10_dermadrive-gd-113.pdf
Page 1
International
English
User Manual
CM2
GD-113
Page 2
Page 3
Contents
1
Important Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2
Safety Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3
Reprocessing - Sterilisable Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
4
Limitations on reprocessing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Safety Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Point of Use (before reprocessing) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Containment and Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Cleaning and Disinfection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Inspection and Function Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Packaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Sterilisation of Handpieces and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Point of Use (after reprocessing) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Reprocessing - Non-sterilisable Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
5
Limitations on reprocessing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Safety Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Manual Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
6
Front . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Rear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Dermatome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Configuring the Control Box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
7
Fitting and Removing the Micro-motor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Fitting and Removing the Pedal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Setting the Maximum Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Controlling the Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Configuring the Dermatome Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
8
Fitting and Removing the Handle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Fitting a Blade and Sole Plate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Removing a Blade and Sole Plate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Using the Dermatome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
9
Fitting and Removing the Dermatome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Adjusting the Graft Thickness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Fitting and Removing a Drive Bush . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Technical and Ordering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
10
Control Box Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Sterilisation Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Page 4
11
Further Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Service and Repair Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Guarantee and Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
EMC Guidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Page 5
Important Information
Save this user manual. This user manual contains important safety and operating instructions for
this equipment.
Throughout this user manual, the words WARNING, CAUTION and NOTE are used to highlight
important information.
WARNING:
WARNING information identifies conditions or practices that could result in injury
CAUTION:
CAUTION information identifies conditions or practices that could result in damage to
the equipment or system
NOTE:
NOTE information is provided to clarify or supplement procedural information
Safety Instructions
General
WARNING:
do not attempt to use this equipment until this user manual and all cautionary markings
have been studied and understood
WARNING:
this equipment should only be used by personnel with appropriate training
WARNING:
inspect all equipment before use and do not use suspect, damaged or worn equipment
WARNING:
this equipment is not intended for use in an oxygen rich environment or in the presence
of flammable gases
WARNING:
never reuse items marked for single-use
. Risks associated with reuse include:
• cross contamination between patients
• bone necrosis due to extra heat generation
• inaccurate cutting.
CAUTION: ensure this equipment is regularly serviced. Refer to the service and repair information
section of this user manual.
CAUTION:
only reprocess this equipment as directed in this user manual
CAUTION:
only use Stericut or De Soutter Medical approved accessories
WARNING:
always allow the handpiece to stop before removing from the surgical site
Control Box, Micro-motor & Foot pedal
WARNING:
this equipment must be only be connected to a supply with a protective earth
CAUTION: this equipment must only be used in accordance with the EMC guidelines described in
this user manual. Use of accessories other than those approved by De Soutter Medical may result
in increased interference or emissions.
NOTE:
if electro-magnetic interference occurs, causing undesirable operation, increase the
distance between the interfering devices and if possible, connect the items of equipment to
separate power outlets
CAUTION:
do not wash the control box, the foot pedal or the micro-motor. Refer to separate
cleaning instructions.
CAUTION:
do not sterilise the control box or the foot pedal. Refer to separate cleaning instructions.
CAUTION:
do not immerse any part of this equipment in fluids
Dermatome Head
CAUTION:
do not immerse any part of this equipment in fluids except as required by an automatic
washer-disinfector cycle
1
Page 6
Intended Use
The equipment described in this user manual is intended for use in surgical procedures to harvest
thin slices of skin for grafting.
Disposal
All equipment should be recycled or disposed of, in accordance with local regulations.
2
Page 7
Symbols
Symbol
SN 12/00500
Meaning
Symbol
Meaning
Refer to the user manual
Only for use by a physician
Single-use only
Do not immerse
Dispose of in accordance
with local regulations
Vacuum steam sterilise
The first two digits indicate
the year of manufacture
Type B protection
3
Page 8
Reprocessing - Sterilisable Equipment
These reprocessing instructions are suitable for the sterilisable equipment described in this user
manual.
