1、Nasal and sinus dressings鼻腔及鼻窦止血材料,For internal use only. Not for distribution in the United States,Internal training material,Disclaimer 免责声明,7/21/2018,2,The information presented is solely for training purposes. It is not intended for distribution to customers, surgeons, or user facilities. Promot
2、ion of ArthroCare products is to be on-label and consistent with approved indications and intended uses. The information in this presentation is considered proprietary and is not to be copied or distributed.Some of the information presented herein is solely the opinion of the presenter, and is not n
3、ecessarily shared by ArthroCare Corporation.,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,Overview,7/21/2018,3,Anatomy 解剖Pathology病理ArthroCare products 产品ArthroCare procedures 手术Competition竞争,For internal use only. Not for distribution in the United States. P/N
4、46510 Rev. A,Anatomy解剖,For internal use only. Not for distribution in the United States,Nasal and sinus dressings,Anatomy - nose,image: P/N 30547B,Opening to each nostril is the nares. 鼻孔The septum is the bone and cartilage structure that divides the nose into two chambers. 鼻中隔Lateral wall is compri
5、sed of three conchas or turbinates.Inferior, middle and superior turbinate. 上、中、下鼻甲,7/21/2018,5,Nares,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,Anatomy Kiesselbachs plexus克氏血管丛,image: P/N EX00311,7/21/2018,6,Kiesselbachs plexus is a region in the antero-infer
6、ior part of the nasal septum 鼻中隔前下黎氏区克氏血管丛Most anterior nosebleeds originate from this area. 前鼻腔的出血多发源于此,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,Anatomy sinuses,7/21/2018,7,Sinuses are bony, air-filled spaces within the nasal cavity.The ethmoidal sinus is t
7、he central bony labyrinth that all other sinuses drain into.The ostium is the natural opening to each sinus. 窦口Access to the sinuses is made through the space lateral to the middle turbinate.,image: ,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,蝶窦 筛窦 上颌窦 额窦,Path
8、ology,For internal use only. Not for distribution in the United States,Nasal and sinus dressings,Pathology,7/21/2018,9,Nasal and sinus dressings are among others used after:止血材料用于Nasal surgery 鼻腔手术Sinus surgery 鼻窦手术Epistaxis 鼻衄主要靠“压迫”止血,For internal use only. Not for distribution in the United State
9、s. P/N 46510 Rev. A,Nasal surgery,7/21/2018,10,Septoplasty/rhinoplasty 鼻中隔成形术/鼻成形术Straighten the septum in order toRestore proper breathing.气道修复Cosmetic purposes. 美容Inferior or middle turbinate reduction下/中鼻甲减容For better airflow.Nasal polyp removal 鼻息肉切除Polyps are very vascular and bleeding can be d
10、ifficult to control.,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,Sinus surgery,7/21/2018,11,FESS functional endoscopic sinus surgery 功能性鼻窦内镜手术Blockages within the sinus anatomy that prevent proper drainageProcedure attempted to surgically open blockages to allo
11、w proper drainage.Polyps are commonly originating from sinus cavities.,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,Epistaxis 鼻衄,7/21/2018,12,Anterior epistaxisAccounts for 90% of all nosebleeds.Kiesselbachs plexus located on the anterior septal mucosa.Usually l
12、ess serious for the patient.通常出血不凶Posterior epistaxisOriginates via branches of the sphenopalatine artery.Often life threatening for the patient.凶甚至危及生命,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,ArthroCare 产品,For internal use only. Not for distribution in the
13、 United States,Nasal and sinus dressings,ArthroCare products,Knitted CMC (no nylon dissolvable)（非尼龙可分解-非取出）Sinu-Knit (inverted multilayer of CMC) RR600Stammberger Sinu-Foam RR650Knitted CMC reinforced with nylon (removable)(尼龙取出）Gel-Knit Rapid Rhino epistaxis packs,7/21/2018,14,For internal use only
14、. Not for distribution in the United States. P/N 46510 Rev. A,CMC （羧甲基纤维素钠）technology,Carboxymethylcellulose (CMC) is the basis of all our Rapid Rhino products.Very common material used in varied applications such as food additive, cosmetics, eyedrops, toothpaste, pharmaceuticals, 食品添加剂，药物，牙膏等Common
15、ly as a powder.Odorless and flavorless 无色无味Soluble 可溶Advantages: 优点Easy removal易放入和取出Stays moist for several days allowing easy, pain-free removal.数天内保持湿润 舒适度高Provides a moist barrier湿性屏障 防粘连Separated anatomy preventing adhesions from forming.Bleed control Controls oozing and minor bleedings.减少渗血,7/
16、21/2018,15,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,CMC（羧甲基纤维素钠） characteristics,Gel-like surface allows for easy insertion and removal of dressings. 胶状物易放入和取出Provides a moist barrier.湿性屏障 防粘连Conforms to the nasal anatomy.解剖顺应性Dissolvable.可分解Neutral pH (low
17、pH causes inflammation/burning sensation).中性pHHydrocolloid: a substance that turns to gel with water.遇水成胶CMC can carry up to 20 times its own weight of water.吸收承载20倍的水,7/21/2018,16,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,Sinu-Knit and Stammberger Sinu-Foam,
18、Dissolving CMC. 可分解Used in operating room (post-op).用于术后渗血Do not need to be removed.Last 7-10 days.可放置710天,7/21/2018,17,Stammberger Sinu-Foam RR 650,Sinu-KnitRR 600,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,How to use Stammberger Sinu-Foam?,Draw sterile water
19、 up to the black line (ca. 8cc) of the small syringe.Screw and connect the two syringes together.,7/21/2018,18,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,Gel-Knit,Foam wrapped in CMC with nylon. 带尼龙的CMCUsed in emergency and operating room.急诊室和手术室Need to be rem
20、oved after 2-3 days. 23天后取出Available in different sizes.不同大小,7/21/2018,19,Riemann 3 and 4 cmRR 300 and RR 400,Goodman 5.5 cmRR 500,Mannheim 8.0 cmRR 800,Sinus surgery,Septoplasty/Rhinoplasty,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,Epistaxis tamponades鼻衄的鼻腔填
21、塞,Inflation balloons wrapped in CMC with nylon 带尼龙的CMM包裹气囊.Used in emergency room. 常用在急症室Need to be removed after 2-3 days. 需23天后取出Available in different models and sizes. 不同型号和大小,7/21/2018,20,Inflation catheter,Butterfly swallow guard,Inflation valve,Pilot cuff,7.5cm w/airway,For internal use only.
