鼻腔止血材料 CAMP課件

Nasalandsinusdressings鼻腔及鼻竇止血材料Forinternaluseonly.NotfordistributionintheUnitedStatesInternaltrainingmaterialDisclaimer免責(zé)聲明Theinformationpresentedissolelyfortrainingpurposes.

Itisnotintendedfordistributiontocustomers,surgeons,oruserfacilities.

PromotionofArthroCareproductsistobeon-labelandconsistentwithapprovedindicationsandintendeduses.

Theinformationinthispresentationisconsideredproprietaryandisnottobecopiedordistributed.Someoftheinformationpresentedhereinissolelytheopinionofthepresenter,andisnotnecessarilysharedbyArthroCareCorporation.11/8/20222Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.AOverviewAnatomy解剖Pathology病理ArthroCareproducts產(chǎn)品ArthroCareprocedures手術(shù)Competition競爭11/8/20223Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.AAnatomy-noseimage:P/N30547BOpeningtoeachnostrilisthe

nares.鼻孔Theseptum

istheboneandcartilagestructurethatdividesthenoseintotwochambers.鼻中隔Lateralwalliscomprisedofthreeconchasorturbinates.Inferior,middle

andsuperiorturbinate.上、中、下鼻甲Nares11/8/20225Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.AAnatomy–Kiesselbach’splexus克氏血管叢image:P/NEX00311Kiesselbach’splexusisaregionintheantero-inferiorpartofthenasalseptum鼻中隔前下黎氏區(qū)克氏血管叢Mostanteriornosebleedsoriginatefromthisarea.前鼻腔的出血多發(fā)源于此11/8/20226Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.AAnatomy–sinusesSinusesarebony,air-filledspaceswithinthenasalcavity.Theethmoidalsinusisthecentralbonylabyrinththatallothersinusesdraininto.Theostiumisthenaturalopeningtoeachsinus.

竇口Accesstothesinusesismadethroughthespacelateraltothemiddleturbinate.image:蝶竇篩竇上頜竇額竇11/8/20227Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.APathologyForinternaluseonly.NotfordistributionintheUnitedStatesNasalandsinusdressingsNasalsurgerySeptoplasty/rhinoplasty鼻中隔成形術(shù)/鼻成形術(shù)StraightentheseptuminordertoRestoreproperbreathing.氣道修復(fù)Cosmeticpurposes.美容Inferiorormiddleturbinatereduction下/中鼻甲減容Forbetterairflow.Nasalpolypremoval鼻息肉切除Polypsareveryvascularandbleedingcanbedifficulttocontrol.11/8/202210Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.AEpistaxis鼻衄

AnteriorepistaxisAccountsfor90%ofallnosebleeds.Kiesselbach’splexuslocatedontheanteriorseptalmucosa.Usuallylessseriousforthepatient.通常出血不兇PosteriorepistaxisOriginatesviabranchesofthesphenopalatineartery.Oftenlifethreateningforthepatient.兇——甚至危及生命11/8/202212Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.AArthroCareproductsKnittedCMC(nonylon–dissolvable)（非尼龍—可分解-非取出）Sinu-Knit?(invertedmultilayerofCMC)RR600StammbergerSinu-Foam?RR650KnittedCMCreinforcedwithnylon(removable)(尼龍—取出）Gel-Knit?RapidRhino?epistaxispacks11/8/202214Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.ACMC（羧甲基纖維素鈉）technologyCarboxymethylcellulose(CMC)isthebasisofallourRapidRhinoproducts.Verycommonmaterialusedinvariedapplicationssuchasfoodadditive,cosmetics,eyedrops,toothpaste,pharmaceuticals,…食品添加劑，藥物，牙膏等Commonlyasapowder.Odorlessandflavorless無色無味Soluble可溶Advantages:優(yōu)點(diǎn)Easyremoval易放入和取出Staysmoistforseveraldaysallowingeasy,pain-freeremoval.數(shù)天內(nèi)保持濕潤舒適度高Providesamoistbarrier濕性屏障防粘連Separatedanatomypreventingadhesionsfromforming.BleedcontrolControlsoozingandminorbleedings.減少滲血11/8/202215Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.ACMC（羧甲基纖維素鈉）characteristicsGel-likesurfaceallowsforeasyinsertionandremovalofdressings.膠狀物易放入和取出Providesamoistbarrier.濕性屏障防粘連Conformstothenasalanatomy.解剖順應(yīng)性Dissolvable.可分解NeutralpH(lowpHcausesinflammation/burningsensation).中性pHHydrocolloid:asubstancethatturnstogelwithwater.遇水成膠CMCcancarryupto20timesitsownweightofwater.吸收承載20倍的水11/8/202216Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.ASinu-KnitandStammbergerSinu-FoamDissolvingCMC.可分解Usedinoperatingroom(post-op).用于術(shù)后滲血Donotneedtoberemoved.Last7-10days.可放置7~10天StammbergerSinu-FoamRR650Sinu-KnitRR60011/8/202217Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.AHowtouseStammbergerSinu-Foam?Drawsterilewateruptotheblackline(ca.8cc)ofthesmallsyringe.Screwandconnectthetwosyringestogether.11/8/202218Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.AEpistaxistamponades鼻衄的鼻腔填塞InflationballoonswrappedinCMCwithnylon

