MISONIX
BoneScalpel System Model BCM-SY Instructions for Use Rev G
Instructions for Use
54 Pages
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Page 1
BoneScalpel™ System With SonicOne Technology
Instructions For Use Model BCM-SY
Instructions For Use
BCM-UM Rev G
BoneScalpel™ with SonicOne® Technology
Page 1
Instructions For Use
BoneScalpel™ with SonicOne® Technology
Table of Contents 1. General Safety Statements... 3 1.1. EMC Statement ... 3 1.2. Electrical Safety Statement ... 6 1.3. Environmental Statement ... 6 1.4. Summary Of Safety Notices ... 7 1.5. Trademark Information ... 10 1.6. Explanation Of Symbols ... 11 2. Indications And Contra Indications ...12 2.1. Indications ... 12 2.2. Contra Indications ... 12 3. Adverse Effects ...13 4. Considerations During Clinical Use ...14 4.1. HARD Tissue Use ... 15 4.2. SOFT Tissue Use ... 16 5. System Overview ...17 5.1. Principle Of Operation ... 17 5.2. Reusable System Components ... 18 5.3. Single-use, Sterile Components ... 19 6. Console ...21 6.1. Receptacles, Controls And Indicators ... 21 6.2. Menu Functions ... 22 6.3. Main Functions... 24 6.4. Alerts And Indicators ... 26 7. System Set-up ...28 7.1. Installation ... 28 7.2. Console Set-up – Part I (Non-sterile) ... 29 7.3. Handpiece Assembly (Sterile)... 29 7.4. Console Set-up – Part II (Non-sterile) ... 30 7.5. Perform System Check ... 32 8. Handpiece Assembly And Disassembly By Application ...33 8.1. Handpiece Assembly - HARD Tissue Use ... 33 8.2. Handpiece Disassembly - HARD Tissue Use ... 35 8.3. Handpiece Assembly - SOFT Tissue Use ... 36 8.4. Handpiece Disassembly - SOFT Tissue Use ... 38 9. Cleaning And Sterilization ...40 9.1. Disassembly ... 40 9.2. Cleaning ... 40 9.3. Sterilizing By Steam Autoclave ... 42 9.4. Expected Life, Reusable Components ... 43 9.5. Deviations From Decontamination, Cleaning And Sterilization Instructions ... 43 10. Troubleshooting ...44 11. Specifications ...47 12. Service, Repair And Technical Correspondence ...49 12.1. Fuse Replacement ... 49 12.2. Pump Head Replacement... 50 12.3. Repair, Service and Replacement Parts ... 50 12.4. Important Notice... 51
BCM-UM Rev G
Page 2
BoneScalpel™ with SonicOne® Technology
Instructions For Use
1. General Safety Statements WARNING 1.1
The BoneScalpel system is an electro-mechanical device, which under certain circumstances could present an electrical shock hazard to the operator and/or patient. Please read manual thoroughly and follow directions stated herein to assure maximum safety during operation. This manual shall be kept in close proximity to the system for easy referral when needed.
WARNING 1.2
The BoneScalpel system is intended to be used in various types of invasive, surgical procedures. There may be indirect danger to the patient should the device fail during the procedure. It is recommended that the facility follows its back-up equipment protocols.
CAUTION 1.1
Federal law restricts this device to sale by or on the order of a licensed healthcare practitioner
1.1.
EMC Statement
The BoneScalpel system is designed and tested to comply with FCC regulations for conducted and radiated emissions under Part 18 Subchapter J. and to comply with IEC EN60601-1-2: 2007 guidelines for EMC.
CAUTION 1.2
This device is considered medical electrical equipment. Medical electrical equipment needs special precautions regarding electromagnetic compatibility (EMC) and needs to be installed and put into service according to the EMC information provided in this operator’s manual.
CAUTION 1.3
Portable and mobile RF communication equipment can affect medical electrical equipment. If RF equipment is in use monitor the Bonescalpel for proper function during procedure.
CAUTION 1.4
The use of accessories, transducers and cables other than those specified may result in increased emissions or decreased immunity of the device. Use only Misonix branded equipment and accessories.
CAUTION 1.5
The console should not be used adjacent to or stacked with other electrical equipment. If adjacent or stacked use is necessary, the console should be observed to verify normal operation in the configuration in which it will be used.