• GD-1xx - Dermatome Head
• Micro-motor (refer to separate cleaning and sterilisation instructions)
Limitations on reprocessing
Repeated processing as specified in these instructions has minimal effect on this equipment.
Equipment end-of-life is normally determined by wear or damage during use.
Safety Instructions
General
WARNING:
never reuse items marked for single-use
. Risks associated with reuse include:
• cross contamination between patients
• bone necrosis due to extra heat generation
• inaccurate cutting.
CAUTION: following a wet cleaning process, ensure that this equipment is dried immediately
CAUTION:
correct internal drying of sterilisable equipment can only be achieved by using a vacuum
steam autoclave with the vacuum assisted drying period activated
CAUTION:
do not immerse any part of this equipment in fluids except as required by an automatic
washer-disinfector cycle
CAUTION:
do not exceed temperatures of 140°C
CAUTION:
do not clean any part of this equipment in an ultrasonic cleaner
NOTE:
ensure that attachments and handpieces with collet mechanisms are fully open when
reprocessing
NOTE:
cannulations, blind holes, recesses, and other surfaces which are hard to reach, require
particular attention during reprocessing
NOTE:
STERIS processes will affect the appearance of equipment with coloured anodizing. The
discolouration caused by the processes will not affect the performance of the product.
Control Box, Micro-motor & Foot pedal
CAUTION:
do not wash the control box, the foot pedal or the micro-motor. Refer to separate
cleaning instructions.
CAUTION:
do not sterilise the control box or the foot pedal. Refer to separate cleaning instructions.
CAUTION:
the micro-motor must be inspected and cleaned separately, prior to any further
reprocessing
CAUTION:
do not autoclave the micro-motor without a sterilisation bag
4
Page 9
Detergents and Rinse Aids
WARNING:
the choice of detergent or rinse aid, and the manner in which they are used, is critical
to sustaining the reliability of the equipment. Failure to follow the instructions given in this user
manual may cause premature failure of the equipment and may compromise patient safety.
CAUTION:
ensure the detergent or rinse aid manufacturer’s guidelines and process parameters
(such as, dilution and temperature) are followed
CAUTION:
ensure the detergent or rinse aid used is suitable for use on anodised aluminium and
the following plastics: PEEK and PPSU
CAUTION:
NOTE:
never use detergents with a pH value greater than 11.0
the use of pH-neutral enzymatic detergents is highly recommended
Point of Use (before reprocessing)
Remove excess soil with a disposable cloth or other suitable wipe.
Containment and Transportation
It is important that this equipment is reprocessed immediately after use. In order to minimise
contamination risks, the handling, collection and transportation of soiled equipment should be
strictly controlled.
Cleaning and Disinfection
Cleaning the Micro-motor
CAUTION:
do not immerse any part of this equipment in fluids
CAUTION:
the micro-motor must be inspected and cleaned separately, prior to any further
reprocessing
1. Unscrew the front housing of the micro-motor.
2. Clean the micro-motor and the housing, ensuring any fluid and contaminant deposits are
removed in accordance with local reprocessing guidelines.
NOTE: use a clean cloth dampened with a suitable disinfectant solution
3. Ensure the micro-motor and the front housing are completely dry.
4. Re-assemble the micro-motor.
5. Fit the sterilisation stopper.
6. Wipe the outside case and power cable.
NOTE: use a clean cloth dampened with a suitable disinfectant solution
5
Page 10
Manual Cleaning
CAUTION: do not wash the control box, the foot pedal or the micro-motor. Refer to separate
cleaning instructions.
• Remove all attachments and accessories and wash them separately.
• Dispose of single-use accessories in accordance with local guidelines.
Manual cleaning should only be carried out where an automatic washer-disinfector is not
available, or in order to remove large contaminant deposits. Manual cleaning should be conducted
in a dedicated area, by trained personnel who are wearing protective clothing, for example:
gloves, a waterproof apron, and goggles or a visor.
