings in the filter.

REMOVAL PROCEDUREQUESTION: Can the filter be removed?
ANSWER: Depending on the type of filter you receive, the filter may be able to be removed when your physician determines that you no longer need it.

QUESTION: How will the fitler be removed?
ANSWER: Your physician will remove the filter through either the right or left internal jugular vein (see anatomic illustration in the section “The Implant Procedure”). He/she will insert a small tube called a catheter. Through the catheter, a grasping device will be advanced to the filter. The filter will be grasped, and then pulled into the catheter. Your physician will then remove the entire system together.

QUESTION: How long does the retrieval procedure take?
ANSWER: Although it varies depending upon the individual patient and the specific circumstances, the retrieval of the filter generally takes less than an hour.

QUESTION: Will I experience discomfort during and after the procedure?
ANSWER: As with the implant procedure, local anesthesia, helped by a mild sedative given before the procedure, will normally result in little to no discomfort while the filter is being removed. Afterwards, you may experience mild soreness in your neck for a few days. This is normal and will disappear. You will be left with a small scar on your neck at the puncture site.

QUESTION: How long will it take to fully recover from the removal procedure?
ANSWER: Recovery from the removal procedure should be rapid, although the specific length of time will vary from patient to patient, depending upon factors such as age, general state of health, etc. Typically, you will be discharged several (2-3) hours after the procedure.

RESUMING YOUR NORMAL LIFESTYLEQUESTION: Should I restrict my activities after the filter implantation or removal procedure?
ANSWER: The implantation or removal of a vena cava filter is not necessarily a reason to restrict your normal activity level; however, each patient is unique and there may be other medical reasons for doing so. Be sure to discuss with your doctor what level of activity is most appropriate for you following the procedure.

For more frequently asked questions click here.  

ECLIPSE™ Vena Cava Filter SIMON NITINOL® Filter 

For more information on these products click here.

Vascular

Bard Peripheral Vascular 

www.filterfacts.com/
www.outcomes-umassmed.org/dvt/ 

Influenced by a variety of factors, including vaginal childbirth, strenuous exercise, and gynecologic surgeries, Stress Urinary Incontinence is a common disorder affecting millions of women. And fortunately, it is highly treatable. Your doctor can choose from a variety of excellent, minimally-invasive treatment options to help restore a better quality of life for you.

Eighty-five - ninety percent of all stress urinary incontinence can be successfully treated. That means that it is possible to regain your independence, and return to an active, healthy lifestyle.

There are a variety of treatment options for Stress Urinary Incontinence.

Behavioral therapy helps retrain the bladder and sphincter muscles.

Bulking therapy is an innovative, non-surgical procedure to implant a bulking agent—either natural collagen protein or another biocompatible substance—into the tissues surrounding the urethra/bladder junction to help reinforce the closure mechanism and prevent accidental urine leakage.

Surgery helps rebuild the urinary system's architecture to restore normal bladder function. One of the most effective surgical treatments for Stress Urinary Incontinence is the surgical implantation of a urethral sling. It involves placing a slender strip of material underneath the urethra to help support your natural tissues. It's minimally invasive, and is one of today's most successful procedures. In fact, hundreds of thousands of slings have been implanted worldwide.

Your doctor can give you more information about treatments for SUI, their risks, and their benefits. 

Related links
National Association for Continence
The Simon Foundation for Continence 

BARD links
Glossary of Terms
Questions to Ask Your Doctor
Sling Therapy Pamphlet eBrochure
Bulking Therapy Patient eBrochure  

QUESTION: What is Stress Urinary Incontinence?
ANSWER: Stress urinary incontinence, or SUI, is the body's inability to prevent accidental leakage of urine when pressure is exerted on the abdomen. It can result from weakened muscles supporting the bladder or urethra. And it can seriously affect your life, making it difficult to do the things you love—or even the things we take for granted in everyday life, such as coughing, sneezing, laughing, or climbing the stairs, without getting wet.

QUESTION: What causes stress urinary incontinence (SUI)?
ANSWER: Stress urinary incontinence is a sign of an underlying condition often characterized by one or more of the following:
 

• Poorly functioning urethral sphincter muscle, the smooth muscle which helps to form a seal at the neck of the bladder.
• Excessive movement of the female urethra, the muscular tube that allows urine to flow from the bladder to the outside of the body
• Weakened muscles which no longer adequately support the bladder and other organs of the pelvic area.

For women, these conditions may be influenced by a number of factors that can lead to incontinence, including:
 

• pregnancy and/or natural childbirth
• strenuous exercise
• loss of pelvic muscle tone
• previous gynecologic surgery

In men, stress incontinence generally results from previous surgical procedures (such as a radical prostatectomy, the removal of a diseased prostate) or accidental trauma.

For additional frequently asked questions on stress urinary incontinence click here.

This site is not intended as a substitute for professional medical care. Only your physician can diagnose and appropriately treat your symptoms.

Bulking Therapy:
CONTIGEN® BARD® Collagen Implant  

For more information on BARD products for stress urinary incontinence click here.  

Urology

Bard Medical Division 

Because of your medical problem, your body is having trouble completely emptying your bladder of urine.  Your doctor may use a Foley catheter or an Intermittent catheter.

Foley catheters are flexible tubes that are passed through the urethra during urinary catheterization and into the bladder to drain urine. They are retained by means of a balloon at the tip which is inflated with sterile water.

Some people may need a catheter for a short period of time or occasionally. Intermittent catheters do not have a balloon and may be prescribed by your doctor for self-catheterization. Short-term (intermittent) catheterization may be necessary for: anyone who is unable to properly empty the bladder, people with neurological disorders or women who have had certain gynecological surgeries.

Your doctor can give you more information about Foley and intermittent catheters, their risks, and their benefits.

The catheter will act as a drain to keep your bladder empty.  

BARD links
Foley Catheterization 

BARD® TOUCHLESS® Plus Intermittent Catheter System 

Boys I Can Go Anywhere Children’s Brochure - English & Spanish
Girls I Can Go Anywhere Children's Brochure - English & Spanish
Extended Care Urology Products 

BARD® Foley Catheter - Inflation/Deflation Guidelines 

BARD® CLEAN-CATH® Intermittent Catheter 

Achieving Independence: A Guide to Self-Catheterization - English & Spanish 

QUESTION: How can I prevent problems with my Foley catheter?
ANSWER: The Foley catheter is a necessary aid for managing your urinary drainage.  With proper management and care, more potential problems with your Foley catheter can be avoided.

QUESTION: What should I do if I think I have a problem?
ANSWER: Talk to your nurse whenever you think you may have a problem.

For Frequently Asked Questions about catheter-associated urinary track infections click here.

This site is not intended as a substitute for professional medical care.  Only your physician can diagnose and appropriately treat your symptoms.

Foley Catheters
Urethral Catheters and Trays 

Urology 

Bard Medical Division