Electromagnetic Compatibility Guidance (in accordance with EN/IEC 60601-1-2:2007) Guidance And Manufacturer’s Declaration – Electromagnetic Emissions (Table 201) The BONESCALPEL SYSTEM is intended for use in the electromagnetic environment specified below. The customer or the user of BONESCALPEL SYSTEM should ensure that it is used in such an environment. Emissions test RF emissions CISPR 11 RF emissions
Compliance
Electromagnetic environment – guidance
Group 1
The BONESCALPEL SYSTEM uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment.
Class A
CISPR 11 Harmonic emissions IEC 61000-3-2 Voltage fluctuations/ flicker emissions
Class A
The BONESCALPEL SYSTEM is suitable for use in all establishments other than domestic and those directly connected to the public lowvoltage power supply network that supplies buildings used for domestic purposes.
Complies
IEC 61000-3-3
Table 1.1
BCM-UM Rev G
Guidance & manufacturer’s declaration on electromagnetic emissions (EN table 201)
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BoneScalpel™ with SonicOne® Technology
Instructions For Use
Guidance And Manufacturer’s Declaration – Electromagnetic Immunity (Table 202) The BONESCALPEL SYSTEM is intended for use in the electromagnetic environment specified below. The customer or the user of the BONESCALPEL SYSTEM should assure that it is used in such an environment. IEC 60601 test level
Immunity test Electrostatic discharge (ESD)
Compliance level
Electromagnetic environment – guidance
o ±6 kV contact
o ±6 kV contact
o ±8 kV air
o 8 kV air
Electrical fast transient/burst
o ±2 kV for power supply lines
IEC 61000-4-4
o ±1 kV for
o ±2 kV for power supply lines o ±1 kV for input/output lines
Mains power quality should be that of a typical commercial or hospital environment.
Surge
o ±1 kV differential mode
o ±2 kV common mode
o ±1 kV differential mode o 2 kV common mode
Mains power quality should be that of a typical commercial or hospital environment.
<5 % UT (>95 % dip in UT) for 0,5 cycle
<5 % UT (>95 % dip in UT) for 0,5 cycle
40 % UT (60 % dip in UT) for 5 cycles
40 % UT (60 % dip in UT) for 5 cycles
70 % UT (30 % dip in UT) for 25 cycles
70 % UT (30 % dip in UT) for 25 cycles
Mains power quality should be that of a typical commercial or hospital environment. If the user of the BONESCALPEL SYSTEM requires continued operation during power mains interruptions, it is recommended that the powered from an uninterruptible power supply.
<5 % UT (>95 % dip in UT) for 5 sec
<5 % UT (>95 % dip in UT) for 5 sec
3 A/m
3 A/m
IEC 61000-4-2
IEC 61000-4-5 Voltage dips, short interruptions and voltage variations on power supply input lines IEC 61000-4-11
Power frequency (50/60 Hz) magnetic field
input/output lines
IEC 61000-4-8 NOTE
Floors should be wood, concrete or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%.
Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment.
UT is the AC mains voltage prior to application of the test level.
Table 1.2
Guidance & manufacturer’s declaration on electromagnetic immunity (EN table 202)
List of Cables Item
Cable Length
Type
Handpiece cable
15 ft | 4.6 m
shielded 2-conductor
Power cord
10 ft | 3.0 m
unshielded 3-conducter
Footswitch cable
14 ft | 4.3 m
shielded 2-conductor
Table 1.3
BCM-UM Rev G
List of cables
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BoneScalpel™ with SonicOne® Technology
Instructions For Use
Guidance And Manufacturer’s Declaration – Electromagnetic Immunity (Table 204) The BONESCALPEL SYSTEM is intended for use in the electromagnetic environment specified below. The customer or the user of the BONESCALPEL SYSTEM should assure that it is used in such an environment. Immunity test
IEC 60601 test level
Compliance level
Electromagnetic environment – guidance Portable and mobile RF communications equipment should be used no closer to any part of the BONESCALPEL SYSTEM, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter. Recommended separation distance
Conducted RF
3 Vrms
IEC 61000-4-6
150 kHz to 80 MHz
Radiated RF
3 V/m
IEC 61000-4-3
80 MHz to 2.5 GHz
3V
3 V/m
d 1.2 P d 1.2 P
80 MHz to 800 MHz
d 2.3 P
800 MHz to 2.5 GHz
where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in meters (m). Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey,a should be less than the compliance level in each frequency range.b
Interference may occur in the vicinity of equipment marked with the following symbol:
NOTE 1
At 80 MHz and 800 MHz, the higher frequency range applies.