NOTE: the use of dedicated sinks with temperature controlled water, ideally deionised or distilled,
is recommended
NOTE:
cannulations, blind holes, recesses, and other surfaces which are hard to reach, require
particular attention during reprocessing
1. Wash off excess soil with running water (maximum 35°C).
NOTE: avoid fluid ingress
2. Prepare a solution of detergent according to the detergent manufacturer’s instructions.
3. Remove all visible traces of contaminant, using suitable nylon brushes to scrub the
equipment thoroughly.
i) Manually open and close chucks and blade clamps.
ii) Ensure any trapped contaminants are removed by flushing through cannulations
and other surfaces which are hard to reach.
4. Rinse off all traces of the detergent with deionised or distilled running water (45 - 65°C).
5. Shake off any excess water and dry the surfaces with a lint-free cloth.
6. Visually inspect each item. Verify that all contaminants have been removed in
accordance with local reprocessing guidelines.
6
Page 11
Automatic Cleaning
CAUTION: do not wash the control box, the foot pedal or the micro-motor. Refer to separate
cleaning instructions.
• Large contaminant deposits should be removed by manual cleaning.
• Remove all attachments and accessories and wash them separately.
• Dispose of single-use accessories in accordance with local guidelines.
An automatic washer-disinfector, capable of meeting the relevant national and international
cleaning and disinfection standards (such as, ISO 15883 or HTM 2030), should be used.
NOTE: cannulations, blind holes, recesses, and other surfaces which are hard to reach, require
particular attention during reprocessing
1. Place the dermatome head into a wire basket.
i) Remove the sole plate.
ii) Set the blade adjuster to a middle position.
iii) Ensure that all items are separated.
NOTE:
the placement of items in automatic washer-disinfector baskets can be a critical
factor in achieving effective cleaning. The basket type and the position of the items within
the basket should be managed by suitably trained personnel and be in accordance with
the manufacturer’s instructions.
2. Follow the washer-disinfector manufacturer’s loading instructions and select the
appropriate cycle. The cycle should include the following:
Cycle Stage
Minimum Recirculation
Time (min:secs)
Temperature
Detergent
Pre-wash
5:00
< 35°C
-
Enzyme wash
5:00
> 55°C
Endozime AW Triple
Plusa
Rinse 1
2:00
> 55°C
-
Rinse 2
2:00
> 55°C
-
Thermal rinse
1:00
90°C
-
Pure water rinse
0:10
66°C
-
Drying
20:00
110°C maximum
-
a. other brands of detergent may be used provided the suitability of the detergent is verified before use.
3. Remove the disinfected equipment from the washer-disinfector to a clean area.
4. Visually inspect each item. Verify that all contaminants have been removed in
accordance with local reprocessing guidelines.
7
Page 12
Disinfection
Thermal disinfection is recommended and included in the automatic cleaning process.
Where the use of an automatic washer-disinfector is not possible, the equipment should be wiped
with a suitable disinfectant.
Maintenance
CAUTION:
do not lubricate the micro-motor
No lubrication is necessary during reprocessing.
Inspection and Function Testing
WARNING:
inspect all equipment before use and do not use suspect, damaged or worn equipment
WARNING:
never reuse items marked for single-use
. Risks associated with reuse include:
• cross contamination between patients
• bone necrosis due to extra heat generation
• inaccurate cutting.
1. Ensure the equipment is in good working order.
i) Note any unusual sounds, vibrations or operating speeds.
NOTE:
if operating difficulties are experienced, refer to the troubleshooting section of this
user manual
2. Inspect reusable cutting accessories (such as, drill bits and reamer shells) for damage
and wear.
NOTE: dispose of worn or damaged cutting accessories appropriately
Packaging
CAUTION: ensure the micro-motor is completely dry before sealing inside a sterilisation bag.
Failure to do so may damage the micro-motor.
CAUTION:
ensure the sterilisation plug is fitted to the micro-motor
1. Place the clean, dry, micro-motor and the attached cable inside a porous sterilisation
bag.
