Quick Reference Guide
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DUPLOSPRAY Quick Reference Guide (laparoscopic procedures) Instructions for Circulating Nurse | DUPLOSPRAY MIS Regulator 1
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Position DUPLOSPRAY System so the foot pedal is placed next to the surgeon’s foot at time of application.
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Attach gas supply hose, located at back of regulator, to source of medical grade CO2.
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Attach spray set to regulator. Connect the blue vent line filter to the blue female luer and the clear gas line filter to the male luer on the regulator.
While depressing foot pedal, adjust gas flow rate to 1.0-2.0 litres per minute. Check gas flow by noting height of ball in flow gauge while stepping on foot pedal.
Instructions for Scrub Nurse | DUPLOSPRAY MIS Applicator 1
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Thread sterile replaceable tip onto applicator using tip alignment tool.
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Firmly attach the applicator to the nozzles of the double syringe.
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Fasten the pull strap to the double syringe holder to assure the spray applicator is tightly secured.
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Attach gas supply line (clear luer connector) to sterile applicator. Turn white locking collar to secure connection.
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Pass assembled double syringe and spray applicator to surgeon for spray application.
Attach patient vent line (red luer connector) to available female luer on trocar vent valve. Ensure vent valve is fully open.
Instructions for Surgeon 1
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The use of TISSEEL Fibrin Sealant is restricted to experienced surgeons who have been trained in the use of TISSEEL. In order to ensure optimal safe use of TISSEEL by spray application, apply a minimum spray distance of 2 cm and a maximum spray pressure of 1.5 bar to minimise the potential risk of air or gas embolism, tissue rupture, or air or gas entrapment with compression.
TIPS • The patient vent line attached to the trocar cannula vent valve will only vent gas out when foot pedal is depressed. After connection to trocar cannula, ensure vent valve is fully open on trocar cannula prior to spray application. Confirm actual flow of max 2 litres/min with theatre personnel.
Depress foot pedal to start gas flow prior to applying TISSEEL Fibrin Sealant. Check gas flow gauge on regulator before inserting applicator. If flow level ball does not move when foot pedal is depressed, the applicator tip is occluded and should be replaced.
While activating foot pedal dispense TISSEEL Fibrin Sealant through applicator tip by depressing double syringe plungers using very slow, steady pressure. To stop spray delivery release pressure on plungers while maintaining gas flow by holding down foot pedal for an additional 3-5 seconds to clear applicator tip.
• If tip becomes occluded during use, remove plugged tip by unscrewing it counterclockwise. Using a sterile cloth, wipe any clotted material off exposed tube ends. Screw on new tip and tighten with finger pressure. • The twin-tube assembly can be easily separated as necessary to allow freedom of movement. Please see the TISSEEL SmPC provided together with this material.
duploSPRAY Quick Reference Guide CAUTION BOX Any application of pressurised gas may be associated with a potential risk of air or gas embolism, tissue rupture or air or gas entrapment with compression, which may be life threatening if the product is sprayed incorrectly Precautions For TISSEEL Fibrin Sealant • Spray application should only be used if it is possible to accurately judge the spray distance as recommended by the manufacturer. Do not spray closer than the recommended distances. • Prior to applying sprayable Fibrin solutions for sealant, the surface area of the wound should only be dried using standard techniques (eg, intermittent application of compresses, swabs, use of suction devices). • Blood pressure, pulse rate, oxygen saturation and end tidal CO2 should be monitored closely when spraying Fibrin solutions for sealant using a pressure regulator device, because of the possibility of occurrence of air or gas embolism. • Regulators should be used in line with manufacturer recommendations and the SmPC and Instruction for Use. • In laparoscopic procedures: Use CO2 only when using spray application. When applying the product as a spray using a CO2 pressure regulator device, the maximum pressure should be 1.5 bar (22 psi). The product should be sprayed at a distance at least 2cm (recommended range 2-5cm) from the tissue surface.
In order to ensure optimal safe use of TISSEEL by spray application the following recommendations should be followed: Recommended pressure, distance and devices for spray application of TISSEEL Surgery
Spray set to be used
Applicator tips to be used Duplospray MIS Applicator 20cm
Laparoscopic/ minimally invasive procedures
Duplospray MIS Applicator 30cm n.a. Duplospray MIS Applicator 40cm Replaceable tip
Pressure regulator to be used
Recommended distance from target tissue
Recommended spray pressure
2 – 5 cm
1.2-1.5 bar (18-22 psi)
Duplospray MIS Regulator Duplospray MIS Regulator NIST B11 Duplospray MIS Regulator Duplospray MIS Regulator NIST B11 Duplospray MIS Regulator Duplospray MIS Regulator NIST B11 Duplospray MIS Regulator Duplospray MIS Regulator NIST B11
When spraying the TISSEEL, changes in blood pressure, pulse, oxygen saturation and end tidal CO2 should be monitored because of the possibility of occurrence of air or gas embolism.
Connect to regulated CO2 gas source only; maximum input pressure not to exceed 100 psi. To avoid possible air or gas embolism, do not directly spray into circulatory pathways.