NOTE 2
These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.
a
b
Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the BONESCALPEL SYSTEM is used exceeds the applicable RF compliance level above, the BONESCALPEL SYSTEM should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating the BONESCALPEL SYSTEM. Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3 V/m.
Table 1.4
BCM-UM Rev G
Guidance & manufacturer’s declaration on electromagnetic immunity (EN table 204)
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BoneScalpel™ with SonicOne® Technology
Instructions For Use
Recommended Separation Distances Between Portable And Mobile RF Communications Equipment And The BONESCALPEL SYSTEM (Table 206) The BONESCALPEL SYSTEM is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the BONESCALPEL SYSTEM can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the BONESCALPEL SYSTEM below, according to the maximum output power of the communications equipment. Rated maximum output power of transmitter
Separation distance according to frequency of transmitter M 150 kHz to 80 MHz
80 MHz to 800 MHz
800 MHz to 2,5 GHz
d 1.2 P
d 1.2 P
d 2.3 P
0.01
0.12
0.12
0.23
0.1
0.37
0.37
0.37
W
1
1.2
1.2
2.3
10
3.7
3.7
7.4
100
12
12
23
For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters (m) can be estimated using the equation applicable to the frequency of t he transmitter, where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer. NOTE 1 At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies. NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.
Table 1.5
1.2.
Recommended separation distances (EN table 206)
Electrical Safety Statement
The BoneScalpel System is designed and tested to comply with UL 60601-1 and EN 60601-1.
WARNING 1.3
The BoneScalpel system generates high voltages within the console itself and the connected handpiece. To avoid injury, the console should never be operated before ensuring that its cover is properly closed and not tampered with. Do not attempt to remove or disassemble the cover. There are no user-serviceable parts inside the console. All service should only be performed by an authorized Misonix representative. No modification of this equipment is required.
WARNING 1.4
Proper system grounding can only be ensured when an approved, hospital-grade receptacle and matching power cord are used. To avoid the risk of electric shock, this equipment must only be connected to a supply with protective earth. Install plug and receptacles as per local regulations before operating the unit. Power cord, plug and receptacle should be examined to verify that they are in good working condition before connecting the console. Never pull on the power cord to remove it from the receptacle.
WARNING 1.5
Connecting the console to a power outlet with inadequate voltage or frequency may cause the unit to malfunction or to create a shock or fire hazard. Confirm that the voltage selector switch on the console rear panel is set to the local voltage setting and ensure that the correct fuses are being used. Refer to section 12.1 on instructions for fuse replacement.
1.3.
Environmental Statement
This equipment consists of materials that may be recycled if disassembled by a specialized company. Please observe local and federal regulations regarding the disposal of packing materials and old equipment.
BCM-UM Rev G
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BoneScalpel™ with SonicOne® Technology
Instructions For Use
Important Environmental Information for Users within the European Economic Area The European Parliament did enforce new regulations developed in 2005 concerning the disposal medical electrical and electronic equipment. The regulations, called Directives, place responsibilities on the supplier and you, the purchaser/user. One of the actions required is to inform users of their obligations. The device has been assessed in accordance with the European Parliament Directive 2002/96/EC on Waste Electrical and Electronic Equipment, usually referred to as WEEE Directive. The WEEE Directive requires that the device be disposed of at the end of its useful life in an environmentally responsible manner. Similar requirements have been applied to refrigerators for some time. The WEEE Directive requires that if replacing the device with a new equivalent product, that supplier shall collect the old item without cost to the user. If you wish to dispose of the device without replacing it then the device must not be mixed with unsorted municipal waste. The crossed-out wheeled bin symbol on the unit label or packaging, and repeated below, indicates this requirement.
