旋磨操作介绍.pptx

1Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 旋磨操作介绍 2Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 公司简介 公司总部设在美国马萨诸塞 州波士顿地区的内提克市 全球共有约24,000名员工 业务遍及全球各个国家 作为全球医疗技术行业创新 领导者，波士顿科学每年研 发投入资金达8.86亿美金 在世界范围内拥有超过 15,000项授权专利 波士顿科学公司 Boston Scientific 3Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 介绍内容 设备连接 操作技巧 “鸡尾酒”配方 经压力表输出到主机的压力保持在90-110 PSI /620.55kPa - 758.45kPa B.连接DyanaglideTM 脚踏开关软管 绿管和蓝管接在主机背板上， 粉色管接在主机前面板上 C.主机接通电源打开开关 D.连接推进器光纤接头 E.连接推进器空气管 F.将推进器盐水输入管和生理盐水袋连接并加压 6Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 旋磨导管和推进器连接 Prior to use, please see the complete Directions For Use for more information on Indications, Contraindications, Warnings, Precautions, Adverse Events and Operators Instructions. 旋磨导管和推进器连接好以后 再移除磨头保护套 7Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 系统测试（体外） 测试脚踏开关对系统的控制 调整磨头的转速 磨头尺寸 1.25-2.0 mm 2.15-2.5 mm 理想的转速 160,000 - 180,000 转/分 150,000 - 170,000 转/分 注意: 避免磨头接触毛巾，纱布，手套等 8Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally D.R.A.W. 体外测试 Drip 盐水有无从推进器和磨头出滴出* Rotate 磨头旋转且转速稳定* Advancer 推进器把手可以自由移动 Wire 推进器尾部导丝可见，磨头旋转时导丝无法移动 Prior to use, please see the complete Directions For Use for more information on Indications, Contraindications, Warnings, Precautions, Adverse Events and Operators Instructions. *必须要有盐水注入的条件下才可操作旋磨推进器，用于冷却和润滑推进器。否则会造成推进器损坏 *磨头高速旋转时使用推进器把手轻柔前后移动，不要使磨头保持在一个位置，否则会造成旋磨导丝损耗 9Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 操作技巧 Prior to use, please see the complete Directions For Use for more information on Indications, Contraindications, Warnings, Precautions, Adverse Events and Operators Instructions. 10Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 操作技巧磨头位置 磨头送入导管之前，推进器把手请先固定在滑动槽中间 握住导丝时将磨头送入导管 当磨头接近病变区域近端时，松开推进器把手，慢慢回撤把手，使旋磨 导管在导引导管内逐步伸展，解除前倾力 磨头转速 Small burrs (1.25-2.0mm) 160,000 180,000 rpm Large burrs ( 2.15mm) 140,000 160,000 rpm Prior to use, please see the complete Directions For Use for more information on Indications, Contraindications, Warnings, Precautions, Adverse Events and Operators Instructions. 11Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 操作技巧磨头移动 操作旋磨的时候需要前后来回移动磨 头，建议距离3cm，遇到轻微阻力时可 以再往前送 每次磨的时间不要超过30秒 整个旋磨手术操作时间不超过5分钟 根据需要选择磨头，磨头尺寸逐步增 加 .25mm 递增. Prior to use, please see the complete Directions For Use for more information on Indications, Contraindications, Warnings, Precautions, Adverse Events and Operators Instructions. 重要提示！ 磨头旋转时候必须前后移动 高速旋转时磨头固定在一处，会造成导丝损坏 12Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 操作技巧操作提示 Prior to use, please see the complete Directions For Use for more information on Indications, Contraindications, Warnings, Precautions, Adverse Events and Operators Instructions. Y阀不宜拧的太紧，避免造成磨头导管挤压损 坏 磨头停止旋转时，不能停留在病变区域内 或病变区域远端 旋磨消融时候不能调节转速 磨头不要和旋磨导丝的弹簧头端接触， 防止导丝损坏或磨头卡住 磨头高速旋转时不宜停留在一处 磨头高速旋转时，前后移动动作轻柔 在导管内避免旋转磨头 13Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally “鸡尾酒”配方&常见问题 14Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally “鸡尾酒”配方 500ml 生理盐水 硝酸甘油 2-4 mg 异博定 5mg 肝素10000u 含”鸡尾酒”成分的盐水袋 应该通过连接管连接到推进器手 柄位置的盐水接口上 在盐水袋上应使用压力袋并保证200mmHg的压力以提供足够速 度的盐水冲洗 15Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 常见问题 导丝上的白色物质：HYSTRENE棕榈油衍生物，用于润滑磨头导管， 不要去除！ 