帶尼龍的CMM包裹氣囊.Usedinemergencyroom.常用在急癥室Needtoberemovedafter2-3days.需2~3天后取出Availableindifferentmodelsandsizes.不同型號(hào)和大小InflationcatheterButterflyswallowguardInflationvalvePilotcuff7.5cmw/airway11/8/202220Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.ARapidRhinoproductsforepistaxisRR450 4,5cmforpaediatric/smallanatomy.兒童RR550 5,5cmisthestandardanteriorsize.標(biāo)準(zhǔn)RR551 5,5cmwithairway帶通氣管RR750 7,5cmisusedforposteriorbleeds.

后鼻道出血RR752 7,5cm雙氣囊RR900 9,0cmforposteriorepistaxis.無證11/8/202221Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.AHowtouseRapidRhinonasaltamponade?ButterflyswallowguardInflationvalvePilotcuffInflationcatheterBlueindicatorring使用錄像111/8/202223Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.A1.Soak60secondsinsterilewater浸泡

無菌注射用水中浸泡60秒Removetheblueplasticsheath.SoaktheRapidRhinoinsterilewaterfor60secondstoconvertthehydrocolloidfabrictoaself-lubricatingsurface.DONOTusesalineorANYtopicalointmentsasmayinhibittheeffectivenessoftheCMCfabric.不能用生理鹽水，會(huì)抑制CMC效應(yīng)HowtouseRapidRhinonasaltamponade?11/8/202224Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.A3.Inflate充氣Usinga20ccsyringe,inflatethedevicewithAIRonly.Monitorthepilotcufffordirecttactilefeedback.指示氣囊觸覺反饋Stopinflationwhenthepilotcuffbecomesroundedandfeelsfirmwhensqueezed.Similartothewaythepilotcufffeelswhenanendotrachealtubeisinflated.指壓指示氣囊鼓脹較硬時(shí)停止充氣MaximumInflationVolumes不同型號(hào)最大充氣量

4.5cm25cc5.5cm30cc7.5cm40cc11/8/202226Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.A4.CuffconformstothepatientanatomyAsthecuffinflatesitconformstothepatient’suniqueanatomytherebyprovidingagentle,lowpressuretamponadethatdeliverstheCMCfabricdirectlytothebleedsite.指示氣囊充盈，較低壓力下降外層CMC擠壓入出血部位，貼合不同解

剖形狀的鼻腔Theamountofairisdeterminedbythesizeofthenasalanatomy.據(jù)鼻腔大小差異調(diào)節(jié)充氣量11/8/202227Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.AHowtouseStammbergerSinu-Foam?Drawsterilewateruptotheblackline(ca.7~8cc)ofthesmallsyringe.7~8毫升無菌注射水溶解RR650Screwandconnectthetwosyringestogether.使用錄像211/8/202228Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.ACompetition–topremovablenasaldressingsRibbongauzepacking凡士林砂條Merocel(Medtronic/Xomed)美敦力膨脹海綿Epistatballoon(Medtronic/Xomed)硅膠球囊11/8/202230Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.ACompetition–ribbongauzepacking凡士林砂條填塞Patientispackedwithupto180cmofVaseline-coated1,25cmwideribbongauze.ENTdoctorswilllayeritfrombottomtotopinsidetheanteriornasalcavitytofillthenasalcavity.Thiswastheonlywaytopack20yearsago.Lessoftenusednowadays.11/8/202231Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.ACompetition–Merocel(Medtronic/Xomed)膨脹海綿鼻腔填塞Addpicsimage:11/8/202232Forinternaluseonly.NotfordistributionintheUnitedStates.P/N46510Rev.ACompetition