Disposal Symbol, disposal to be compliant with EN 50419 You must ensure that the device is disposed of at an authorized treatment facility; details can be obtained from your local council. Your role is critical and will help to ensure the Earth’s resources are maintained and that as much re-useable and recyclable material as possible is processed. It will also ensure that the landfill volume requirements are kept at a minimum and that hazardous materials are not buried thereby providing potential future problems for the environmental and human health.
Table 1.6
1.4.
Environmental statement
Summary Of Safety Notices
Please read this section of the manual carefully. It contains a summary of all precaution, warning and caution statements contained in the manual. However, the user is advised to read the entire manual and operate the device only in accordance with all of the instructions contained herein. Servicing of this device should only be performed by qualified technicians authorized by Misonix, Inc. There are no service controls accessible to the user.
Conventions on Warnings, Cautions and Notes WARNING
Denotes potentially dangerous situation that could result in death or serious injury to patient, operator or staff.
CAUTION
Denotes potentially dangerous situation that could result in moderate injury to patient, operator or staff.
NOTE
Indicates potential hazard that may result in product damage.
Table 1.7
BCM-UM Rev G
Conventions on warnings, cautions and notes
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Instructions For Use
BoneScalpel™ with SonicOne® Technology
List Of Warnings WARNING 1.1
The BoneScalpel system is an electro-mechanical device, which under certain circumstances could present an electrical shock hazard to the operator and/or patient. Please read manual thoroughly and follow directions stated herein to assure maximum safety during operation. This manual shall be kept in close proximity to the system for easy referral when needed.
WARNING 1.2
The BoneScalpel system is intended to be used in various types of invasive, surgical procedures. There may be indirect danger to the patient should the device fail during the procedure. It is recommended that the facility follows its back-up equipment protocols.
WARNING 1.3
The BoneScalpel system generates high voltages within the console itself and the connected handpiece. To avoid injury, the console should never be operated before ensuring that its cover is properly closed and not tampered with. Do not attempt to remove or disassemble the cover. There are no user-serviceable parts inside the console. All service should only be performed by an authorized Misonix representative.
WARNING 1.4
Proper system grounding can only be ensured when an approved, hospital-grade receptacle and matching power cord are used. Install plug and receptacles as per local regulations before operating the unit. Power cord, plug and receptacle should be examined to verify that they are in good working condition before connecting the console. Never pull on the power cord to remove it from the receptacle.
WARNING 1.5
Connecting the console to a power outlet with inadequate voltage or frequency may cause the unit to malfunction or to create a shock or fire hazard. Confirm that the voltage selector switch on the console rear panel is set to the local voltage setting and ensure that the correct fuses are being used. Refer to section 12.1 on instructions for fuse replacement.
WARNING 3.1
Tip and irrigant temperatures may exceed the tissue necrosis point if insufficient irrigation flow rates are used. For hard tissue removal , set the irrigation flowrate to a setting no less than the comparable vibration setting. For example, if the vibration setting is 7, a minimum flow setting of 70% should be used. Additional external irrigation, e.g. by administering sterile saline with a syringe over the distal tip portion, may be necessary for removal of very dense, hard osseous structures.
WARNING 3.2
Tissue necrosis may result if tip is not moved relative to tissue. A continuous, lateral sweeping motion is recommended in order to minimize contact duration with the ultrasonic tip and minimize heat build-up. When lateral motion is not possible withdraw and re-insert tip frequently.
WARNING 4.1
Contact to vibrating elements like extension and ultrasonic tip may cause burns and should be avoided by all means. The handpiece should only be held at the black housing area. An optional, protective silicone sleeve, included with certain tips, reduces the risk of thermal damage but does not eliminate it. Contact with the silicone sleeve should be avoided or kept brief with minimal amount of contact pressure. Pressure and extended exposure can still result in excessive frictional heat and cause burns.
WARNING 4.2
Additional external irrigation, e.g. by administering sterile saline with a syringe over the distal tip portion, may be necessary for removal of very dense, hard osseous structures of the skull, when using the BoneScalpel accessories.
WARNING 4.3
Ultrasonic tips can break under excessive use in extreme conditions, e.g. when cutting for extended duration in tight cavities with limited lateral motion. The tip could break into two or more fragments with the main fragment remaining attached to the handpiece. All fragments must be retrieved immediately from the surgical site. The fragments should be checked to ensure that no further pieces are missing. It is possible that a fragment is propelled outside of the surgical cavity. Diagnostic imaging, such as X-ray, must be used if a fragment cannot be found to confirm that the broken piece is outside of the surgical cavity.
