Nasalandsinusdressings鼻腔及鼻竇止血材料Forinternaluseonly.NotfordistributionintheUnitedStatesInternaltrainingmaterialDisclaimer免責聲明4/8/20232Theinformationpresentedissolelyfortrainingpurposes.

Itisnotintendedfordistributiontocustomers,surgeons,oruserfacilities.

PromotionofArthroCareproductsistobeon-labelandconsistentwithapprovedindicationsandintendeduses.

Theinformationinthispresentationisconsideredproprietaryandisnottobecopiedordistributed.Someoftheinformationpresentedhereinissolelytheopinionofthepresenter,andisnotnecessarilysharedbyArthroCareCorporation.編輯pptOverview4/8/20233Anatomy解剖Pathology病理ArthroCareproducts產品ArthroCareprocedures手術Competition競爭編輯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編輯pptAnatomy–Kiesselbach’splexus克氏血管叢image:P/NEX003114/8/20236Kiesselbach’splexusisaregionintheantero-inferiorpartofthenasalseptum鼻中隔前下黎氏區克氏血管叢Mostanteriornosebleedsoriginatefromthisarea.前鼻腔的出血多發源于此編輯pptAnatomy–sinuses4/8/20237Sinusesarebony,air-filledspaceswithinthenasalcavity.Theethmoidalsinusisthecentralbonylabyrinththatallothersinusesdraininto.Theostiumisthenaturalopeningtoeachsinus.

竇口Accesstothesinusesismadethroughthespacelateraltothemiddleturbinate.image:編輯ppt蝶竇篩竇上頜竇額竇PathologyForinternaluseonly.NotfordistributionintheUnitedStatesNasalandsinusdressingsPathology4/8/20239Nasalandsinusdressingsareamongothersusedafter:止血材料用于Nasalsurgery鼻腔手術Sinussurgery鼻竇手術Epistaxis鼻衄主要靠“壓迫”止血編輯pptNasalsurgery4/8/202310Septoplasty/rhinoplasty鼻中隔成形術/鼻成形術StraightentheseptuminordertoRestoreproperbreathing.氣道修復Cosmeticpurposes.美容Inferiorormiddleturbinatereduction下/中鼻甲減容Forbetterairflow.Nasalpolypremoval鼻息肉切除Polypsareveryvascularandbleedingcanbedifficulttocontrol.編輯pptSinussurgery4/8/202311FESS–functionalendoscopicsinussurgery

功能性鼻竇內鏡手術BlockageswithinthesinusanatomythatpreventproperdrainageProcedureattemptedtosurgicallyopenblockagestoallowproperdrainage.Polypsarecommonlyoriginatingfromsinuscavities.編輯pptEpistaxis鼻衄

4/8/202312AnteriorepistaxisAccountsfor90%ofallnosebleeds.Kiesselbach’splexuslocatedontheanteriorseptalmucosa.Usuallylessseriousforthepatient.通常出血不兇PosteriorepistaxisOriginatesviabranchesofthesphenopalatineartery.Oftenlifethreateningforthepatient.兇——甚至危及生命編輯pptArthroCare產品Forinternaluseonly.NotfordistributionintheUnitedStatesNasalandsinusdressingsArthroCareproductsKnittedCMC(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?epistaxispacks4/8/202314編輯pptCMC（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:優點Easyremoval易放入和取出Staysmoistforseveraldaysallowingeasy,pain-freeremoval.數天內保持濕潤舒適度高Providesamoistbarrier濕性屏障防粘連Separatedanatomypreventingadhesionsfromforming.BleedcontrolControlsoozingandminorbleedings.減少滲血4/8/202315編輯pptCMC（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4/8/202316編輯pptSinu-KnitandStammbergerSinu-FoamDissolvingCMC.可分解Usedinoperatingroom(post-op).用于術后滲血Donotneedtoberemoved.Last7-10days.可放置7~10天4/8/202317StammbergerSinu-FoamRR650Sinu-KnitRR600編輯pptHowtouseStammbergerSinu-Foam?Drawsterilewateruptotheblackline(ca.8cc)ofthesmallsyringe.Screwandconnectthetwosyringestogether.4/8/202318編輯pptGel-KnitFoamwrappedinCMCwithnylon.帶尼龍的CMCUsedinemergencyandoperatingroom.急診室和手術室Needtoberemovedafter2-3days.2~3天后取出Availableindifferentsizes.不同大小4/8/202319Riemann3and4cmRR300andRR400Goodman5.5cmRR500Mannheim8.0cmRR800SinussurgerySeptoplasty/Rhinoplasty編輯pptEpistaxistamponades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.不同型號和大小4/8/202320InflationcatheterButterflyswallowguardInflationvalvePilotcuff7.5cmw/airway編輯pptRapidRhinoproductsforepistaxisRR450 4,5cmforpaediatric/smallanatomy.兒童RR550 5,5cmisthestandardanteriorsize.標準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4/8/202321編輯pptRR的使用Forinternaluseonly.NotfordistributionintheUnitedStatesNasalandsinusdressingsHowtouseRapidRhinonasaltamponade?4/8/202323ButterflyswallowguardInflationvalvePilotcuffInflationcatheterBlueindicatorring編輯ppt使用錄像11.Soak60secondsinsterilewater浸泡

無菌注射用水中浸泡60秒4/8/202324Removetheblueplasticsheath.SoaktheRapidRhinoinsterilewaterfor60secondstoconvertthehydrocolloidfabrictoaself-lubricatingsurface.DONOTusesalineorANYtopicalointmentsasmayinhibittheeffectivenessoftheCMCfabric.不能用生理鹽水，會抑制CMC效應編輯pptHowtouseRapidRhinonasaltamponade?2.Insertion放入4/8/202325InserttheRapidRhinointothenasalcavityalongtheseptalfloorandparalleltothehardpalateuntiltheblueindicatorringiswellwithinthenares.沿鼻中隔面平行硬腭放入鼻腔編輯ppt3.Inflate充氣4/8/202326Usinga20ccsyringe,inflatethedevicewithAIRonly.Monitorthepilotcufffordirecttactilefeedback.指示氣囊觸覺反饋Stopinflationwhenthepilotcuffbecomesroundedandfeelsfirmwhensqueezed.Similartothewaythepilotcufffeelswhenanendotrachealtubeisinflated.指壓指示氣囊鼓脹較硬時停止充氣MaximumInflationVolumes不同型號最大充氣量

4.5cm25cc5.5cm30cc7.5cm40cc編輯ppt4.Cuffconformstothepatientanatomy4/8/202327Asthecuffinflatesitconformstothepatient’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.據鼻腔大小差異調節充氣量編輯pptHowtouseStammbergerSinu-Foam?Drawsterilewateruptotheblackline(ca.7~8cc)ofthesmallsyringe.7~8毫升無菌注射水溶解RR650Screwandconnectthetwosyringestogether.4/8/202328編輯ppt使用錄像2CompetitionForinternaluseonly.NotfordistributionintheUnitedStatesNasalandsinusdressingsCompetition–topremovablenasaldressings4/8/202330Ribbongauzepacking凡士林砂條Merocel(Medtronic/Xomed)美敦力膨脹海綿Epistatballoon(Medtronic/Xomed)硅膠球囊編輯pptCompetition–ribbongauzepacking凡士林砂條填塞4/8/202331Patientispackedwithupto180cmofVaseline-coated1,25cmwideribbongauze.ENTdoctorswilllayeritfrombottomtotopinsidetheanteriornasalcavitytofillthenasalc