推进器不再工作：检查气瓶内气压和输出气压是否够，若无盐水滴 出，需要更换推进器 Stall Light (失速灯）亮起： 当转速下降到15000转以下，并持续半秒钟以上时，作为安全措施， 系统会自动亮灯 确保磨头没有嵌顿 回撤磨头，再重新送到病变区域近端 确保连接无问题，供气正常，滴液正常 16Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 指引导管&磨头选择策略 17Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 指引导管的选择 建议使用代侧孔的指引导管 同轴性要好 确信指引导管能容纳最后使用的磨头的尺寸 18Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 指引导管 / 磨头兼容性 * an .004” clearance is recommended 19Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 磨头尺寸选择策略 保守的磨头选择： 小或分叉病变 角度大于60 度 高度钙化 全闭塞 长病变 (评估斑块的负担) 指引导丝的斜线 20Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 选磨头尺寸策略 确定最后的最大的磨头尺寸: 需消融的最大的斑块的血管直径的70% 到 85% 磨头的直径增加以 0.5mm 为限 与预先最后的最大的直径相比，磨头应最少0.5mm 以下开始 21Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 磨头尺寸 磨头的尺寸受以下几个方面的影响： 血管的尺寸 病变的形态学 远端血管 左心功能 残留血管的状况 考虑患者的全身情况，心功能等. 考虑医生的经验 22Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 旋磨的手法 23Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 顺利的手术者. 24Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 指引导丝的放置 指引导丝应放在病变的远端 指引导丝应放在病变的远端最大的血管 (避免放在小侧支) 如果存在复杂的解剖或没有成功： 用保守的指引导丝和用交换导丝将旋磨导丝交换进去 用交换球囊或 PTCA 球囊为指引导丝做支撑 25Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 指引导丝的放置防范 总是用导丝夹将导丝尾部夹紧 不要操作已经扭曲或打弯的指引导丝 如果指引导丝的弹簧头已经脱垂不要操作 2 5 26Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 消融技巧 27Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 磨头的位置 在保持张力的指引钢丝上平坦的推进磨头 将推进器的球形手柄放在“ 1”的位置并 锁上 28Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 消融技巧 缓慢向前推磨头 维持转速不小于基础转速 5,000 转/分 在病变的近端设定基础转速 磨头尺寸 1.25-2.0 mm 2.15-2.5 mm 理想的转速 160,000 - 180,000 转/分 150,000 - 170,000 转/分 29Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 消融技巧 不正确 正确 30Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 消融技巧 31Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 消融技巧注意事项 Y接头不要拧的太紧 磨头在病变中不要停下来或开始 在消融结束前磨头不要在病变的远端停下来 在消融过程中不要调整转速 3 1 32Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 消融技巧注意事项 不要将磨头推进到指引钢丝的尖端 在磨头高速转动时不要停留在一个位置 在磨头高速转动时前进或后退都需要轻 避免在指引导管内高速转动磨头 33Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 消融时的反馈 34Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 消融时的反馈 目视 在透视的情况下顺利推进 注射造影剂辨别病变及正常的边界 35Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 消融时的反馈 耳听 磨头遇到阻力时系统的声音可以发生改变 36Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally Boston Scientific Confidential - For Internal Use Only. Do Not Copy, Display or Distribute Externally 消融时的反馈 手感： 推进器的按钮阻力或磨头驱动鞘的过分抖动可由以下因素： 磨头的负荷过重 磨头推进太快 相对于血管/病变磨头太大 37Boston Scientific Confidential - For Internal Use