WARNING 4.4
Breakage of ultrasonic tips will result in sharp edges that can be harmful to soft tissue even without activation of ultrasound. Tips can bend or deform before they actually brake. Tips showing signs of deformation or cracking should be replaced immediately since tip breakage is otherwise imminent. Do not bend or twist the ultrasonic tips since it reduces the structural integrity and can result in tip breakage during use. Dispose of deformed or broken tips immediately in a sharps container.
WARNING 6.1
Immediately suspend operation if Electrical Fault appears on display and/or an Electrical Fault audible Indicator sounds. Remove ultrasonic tip from surgical site. Turn Mains Power OFF. Do not touch any metallic parts of handpiece, extension, ultrasonic tip or generator while fault is indicated.
WARNING 7.1
Improper connection of the handpiece cable may present a shock hazard. Confirm that handpiece connector is dry prior to plugging it in.
WARNING 7.2
Do not operate pump with pump cover in raised position. Rollers might pinch loose clothing or fingers. Personal injuries may result. Cooling of the ultrasonic tip and irrigation at the treatment site will be inhibited.
WARNING 7.3
Tip and irrigation temperatures may exceed the tissue necrosis point with BoneScalpel accessories for hard tissue removal if insufficient irrigation flow rates are used. Always set the irrigation flowrate for hard tissue removal to a setting no less than the comparable vibration setting. For example, if the vibration setting is 7, a minimum flow setting of 70% should be used.
BCM-UM Rev G
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Instructions For Use
BoneScalpel™ with SonicOne® Technology
WARNING 7.4
Heat is being generated at the tip/tissue interface. A continuous, lateral sweeping motion is recommended for general bone/tissue removal in order to minimize contact duration with the ultrasonic tip and minimize the temperature increase.
WARNING 8.1
Remove probe cover, ultrasonic tip and extension from the handpiece prior to cleaning and/or sterilization; otherwise proper cleaning/sterilization may be inhibited.
WARNING 9.1
Single-use items should be discarded following each surgical procedure according to hospital protocol for disposal of biocontaminated wastes. Do not attempt to reuse or re-sterilize any single-use items. Dispose ultrasonic tips in a sharps container.
WARNING 9.2
All reusable handpiece parts and accessories must be properly decontaminated, cleaned and sterilized before each use as per instructions contained in this manual. Failure to do so may lead to infections, which can ultimately cause patient death.
WARNING 9.3
Misonix Inc. has validated all cleaning and sterilization cycles given in this manual. It is highly recommended that the procedures given in this manual for cleaning and sterilizing the BoneScalpel System and related accessories be followed. It is the responsibility of the user of this device or any accessories used with it to validate procedures for cleaning and/or sterilization if they differ from the procedures as outlined in this manual.
WARNING 10.1
If a Mains Power fuse fails after replacement when the unit is reactivated, discontinue use of the device and contact an authorized Misonix representative.
WARNING 12.1
Connecting the console to a power outlet with inadequate voltage or frequency may cause the unit to malfunction or to create a shock or fire hazard. Confirm that the voltage selector switch in the console rear is set to the local voltage setting and ensure that the correct fuses are being used. Refer to section 12 on fuse replacement
List Of Cautions CAUTION 1.1
Federal law restricts this device to sale by or on the order of a licensed healthcare practitioner
CAUTION 1.2
This device is considered medical electrical equipment. Medical electrical equipment needs special precautions regarding electromagnetic compatibility (EMC) and needs to be installed and put into service according to the EMC information provided in this operator’s manual.
CAUTION 1.3
Portable and mobile RF communication equipment can affect medical electrical equipment. If RF equipment is in use monitor the Bonescalpel for proper function during procedure.
CAUTION 1.4
The use of accessories, transducers and cables other than those specified may result in increased emissions or decreased immunity of the device. Use only Misonix branded equipment and accessories.
CAUTION 1.5
The console should not be used adjacent to or stacked with other electrical equipment. If adjacent or stacked use is necessary, the console should be observed to verify normal operation in the configuration in which it will be used.
CAUTION 3.1
The BoneScalpel system and its accessories may emit harmful acoustic pressure if exposure exceeds recommended limits.
