旋磨操作介绍专题宣讲.pptx

1BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally旋磨操作介绍旋磨操作介绍旋磨操作介绍专题宣讲第1页2BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally企业介绍企业总部设在美国马萨诸塞州波士顿地域内提克市全球共有约24,000名员工业务遍布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出15,000项授权专利波士顿科学企业BostonScientific旋磨操作介绍专题宣讲第2页3BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally介绍内容介绍内容设备连接操作技巧“鸡尾酒”配方&常见问题指导导管&磨头选择策略旋磨手法 消融技巧消融时反馈交换过程旋磨操作介绍专题宣讲第3页4BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally设备连接设备连接Priortouse,pleaseseethecompleteDirectionsForUseformoreinformationonIndications,Contraindications,Warnings,Precautions,AdverseEventsandOperatorsInstructions.旋磨操作介绍专题宣讲第4页5BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally系统连接系统连接Priortouse,pleaseseethecompleteDirectionsForUseformoreinformationonIndications,Contraindications,Warnings,Precautions,AdverseEventsandOperatorsInstructions.A.连接供气管和氮气瓶连接供气管和氮气瓶,每台手术确保氮气瓶内压力最少为每台手术确保氮气瓶内压力最少为500 PSI/3447.5 kPa;经压力表输出到主机压力保持在经压力表输出到主机压力保持在90-110 PSI/620.55kPa-758.45kPaB.连接连接DyanaglideTM 脚踏开关软管脚踏开关软管 绿管和蓝管接在主机背板上，绿管和蓝管接在主机背板上，粉色管接在主机前面板上粉色管接在主机前面板上C.主机接通电源打开开关主机接通电源打开开关D.连接推进器光纤接头连接推进器光纤接头E.连接推进器空气管连接推进器空气管F.将推进器盐水输入管和生理盐水袋连接并加压将推进器盐水输入管和生理盐水袋连接并加压旋磨操作介绍专题宣讲第5页6BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally旋磨导管和推进器连接旋磨导管和推进器连接Priortouse,pleaseseethecompleteDirectionsForUseformoreinformationonIndications,Contraindications,Warnings,Precautions,AdverseEventsandOperatorsInstructions.旋磨导管和推进器连接好以后旋磨导管和推进器连接好以后再移除磨头保护套再移除磨头保护套旋磨操作介绍专题宣讲第6页7BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally系统测试（体外）测试脚踏开关对系统控制调整磨头转速磨头尺寸1.25-2.0 mm2.15-2.5 mm 理想转速160,000-180,000 转/分150,000-170,000 转/分注意:防止磨头接触毛巾，纱布，手套等旋磨操作介绍专题宣讲第7页8BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyD.R.A.W.D.R.A.W.体外测试体外测试D Drip 盐水有没有从推进器和磨头出滴出*R Rotate 磨头旋转且转速稳定*A Advancer 推进器把手能够自由移动W Wire 推进器尾部导丝可见，磨头旋转时导丝无法移动Priortouse,pleaseseethecompleteDirectionsForUseformoreinformationonIndications,Contraindications,Warnings,Precautions,AdverseEventsandOperatorsInstructions.*必须要有盐水注入条件下才可操作旋磨推进器，用于冷却和润滑推进器。不然会造成推进器损坏必须要有盐水注入条件下才可操作旋磨推进器，用于冷却和润滑推进器。不然会造成推进器损坏*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，不然会造成旋磨导丝损耗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，不然会造成旋磨导丝损耗旋磨操作介绍专题宣讲第8页9BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally操作技巧操作技巧Priortouse,pleaseseethecompleteDirectionsForUseformoreinformationonIndications,Contraindications,Warnings,Precautions,AdverseEventsandOperatorsInstructions.