《鼻腔止血材料cam》

Nasalandsinusdressings鼻腔及鼻窦止血材料Forinternaluseonly.NotfordistributionintheUnitedStatesInternaltrainingmaterialDisclaimer免责声明4/8/20232Theinformationpresentedissolelyfortrainingpurposes.

Itisnotintendedfordistributiontocustomers,surgeons,oruserfacilities.

PromotionofArthroCareproductsistobeon-labelandconsistentwithapprovedindicationsandintendeduses.

Theinformationinthispresentationisconsideredproprietaryandisnottobecopiedordistributed.Someoftheinformationpresentedhereinissolelytheopinionofthepresenter,andisnotnecessarilysharedbyArthroCareCorporation.编辑pptOverview4/8/20233Anatomy解剖Pathology病理ArthroCareproducts产品ArthroCareprocedures手术Competition竞争编辑pptAnatomy解剖Forinternaluseonly.NotfordistributionintheUnitedStatesNasalandsinusdressingsAnatomy-noseimage:P/N30547BOpeningtoeachnostrilisthe

nares.鼻孔Theseptum

istheboneandcartilagestructurethatdividesthenoseintotwochambers.鼻中隔Lateralwalliscomprisedofthreeconchasorturbinates.Inferior,middle

andsuperiorturbinate.上、中、下鼻甲4/8/20235Nares编辑pptAnatomy–Kiesselbach’splexus克氏血管丛image:P/NEX003114/8/20236Kiesselbach’splexusisaregionintheantero-inferiorpartofthenasalseptum鼻中隔前下黎氏区克氏血管丛Mostanteriornosebleedsoriginatefromthisarea.前鼻腔的出血多发源于此编辑pptAnatomy–sinuses4/8/20237Sinusesarebony,air-filledspaceswithinthenasalcavity.Theethmoidalsinusisthecentralbonylabyrinththatallothersinusesdraininto.Theostiumisthenaturalopeningtoeachsinus.

窦口Accesstothesinusesismadethroughthespacelateraltothemiddleturbinate.image:编辑ppt蝶窦筛窦上颌窦额窦PathologyForinternaluseonly.NotfordistributionintheUnitedStatesNasalandsinusdressingsPathology4/8/20239Nasalandsinusdressingsareamongothersusedafter:止血材料用于Nasalsurgery鼻腔手术Sinussurgery鼻窦手术Epistaxis鼻衄主要靠“压迫”止血编辑pptNasalsurgery4/8/202310Septoplasty/rhinoplasty鼻中隔成形术/鼻成形术StraightentheseptuminordertoRestoreproperbreathing.气道修复Cosmeticpurposes.美容Inferiorormiddleturbinatereduction下/中鼻甲减容Forbetterairflow.Nasalpolypremoval鼻息肉切除Polypsareveryvascularandbleedingcanbedifficulttocontrol.编辑pptSinussurgery4/8/202311FESS–functionalendoscopicsinussurgery

功能性鼻窦内镜手术BlockageswithinthesinusanatomythatpreventproperdrainageProcedureattemptedtosurgicallyopenblockagestoallowproperdrainage.Polypsarecommonlyoriginatingfromsinuscavities.编辑pptEpistaxis鼻衄

4/8/202312AnteriorepistaxisAccountsfor90%ofallnosebleeds.Kiesselbach’splexuslocatedontheanteriorseptalmucosa.Usuallylessseriousforthepatient.通常出血不凶PosteriorepistaxisOriginatesviabranchesofthesphenopalatineartery.Oftenlifethreateningforthepatient.凶——甚至危及生命编辑pptArthroCare产品Forinternaluseonly.NotfordistributionintheUnitedStatesNasalandsinusdressingsArthroCareproductsKnittedCMC(nonylon–dissolvable)（非尼龙—可分解-非取出）Sinu-Knit™(invertedmultilayerofCMC)RR600StammbergerSinu-Foam™RR650KnittedCMCreinforcedwithnylon(removable)(尼龙—取出）Gel-Knit™RapidRhino™epistaxispacks4/8/202314编辑pptCMC（羧甲基纤维素钠）technologyCarboxymethylcellulose(CMC)isthebasisofallourRapidRhinoproducts.Verycommonmaterialusedinvariedapplicationssuchasfoodadditive,cosmetics,eyedrops,toothpaste,pharmaceuticals,…食品添加剂，药物，牙膏等Commonlyasapowder.Odorlessandflavorless无色无味Soluble可溶Advantages:优点Easyremoval易放入和取出Staysmoistforseveraldaysallowingeasy,pain-freeremoval.数天内保持湿润舒适度高Providesamoistbarrier湿性屏障防粘连Separatedanatomypreventingadhesionsfromforming.BleedcontrolControlsoozingandminorbleedings.减少渗血4/8/202315编辑pptCMC（羧甲基纤维素钠）characteristicsGel-likesurfaceallowsforeasyinsertionandremovalofdressings.胶状物易放入和取出Providesamoistbarrier.湿性屏障防粘连Conformstothenasalanatomy.解剖顺应性Dissolvable.可分解NeutralpH(lowpHcausesinflammation/burningsensation).中性pHHydrocolloid:asubstancethatturnstogelwithwater.遇水成胶CMCcancarryupto20timesitsownweightofwater.吸收承载20倍的水4/8/202316编辑pptSinu-KnitandStammbergerSinu-FoamDissolvingCMC.可分解Usedinoperatingroom(post-op).用于术后渗血Donotneedtoberemoved.Last7-10days.可放置7~10天4/8/202317StammbergerSinu-FoamRR650Sinu-KnitRR600编辑pptHowtouseStammbergerSinu-Foam?Drawsterilewateruptotheblackline(ca.8cc)ofthesmallsyringe.Screwandconnectthetwosyringestogether.4/8/202318编辑pptGel-KnitFoamwrappedinCMCwithnylon.带尼龙的CMCUsedinemergencyandoperatingroom.急诊室和手术室Needtoberemovedafter2-3days.2~3天后取出Availableindifferentsizes.不同大小4/8/202319Riemann3and4cmRR300andRR400Goodman5.5cmRR500Mannheim8.0cmRR800SinussurgerySeptoplasty/Rhinoplasty编辑pptEpistaxistamponades鼻衄的鼻腔填塞InflationballoonswrappedinCMCwithnylon