CAUTION 4.1
Ultrasonic energy is inhibited if excessive physical force is applied to the ultrasonic tip; use only enough force to guide the tip to the surgical site and to advance it through the tissue. Do not force the tip; allow the ultrasonic action to do the work.
CAUTION 4.2
Insufficient irrigation and high tip pressure (loading) under extended exposure, e.g. in tight cavities, are to be avoided in BoneScalpel hard tissue removal. It is recommended to withdraw and re-insert the ultrasonic tip repeatedly to reestablish adequate cooling and lubrication.
CAUTION 7.1
All reusable system components like handpiece, probe covers, counter wrench, and T-wrench are supplied industrially cleaned, but NON-STERILE. All items intended for use in the sterile field must be cleaned and sterilized as per the indicated instructions before first clinical use and before every subsequent clinical use.
CAUTION 7.2
All items intended for use in the sterile field must be cleaned and sterilized as per indicated instructions before each clinical use.
CAUTION 7.3
The disposable items are intended for one procedure only (single use). Do not attempt to reuse or re-sterilize.
CAUTION 7.4
Do not place the soft silicone tube behind or in front of the rollers (latch removed in illustrations)
CAUTION 7.5
Do not pinch the soft silicone tube when the latch is locked.
CAUTION 7.6
Do not pinch barb fittings when closing the latch.
CAUTION 7.7
Prime the irrigation tubing prior to use. At all times ensure that the irrigant flows towards the handpiece when footswitch is depressed. If no irrigant is flowing, cease use until flow is restored.
CAUTION 7.8
The system check should always be done in advance of preparing patient for surgery to minimize risk to patient in case of system malfunction.
BCM-UM Rev G
Page 9
Instructions For Use
BoneScalpel™ with SonicOne® Technology
CAUTION 8.1
Ensure all connections and mating surfaces of handpiece, extension and ultrasonic tip are clean and dry before assembly.
CAUTION 9.1
Use manual cleaning techniques only. Do not use ultrasonic cleaners or automated washers to clean the handpiece as both methods could damage handpiece.
CAUTION 9.2
Be certain to clear debris from all internal passages by brushing. Failure to do so may hinder sterilization of units during autoclaving.
CAUTION 9.3
Do not immerse ultrasonic console, handpiece, irrigation pump, remote footswitch or electric cables. These items are not sealed against liquids and damage to equipment will result.
CAUTION 12.1
Use only genuine replacement parts from Misonix. Use of parts furnished by other sources may result in patient or operator injury or system malfunction and will void any applicable warranty.
CAUTION 12.2
Before using loose packing materials, such as foam pellets, shredded paper or similar, be sure to wrap the component(s) separately in plastic bags, film or other protective wrapping.
List Of Notes NOTE 4.1
After extended periods of operation, the bottom of the console housing may become warm to the touch. This is normal. Do not touch the bottom of the console housing while in operation or shortly after operation.
NOTE 4.2
Loose tip/tissue contact upon an initial bone incision can cause a thin tip to resonate not only longitudinally but also transversely. This can cause a thin tip to break. It is necessary to engage bone actively and with a minimal tip pressure greater than zero in order to prevent the shattering.
NOTE 4.3
Contact of the ultrasonic tip or the exposed extension with metal, surgical instruments or other objects during ultrasound use must be avoided. Such contact can damage the ultrasonic components very easily and may result in compromised performance, including failure. Discard any extensions or tips that show signs of damages like gouges, nicks or fractures. External aspiration may be used but it is recommended that a plastic suction tip should be used when in proximity with the probe tip.
NOTE 7.1
Adequate air circulation is needed to cool electronic components inside of the unit. Do not block the cooling fan at the console rear or the air vents on the console bottom. Do not place the unit on a towel, foam or other soft surface since the material may block the air vents. Blocking these vents may cause unit to overheat and malfunction or create a shock hazard. A clear drape can be used to protect the console front panel but do not cover the pump housing or other console portions.
NOTE 8.1
The handpiece must be placed into the counter wrench. Do not attempt to tighten or loosen handpiece components by holding the handpiece case or endcap. Always use the T-wrench wrench when tightening or un-tightening the tip or an extension. Never apply a pipe or strap wrench to the handpiece case. Do not over-tighten the tip or the extension.