NOTE: the sterilisation bag should conform to DIN 58953
2. Seal the sterilisation bag according to the bag manufacturer’s instructions.
3. Place the sterilisation bag, the dermatome head, and any other sterilisable accessories
into the sterilisation tray.
NOTE: if wrapping is required, use material suitable for the chosen sterilisation method
8
Page 13
Sterilisation of Handpieces and Accessories
Steam Sterilisation
CAUTION:
do not autoclave the micro-motor without a sterilisation bag
CAUTION:
do not autoclave the sterilisation bag if it has liquid inside. Doing so may permanently
damage the micro-motor.
Cycle
Wrapping
a
Exposure Time and
Temperature
(-0°C / +3°C)
Drying Time b
vacuum assisted
optional
3-4 minutes at 134°C
30 minutes at
maximum 110ºC
vacuum assisted
(flash)
unwrapped
3-4 minutes at 134°C
none
wrapped
15 minutes at 134°C
30 minutes at
maximum 110ºC
wrapped
50 minutes at 121°C
20 minutes at
maximum 110ºC
gravity
a. for reasons of non-repeatability during transport and storage, processes involving unwrapped equipment
cannot be validated beyond the sterilisation procedure.
b. the drying times specified are for a full, wrapped sterilisation case containing 3 handpieces. If different
quantities are used, the necessary drying time may vary.
CAUTION:
allow the micro-motor to dry, at room temperature for at least one hour after sterilisation
CAUTION:
it is normal for water to condense inside the sterilisation bag after sterilisation. If this
occurs, do not remove the micro-motor from the sterilisation bag for 6 hours to allow the water to
drain.
STERIS Sterilisation
WARNING:
STERIS sterilisation is not suitable for the micro-motor
Sterilisation System
Cycle
V-PRO® 1
standard
V-PRO® 1 Plus
lumen
V-PRO® maX
lumen
NOTE:
STERIS processes will affect the appearance of equipment with coloured anodizing. The
discolouration caused by the processes will not affect the performance of the product.
Storage
To preserve sterility, wrap the sterilised equipment with a suitable material, capable of presenting
a barrier to micro-organisms and particulate contamination.
9
Page 14
Point of Use (after reprocessing)
CAUTION:
do not operate this equipment while it is still warm from reprocessing
CAUTION:
this equipment should not be placed in a refrigerator or similar
CAUTION:
allow the micro-motor to cool at room temperature for at least one hour after
autoclaving. Do not use forced air cooling.
Following sterilisation, allow this equipment to cool to room temperature before being used.
Additional Information
Manual cleaning has been validated in accordance with AAMI TIR30.
Automated cleaning has been validated, in accordance with HTM 2030 and AAMI TIR30, using
an automated washer-disinfector.
Vacuum and gravity steam sterilisation have been validated in accordance with HTM 2010, AAMI
TIR12, ANSI/AAMI ST79, ANSI/AAMI/ISO 17665-1 and ANSI/AAMI/ISO 17665-2.
Steris sterilisation has been validated in accordance with AAMI TIR12.
The reprocessing instructions provided in this user manual are compatible with the requirements
of CFPP 01-01.
The reprocessing instructions provided in this user manual have been validated by De Soutter
Medical as being capable of preparing a device for reuse. It remains the responsibility of the
reprocessor to ensure that the reprocessing as actually performed, using equipment, materials
and personnel in the reprocessing facility, achieves the desired result.This normally requires
validation and routine monitoring of the process.
Likewise, any deviation by the reprocessor from the instructions provided in this user manual,
should be properly evaluated for effectiveness and potential adverse consequences.
10
Page 15
Reprocessing - Non-sterilisable Equipment
These reprocessing instructions are suitable for the non-sterilisable equipment described in this
user manual.
• CM2 - Control Box
• Foot pedal
Limitations on reprocessing
Repeated processing as specified in these instructions has minimal effect on this equipment.
Equipment end-of-life is normally determined by wear or damage during use.