带尼龙的CMM包裹气囊.Usedinemergencyroom.常用在急症室Needtoberemovedafter2-3days.需2~3天后取出Availableindifferentmodelsandsizes.不同型号和大小4/8/202320InflationcatheterButterflyswallowguardInflationvalvePilotcuff7.5cmw/airway编辑pptRapidRhinoproductsforepistaxisRR450 4,5cmforpaediatric/smallanatomy.儿童RR550 5,5cmisthestandardanteriorsize.标准RR551 5,5cmwithairway带通气管RR750 7,5cmisusedforposteriorbleeds.

后鼻道出血RR752 7,5cm双气囊RR900 9,0cmforposteriorepistaxis.无证4/8/202321编辑pptRR的使用Forinternaluseonly.NotfordistributionintheUnitedStatesNasalandsinusdressingsHowtouseRapidRhinonasaltamponade?4/8/202323ButterflyswallowguardInflationvalvePilotcuffInflationcatheterBlueindicatorring编辑ppt使用录像11.Soak60secondsinsterilewater浸泡

无菌注射用水中浸泡60秒4/8/202324Removetheblueplasticsheath.SoaktheRapidRhinoinsterilewaterfor60secondstoconvertthehydrocolloidfabrictoaself-lubricatingsurface.DONOTusesalineorANYtopicalointmentsasmayinhibittheeffectivenessoftheCMCfabric.不能用生理盐水，会抑制CMC效应编辑pptHowtouseRapidRhinonasaltamponade?2.Insertion放入4/8/202325InserttheRapidRhinointothenasalcavityalongtheseptalfloorandparalleltothehardpalateuntiltheblueindicatorringiswellwithinthenares.沿鼻中隔面平行硬腭放入鼻腔编辑ppt3.Inflate充气4/8/202326Usinga20ccsyringe,inflatethedevicewithAIRonly.Monitorthepilotcufffordirecttactilefeedback.指示气囊触觉反馈Stopinflationwhenthepilotcuffbecomesroundedandfeelsfirmwhensqueezed.Similartothewaythepilotcufffeelswhenanendotrachealtubeisinflated.指压指示气囊鼓胀较硬时停止充气MaximumInflationVolumes不同型号最大充气量

4.5cm25cc5.5cm30cc7.5cm40cc编辑ppt4.Cuffconformstothepatientanatomy4/8/202327Asthecuffinflatesitconformstothepatient’suniqueanatomytherebyprovidingagentle,lowpressuretamponadethatdeliverstheCMCfabricdirectlytothebleedsite.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Theamountofairisdeterminedbythesizeofthenasalanatomy.据鼻腔大小差异调节充气量编辑pptHowtouseStammbergerSinu-Foam?Drawsterilewateruptotheblackline(ca.7~8cc)ofthesmallsyringe.7~8毫升无菌注射水溶解RR650Screwandconnectthetwosyringestogether.4/8/202328编辑ppt使用录像2CompetitionForinternaluseonly.NotfordistributionintheUnitedStatesNasalandsinusdressingsCompetition–topremovablenasaldressings4/8/202330Ribbongauzepacking凡士林砂条Merocel(Medtronic/Xomed)美敦力膨胀海绵Epistatballoon(Medtronic/Xomed)硅胶球囊编辑pptCompetition–ribbongauzepacking凡士林砂条填塞4/8/202331Patientispackedwithupto180cmofVaseline-coated1,25cmwideribbongauze.ENTdoctorswilllayeritfrombottomtotopinsidetheanteriornasalcavitytofillthenasalc