NOTE 8.2
Always tighten or un-tighten the probe cover by hand and without using any wrenches. Do not over-tighten the probe cover.
NOTE 8.3
Always hold the handpiece at its metallic endcap when tightening or un-tightening the irrigation tubing. Always tighten or un-tighten the irrigation tubing by hand and without using any wrenches. Do not over-tighten the tubing connector.
NOTE 9.1
Allow reusable, autoclavable items to gradually return to room temperature after steam sterilization and prior to usage.
NOTE 9.2
The reuse life given takes into account wear and tear due to cleaning and sterilization only. Damage or wear caused by actual use in treatments will affect life of components.
1.5.
Trademark Information
Misonix® and SonicOne® are registered trademarks of Misonix, Inc., Farmingdale, NY BoneScalpel™ is a pending trademark of Misonix, Inc., Farmingdale, NY ASP Enzol® and Prolystica® are registered trademarks of STERIS Corporation, Mentor, OH
BCM-UM Rev G
Page 10
BoneScalpel™ with SonicOne® Technology
Instructions For Use
1.6.
Explanation Of Symbols Console Related Symbols
Symbol
Description
Symbol
°C Max
0482
BCM-UM Rev G
Description
Caution: Dangerous voltage
Mains Power ON
Scroll through
Caution: Consult accompanying documents
Mains Power OFF
Amplitude setting
Caution: Pinch hazard
Protective earth ground
Pulse setting
Consult Instructions for Use
Equipotentiality connection
Type B equipment
Disposal to be compliant with EN 50419 (WEEE directive)
Flow setting
LATEX
Symbol
Enable / Standby Ultrasound
menu pages
2
Description
Do not reuse
STERILE EO
Sterilized using Ethylene Oxide
Rx ONLY
Restricted to sale by or on the order of a physician only
Do not use if packaging is damaged
STERILE R
Sterilized using Gamma Irradiation
EC REP
Authorized representative
Use by date indicated
REF
Catalog number
Lot or batch code
~
AC Voltage
Contents are latex-free
Do not expose to temperatures greater than indicated
LOT
Must use hospital grade power cord only
Fuse
Manufacturer
Misonix CE number
Classified by UL
Footswitch connector
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Instructions For Use
BoneScalpel™ with SonicOne® Technology
Contains DEHP and/or Phthalates
Table 1.8
Explanation of symbols
2. Indications And Contra Indications 2.1.
Indications
The BoneScalpel system is indicated for use in the fragmentation and aspiration of both soft and hard (e.g.: bone) tissue as used in the following surgical specialties: Orthopedic Surgery Plastic and Reconstructive Surgery Thoracic Surgery NeuroSurgery Wound Care General Surgery It is also indicated for use in debridement of wounds, such as, but not limited to burn wounds, diabetic ulcers, bedsores and vaginal ulcers, soft tissue debridement and cleansing of the surgical site in application, in which, in the physician’s judgment would require the use of an ultrasonic aspirator with sharp debridement. The BoneScalpel system to be operated by surgeons / physicians justified to practice in the fields covered by the stated indications for use.
CAUTION 1.1
2.2.
Federal law restricts this device to sale by or on the order of a licensed healthcare practitioner
Contra Indications
The BoneScalpel system is contra indicated for cardiac surgery and any procedure in the proximity of the heart. The irrigation pump is contra indicated for the administration of parenteral fluids, infusion of drugs or for any life sustaining purposes
BCM-UM Rev G
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Instructions For Use
BoneScalpel™ with SonicOne® Technology
3. Adverse Effects CAUTION 3.1
The BoneScalpel system and its accessories may emit harmful acoustic pressure if exposure exceeds recommended limits. Limits For Airborn Acoustic Exposure Minimum Operating Distance Maximum Exposure Period From operator’s or patient’s ear Within a 24hour period 3” - 12” 8 cm – 30 cm Not to exceed 30 minutes 12” - 24” 30 cm – 60 cm Not to exceed 90 minutes > 24” 60 cm Not to exceed 240 minutes
WARNING 3.1
Tip and irrigant temperatures may exceed the tissue necrosis point if insufficient irrigation flow rates are used. For hard tissue removal , set the irrigation flowrate to a setting no less than the comparable vibration setting. For example, if the vibration setting is 7, a minimum flow setting of 70% should be used. Additional external irrigation, e.g. by administering sterile saline with a syringe over the distal tip portion, may be necessary for removal of very dense, hard osseous structures.