旋磨操作介绍专题宣讲第9页10BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally操作技巧操作技巧磨磨头头位置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握住导丝时将磨头送入导管当磨头靠近病变区域近端时，松开推进器把手，慢慢回撤把手，使旋磨当磨头靠近病变区域近端时，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，解除前倾力导管在导引导管内逐步伸展，解除前倾力磨头转速磨头转速 Small burrs(1.25-2.0mm)160,000 180,000 rpmSmall burrs(1.25-2.0mm)160,000 180,000 rpmLarge burrs(Large burrs(2.15mm 2.15mm)140,000 160,000 rpm140,000 160,000 rpmPriortouse,pleaseseethecompleteDirectionsForUseformoreinformationonIndications,Contraindications,Warnings,Precautions,AdverseEventsandOperatorsInstructions.旋磨操作介绍专题宣讲第10页11BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally操作技巧操作技巧磨头磨头移动移动操作旋磨时候需要前以后回移动磨头，操作旋磨时候需要前以后回移动磨头，提议距离提议距离3cm3cm，碰到轻微阻力时能够再，碰到轻微阻力时能够再往前送往前送每次磨时间不要超出每次磨时间不要超出3030秒秒整个旋磨手术操作时间不超出整个旋磨手术操作时间不超出5 5分钟分钟依据需要选择磨头，磨头尺寸逐步增依据需要选择磨头，磨头尺寸逐步增加加.25mm.25mm 递增递增.Priortouse,pleaseseethecompleteDirectionsForUseformoreinformationonIndications,Contraindications,Warnings,Precautions,AdverseEventsandOperatorsInstructions.主要提醒！主要提醒！磨头旋转时候必须前后移动磨头旋转时候必须前后移动高速旋转时磨头固定在一处，会造成导丝损坏高速旋转时磨头固定在一处，会造成导丝损坏 旋磨操作介绍专题宣讲第11页12BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally操作技巧操作技巧操作操作提醒提醒Priortouse,pleaseseethecompleteDirectionsForUseformoreinformationonIndications,Contraindications,Warnings,Precautions,AdverseEventsandOperatorsInstructions.Y Y阀不宜拧太紧，防止造成磨头导管挤压损坏阀不宜拧太紧，防止造成磨头导管挤压损坏磨头停顿旋转时，不能停留在病变区域内磨头停顿旋转时，不能停留在病变区域内 或病变区域远端或病变区域远端旋磨消融时候不能调整转速旋磨消融时候不能调整转速磨头不要和旋磨导丝弹簧头端接触，磨头不要和旋磨导丝弹簧头端接触，预防导丝损坏或磨头卡住预防导丝损坏或磨头卡住磨磨头高速旋转时不宜停留在一处头高速旋转时不宜停留在一处磨头高速旋转时，前后移动动作轻柔磨头高速旋转时，前后移动动作轻柔在导管内防止旋转磨头在导管内防止旋转磨头旋磨操作介绍专题宣讲第12页13BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally“鸡尾酒”配方&常见问题旋磨操作介绍专题宣讲第13页14BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally“鸡尾酒”配方500ml 500ml 生理盐水生理盐水硝酸甘油硝酸甘油 2-4 mg2-4 mg异博定异博定 5mg5mg肝素肝素10000u10000u含含”鸡尾酒鸡尾酒”成份盐水袋成份盐水袋 应该经过连接管连接到推进器手柄应该经过连接管连接到推进器手柄位置盐水接口上位置盐水接口上在盐水袋上应使用压力袋并确保在盐水袋上应使用压力袋并确保200mmHg200mmHg压力以提供足够速度压力以提供足够速度盐水冲洗盐水冲洗旋磨操作介绍专题宣讲第14页15BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally常见问题常见问题导丝上白色物质：导丝上白色物质：HYSTRENEHYSTRENE棕榈油衍生物，用于润滑磨头导管，不棕榈油衍生物，用于润滑磨头导管，不要去除！要去除！推进器不再工作：检验气瓶内气压和输出气压是否够，若无盐水滴推进器不再工作：检验气瓶内气压和输出气压是否够，若无盐水滴出，需要更换推进器出，需要更换推进器Stall Light(Stall Light(失速灯）亮起：失速灯）亮起：当转速下降到当转速下降到1500015000转以下，并连续半秒钟以上时，作为安全办法，转以下，并连续半秒钟以上时，作为安全办法，系统会自动亮灯系统会自动亮灯确保磨头没有嵌顿确保磨头没有嵌顿回撤磨头，再重新送到病变区域近端回撤磨头，再重新送到病变区域近端确保连接无问题，供气正常，滴液正常确保连接无问题，供气正常，滴液正常旋磨操作介绍专题宣讲第15页16BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally指导导管&磨头选择策略旋磨操作介绍专题宣讲第16页17BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally指导导管选择提议使用代侧孔指导导管同轴性要好确信指导导管能容纳最终使用磨头尺寸旋磨操作介绍专题宣讲第17页18BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally指导导管/磨头兼容性*an.004”clearance is recommended旋磨操作介绍专题宣讲第18页19BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally磨头尺寸选择策略保守磨头选择：小或分叉病变角度大于60 度高度钙化全闭塞长病变(评定斑块负担)指导导丝斜线旋磨操作介绍专题宣讲第19页20BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally选磨头尺寸策略确定最终最大磨头尺寸:需消融最大斑块血管直径70%到 85%磨头直径增加以 0.5mm 为限与预先最终最大直径相比，磨头应最少0.5mm 以下开始旋磨操作介绍专题宣讲第20页21BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally磨头尺寸磨头尺寸受以下几个方面影响：血管尺寸病变形态学远端血管左心功效残留血管情况考虑患者全身情况，心功效等.