22、 Not for distribution in the United States. P/N 46510 Rev. A,Rapid Rhino products for epistaxis,RR 4504,5cm for paediatric/small anatomy.儿童RR 5505,5cm is the standard anterior size.标准RR 5515,5cm with airway 带通气管RR 7507,5cm is used for posterior bleeds. 后鼻道出血RR 7527,5cm 双气囊RR 9009,0cm for posterior e
23、pistaxis. 无证,7/21/2018,21,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,RR的使用,For internal use only. Not for distribution in the United States,Nasal and sinus dressings,How to use Rapid Rhino nasal tamponade?,7/21/2018,23,Butterfly swallow guard,Inflation valve,P
24、ilot cuff,Inflation catheter,Blue indicator ring,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,使 用 录 像 1,1. Soak 60 seconds in sterile water 浸泡无菌注射用水中浸泡60秒,7/21/2018,24,Remove the blue plastic sheath.Soak the Rapid Rhino in sterile water for 60 seconds to convert
25、 the hydrocolloid fabric to a self-lubricating surface.DO NOT use saline or ANY topical ointments as may inhibit the effectiveness of the CMC fabric. 不能用生理盐水，会抑制CMC效应,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,How to use Rapid Rhino nasal tamponade?,2. Inserti
26、on 放入,7/21/2018,25,Insert the Rapid Rhino into the nasal cavity along the septal floor and parallel to the hard palate until the blue indicator ring is well within the nares.沿鼻中隔面平行硬腭放入鼻腔,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,3. Inflate 充气,7/21/2018,26,Us
27、ing a 20cc syringe, inflate the device with AIR only.Monitor the pilot cuff for direct tactile feedback. 指示气囊触觉反馈Stop inflation when the pilot cuff becomes rounded and feels firm when squeezed.Similar to the way the pilot cuff feels when an endotracheal tube is inflated.指压指示气囊鼓胀较硬时停止充气,Maximum Infla
28、tion Volumes不同型号最大充气量 4.5cm 25cc 5.5cm 30cc 7.5cm 40cc,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,4. Cuff conforms to the patient anatomy,7/21/2018,27,As the cuff inflates it conforms to the patients unique anatomy thereby providing a gentle, low pressure tamp
29、onade that delivers the CMC fabric directly to the bleed site. 指示气囊充盈，较低压力下降外层 CMC挤压入出血部位，贴合不同解 剖形状的鼻腔The amount of air is determined by the size of the nasal anatomy.据鼻腔大小差异调节充气量,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,How to use Stammberger Sinu-Foam?,Dra
30、w sterile water up to the black line (ca. 78cc) of the small syringe.78毫升无菌注射水溶解RR650Screw and connect the two syringes together.,7/21/2018,28,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,使用录像2,Competition,For internal use only. Not for distribution in the Unite
31、d States,Nasal and sinus dressings,Competition top removable nasal dressings,7/21/2018,30,Ribbon gauze packing 凡士林砂条Merocel (Medtronic/Xomed) 美敦力膨胀海绵Epistat balloon (Medtronic/Xomed) 硅胶球囊,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,Competition ribbon gauze pack
32、ing凡士林砂条填塞,7/21/2018,31,Patient is packed with up to 180cm of Vaseline-coated 1,25cm wide ribbon gauze.ENT doctors will layer it from bottom to top inside the anterior nasal cavity to fill the nasal cavity.This was the only way to pack 20 years ago. Less often used nowadays.,For internal use only. N
33、ot for distribution in the United States. P/N 46510 Rev. A,Competition Merocel (Medtronic/Xomed),7/21/2018,32,膨胀海绵鼻腔填塞,Add pics,image: ,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,Competition Epistat Balloon (Medtronic/Xomed),7/21/2018,33,硅胶球囊压迫止血,image: ,For i
34、nternal use only. Not for distribution in the United States. P/N 46510 Rev. A,Rapid Rhino advantages (removables),7/21/2018,34,Insertion less painful due to flexibility and lubricious surface.无痛放入容易Only product to combine platelet aggregation and tamponade for haemostasis.Higher success rate at stop
35、ping nosebleeds.唯一的具有促血小板聚集加速止血的产品，促内皮生长，促创面愈合Gentle tamponade compared to Epistat.Much less pain for patient.No risk of tissue necrosis.Remains slippery for several days.舒适湿润防粘连Removal is pain-free. All other products stick and are very uncomfortable to remove.Does not adhere to new clot, much less chance of re-bleed.只用于鼻腔，无用于耳科的止血材料,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,Competition美敦力 纳吸绵等,7/21/2018,35,Nasopore - image: ,Meropack - image: ,For internal use only. Not for distribution in the United States. P/N 46510 Rev. A,