PRESCRIBING INFORMATION - TISSEEL Lyo Two-Component Fibrin Sealant Ready to use Solutions for Sealant (Please consult the Summary of Product Characteristics before prescribing) Name and composition: TISSEEL Lyo - powders and solvents for fibrin sealant. 1) Sealer protein concentrate; after reconstitution 1 ml contains 96-125 mg total protein of which 72-110 mg is fibrinogen; 2) Aprotinin Solution, 3000 KIU per ml; 3) Thrombin Powder, 1 ml contains 500 IU of Thrombin in 45-55 mg total protein; 4) Calcium chloride solution, 40μmol per ml. TISSEEL Ready to use – prefilled double chamber syringe containing Sealer Protein Solution (with aprotinin) deep frozen in one chamber and Thrombin Solution (with Calcium Chloride) deep frozen in the other chamber. Sealer Protein Solution contains 91mg/ml human fibrinogen (clottable protein) and 3000 KIU/ml aprotinin. Thrombin Solution contains 500 IU/ml human thrombin and 40μmol per ml calcium chloride. Presentations of 1, 2 or 5ml in each chamber resulting in total volume of 2ml, 4ml or 10ml of sealant. Indications: Supportive treatment where standard surgical techniques are insufficient, for improvement of haemostasis, as a tissue glue to promote adhesion, sealing or as suture support, in gastrointestinal anastomoses, in neurosurgery where contact with cerebrospinal fluid or dura mater may occur and for mesh fixation in hernia repair, as an alternative or adjunct to sutures or staples. Dosage and Route: The use of TISSEEL is restricted to experienced surgeons who have been trained in the use of TISSEEL. A thin layer is applied to the tissue surface where required. Dose depends on the indication, application method and number of applications. As a guideline for the gluing of surfaces, 1 pack of TISSEEL 2 ml (i.e. 1 ml Sealer Protein Solution plus 1 ml Thrombin Solution) will be sufficient for an area of at least 10 cm2. Apply topically – tissue surface should be as dry as possible before application. Application can be repeated if necessary. Apply by drops or spray as needed depending on indication. Side effects: See Summary of Product Characteristics for detail. Hypersensitivity / anaphylactic / anaphylactoid reactions may occur, especially in patients who have previously received aprotinin. Early symptoms of allergic reactions include flushing, urticaria, pruritus, nausea, hypotension, tachycardia or bradycardia, bronchospasm, tightness in chest and dsypnoea. Do not inject – risk of thromboembolic complications. Precautions: Apply with care in coronary artery bypass surgery due to increased risk of inadvertent intravascular application. TISSEEL and/or Thrombin Solution should only be applied topically. When spraying TISSEEL, changes in blood pressure, pulse, oxygen saturation and end tidal CO2 should be monitored because of the possibility of occurrence of air or gas embolism. Air or gas embolism, tissue rupture, or gas entrapment with compression, which may be life-threatening, have occurred with the use of spray devices employing a pressure regulator to administer fibrin sealant. These events appear to be related to the use of the spray device at higher than recommended pressures and in close proximity to the tissue surface. When applying by spray, follow the instructions provided with the spray device, with particular reference to gas pressure and distance from the tissue surface. Use with caution in patients with prior exposure to aprotinin. Caution in patients with bovine protein allergies. Infectious diseases due to the transmission of infective agents cannot be totally excluded. Use of Tisseel and batch number should be recorded in patient’s notes. Excessive clot thickness may negatively interfere with product efficacy and the healing process. Contraindications: Do not apply intravascularly. Hypersensitivity to active substances or other components. Not for the treatment of active or spurting arterial or venous bleeding. Interactions: Avoid solutions containing alcohol, iodine and heavy metals. Overdose: Not reported. Legal category: POM Basic NHS price: TISSEEL Lyo 2 ml kit - £83.46; 4 ml kit - £166.92; 10 ml kit - £379.85. TISSEEL Ready to use 2ml - £97.50; 4ml - £195; 10ml - £443.75. Marketing Authorisation Number and Holder: TISSEEL Lyo - PL 00116/0321. TISSEEL Ready to use - PL 00116/0627 Baxter Healthcare Limited, Caxton Way, Thetford, Norfolk IP24 3SE Date of preparation: March 2013
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov. uk/yellowcard.Any adverse events relating to Baxter products can also be reported direct to Baxter Pharmacovigilance on 01635 206360, or by email to [email protected]
Caution: Any application of pressurised gas may be associated with a potential risk of air or gas embolism, tissue rupture or air or gas entrapment with compression, which may be life threatening. Be sure to take appropriate measures to address these risks by observing the recommended minimum spraying distance of 2cm (optimal working distance 3cm) and the maximal flow rate of 2.0 standard litres per minute.
Baxter Healthcare Ltd Wallingford Road, Compton Newbury, RG20 7QW Surecall Tel: +44 (0) 1635 206345 Surecall Fax: +44 (0) 1635 206071 Email: [email protected]
For detailed information please contact your local representative In some countries TISSEEL Fibrin Sealant is licensed under the trademark of TISSUCOL Fibrin Sealant. Baxter, Tisseel, Tissucol, and Duplospray are trademarks of Baxter International Inc., its subsidiaries or affiliates.. UK/MG24/13-0003f September 2013