考虑医生经验旋磨操作介绍专题宣讲第21页22BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally旋磨手法 旋磨操作介绍专题宣讲第22页23BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally顺利手术者.旋磨操作介绍专题宣讲第23页24BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally指导导丝放置指导导丝应放在病变远端指导导丝应放在病变远端最大血管(防止放在小侧支)假如存在复杂解剖或没有成功：用保守指导导丝和用交换导丝将旋磨导丝交换进去用交换球囊或 PTCA 球囊为指导导丝做支撑旋磨操作介绍专题宣讲第24页25BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally指导导丝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指导导丝假如指导导丝弹簧头已经脱垂不要操作25旋磨操作介绍专题宣讲第25页26BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally消融技巧旋磨操作介绍专题宣讲第26页27BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally磨头位置在保持张力指导钢丝上平坦推进磨头将推进器球形手柄放在“1”位置并锁上 旋磨操作介绍专题宣讲第27页28BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally消融技巧迟缓向前推磨头维持转速大于基础转速 5,000 转/分在病变近端设定基础转速磨头尺寸1.25-2.0 mm2.15-2.5 mm理想转速160,000-180,000 转/分150,000-170,000 转/分旋磨操作介绍专题宣讲第28页29BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally消融技巧不正确正确旋磨操作介绍专题宣讲第29页30BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally消融技巧旋磨操作介绍专题宣讲第30页31BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally消融技巧注意事项Y接头不要拧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远端停下来在消融过程中不要调整转速31旋磨操作介绍专题宣讲第31页32BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally消融技巧注意事项不要将磨头推进到指导钢丝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 防止在指导导管内高速转动磨头旋磨操作介绍专题宣讲第32页33BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally消融时反馈旋磨操作介绍专题宣讲第33页34BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally消融时反馈目视 在透视情况下顺利推进注射造影剂区分病变及正常边界旋磨操作介绍专题宣讲第34页35BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally消融时反馈 耳听磨头碰到阻力时系统声音能够发生改变旋磨操作介绍专题宣讲第35页36BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally消融时反馈手感：推进器按钮阻力或磨头驱动鞘过分抖动可由以下原因：磨头负荷过重磨头推进太快相对于血管/病变磨头太大旋磨操作介绍专题宣讲第36页37BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally消融时反馈最终抛光：没有转速下掉没有阻力感旋磨操作介绍专题宣讲第37页38BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally交换过程旋磨操作介绍专题宣讲第38页39BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally交换过程检验指导导丝尾部夹子压下脚踏开关激活“Dynaglide”松开制动器拧松Y接头旋磨操作介绍专题宣讲第39页40BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally交换过程压下脚踏开关激活“Dynaglide”使磨头转速在60,000-90,000 转/分在指导导丝推进同时，回撤转动磨头,确保指导导丝在固定原位（相对运动）压下Dynaglide 按钮使高速转动恢复 旋磨操作介绍专题宣讲第40页41BostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyBostonScientificConfidential-ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyTHANKYOU!旋磨操作介绍专题宣讲第41页