Safety Instructions
WARNING:
ensure the equipment is disconnected from all power sources before cleaning
WARNING:
inspect all equipment before use and do not use suspect, damaged or worn equipment
CAUTION:
do not immerse any part of this equipment in fluids
CAUTION:
do not clean this equipment in an automatic washer-disinfector
CAUTION:
do not clean any part of this equipment in an ultrasonic cleaner
Manual Cleaning
NOTE:
cannulations, blind holes, recesses, and other surfaces which are hard to reach, require
particular attention during reprocessing
1. Remove any attachments and accessories.
2. Using a soft brush, clean the fan grill and air vents to remove any dust or debris.
3. Wipe the surfaces of the equipment with a clean, soft cloth, dampened with a mild pH
balanced detergent or alcohol.
NOTE: avoid fluid ingress
4. Wipe the surfaces of the equipment with a clean, soft cloth, dampened with distilled or
sterilised water.
5. Dry the equipment with a clean, soft, dry cloth.
11
Page 16
Overview
Front
1)
Speed display
2)
Direction button
3)
Speed adjust buttons
4)
Micro-motor start/stop button
12
Page 17
Rear
1)
Micro-motor socket
2)
Pedal socket
3)
Power switch
4)
Mains cord
13
Page 18
Dermatome
1)
Handle
2)
Sole plate
3)
Blade
4)
Adjuster clamp screw
14
Page 19
Configuring the Control Box
Fitting and Removing the Micro-motor
WARNING:
ensure the equipment is switched off and the mains supply is disconnected
1. Align the pins in the plug with the pins in the socket.
NOTE: the plug will only fit in one orientation
2. Insert the plug.
3. Rotate the plug sleeve clockwise to secure in place.
4. To remove the plug, rotate the plug sleeve anti-clockwise and remove the plug.
15
Page 20
Fitting and Removing the Pedal
WARNING:
ensure the equipment is switched off and the mains supply is disconnected
1. Align the pins in the plug with the pins in the socket.
NOTE: the plug will only fit in one orientation
2. Insert the plug.
3. Rotate the plug sleeve clockwise to secure in place.
4. To remove the plug, rotate the plug sleeve anti-clockwise and remove the plug.
16
Page 21
Setting the Maximum Speed
1. To increase the maximum speed, press
2. To decrease the maximum speed, press
NOTE:
.
.
the maximum speed is displayed on the front of the control box in revolutions per minute
Controlling the Speed
The speed of the micro-motor is controlled by progressively pressing the foot pedal. Alternatively,
pressing MOTOR will start and stop the micro-motor.
NOTE: if the foot pedal is not fitted, the micro-motor will only run at maximum speed
Pressing REVERSE will run the micro-motor in the opposite direction.
NOTE: the direction has no effect on the oscillating dermatome blade
NOTE:
when running in reverse, an audible alarm will be emitted by the control box
17
Page 22
Configuring the Dermatome Head
Fitting and Removing the Handle
NOTE:
the sole plate must be removed before fitting or removing the handle
1. Align shaft on the handle with the hole in the dermatome head.
2. Insert the handle into the dermatome head.
NOTE: ensure the handle is fully inserted
3. Using the hex tool, tighten the screw to secure the handle.
4. To remove the handle, use the hex tool to loosen the screw and then remove the handle.
18
Page 23
Fitting a Blade and Sole Plate
1. Lubricate the blade carrier with a drop of sterile liquid paraffin.
2. Fit the blade, ensuring the holes in the blade align with the pins on the dermatome head.
3. Lubricate the top of the blade with a drop of sterile liquid paraffin.
4. Insert the sole plate.
19
Page 24
5. Secure the sole plate, using the hex tool to tighten both screws.
NOTE: before tightening the screws, ensure the sole plate is fully inserted and lies square
with edge of the dermatome head
20
Page 25
Removing a Blade and Sole Plate
1. Use the hex tool to loosen the screws holding the sole plate.
2. Remove the sole plate
3. Lift the blade vertically away from the dermatome head.
NOTE: if necessary, tweezers or forceps can be used to aid in removing the blade
21