WARNING 3.2
Tissue necrosis may result if tip is not moved relative to tissue. A continuous, lateral sweeping motion is recommended in order to minimize contact duration with the ultrasonic tip and minimize heat build-up. When lateral motion is not possible withdraw and re-insert tip frequently.
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BoneScalpel™ with SonicOne® Technology
Instructions For Use
4. Considerations During Clinical Use 4.1.
Hand position
Recommended Hand Positions The following illustrations demonstrate safe positions for holding the handpiece.
Figure 4.1
Correct hand position
Holding the handpiece at the silicone sleeve should be avoided or kept brief with minimal amount of contact pressure.
Figure 4.2
WARNING 4.1
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Incorrect hand position
Contact to vibrating elements like extension and ultrasonic tip may cause burns and should be avoided by all means. The handpiece should only be held at the black housing area. An optional, protective silicone sleeve, included with certain tips, reduces the risk of thermal damage but does not eliminate it. Contact with the silicone sleeve should be
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BoneScalpel™ with SonicOne® Technology
Instructions For Use
avoided or kept brief with minimal amount of contact pressure. Pressure and extended exposure can still result in excessive frictional heat and cause burns. NOTE 4.1
4.2.
After extended periods of operation, the bottom of the console housing may become warm to the touch. This is normal. Do not touch the bottom of the console housing while in operation or shortly after operation.
HARD Tissue Use
Recommended Settings For Hard Tissue Use The following settings are general guidelines and should be adjusted based on indication, anatomy, pathology and surgeon’s preference.
Highest Very High High Standard (Default) Moderate Low Table 4.1
Amplitude 10 9 8 7 6 5
Pulse 100% 100% 100% 100% 100% 100%
Flow 100% 90% 80% 70% 60% 50%
Recommended settings for hard tissue removal
A high amplitude setting results in more aggressive tissue removal, a low setting in less aggressive tissue removal. A higher amplitude setting in combination with lower irrigation could result in increased tissue necrosis. A lower amplitude setting in combination with higher irrigation would minimize or eliminate tissue necrosis. Bone shaving tips tend to require a lower amplitude than cutting blades.
WARNING 3.1
Tip and irrigant temperatures may exceed the tissue necrosis point if insufficient irrigation flow rates are used. For hard tissue removal , set the irrigation flowrate to a setting no less than the comparable vibration setting. For example, if the vibration setting is 7, a minimum flow setting of 70% should be used. Additional external irrigation, e.g. by administering sterile saline with a syringe over the distal tip portion, may be necessary for removal of very dense, hard osseous structures.
WARNING 3.2
Tissue necrosis may result if tip is not moved relative to tissue. A continuous, lateral sweeping motion is recommended in order to minimize contact duration with the ultrasonic tip and minimize heat build-up. When lateral motion is not possible withdraw and re-insert tip frequently.
WARNING 4.2
Additional external irrigation, e.g. by administering sterile saline with a syringe over the distal tip portion, may be necessary for removal of very dense, hard osseous structures of the skull, when using the BoneScalpel accessories.
CAUTION 4.1
Ultrasonic energy is inhibited if excessive physical force is applied to the ultrasonic tip; use only enough force to guide the tip to the surgical site and to advance it through the tissue. Do not force the tip; allow the ultrasonic action to do the work.
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BoneScalpel™ with SonicOne® Technology
Instructions For Use
Tip Limitations During Bone Removal Both the ultrasonic tip and the extension are vibrating at high frequency and are thus exposed to extreme mechanical stresses, especially when cutting bone.
WARNING 4.3
Ultrasonic tips can break under excessive use in extreme conditions, e.g. when cutting for extended duration in tight cavities with limited lateral motion. The tip could break into two or more fragments with the main fragment remaining attached to the handpiece. All fragments must be retrieved immediately from the surgical site. The fragments should be checked to ensure that no further pieces are missing. It is possible that a fragment is propelled outside of the surgical cavity. Diagnostic imaging, such as X-ray, must be used if a fragment cannot be found to confirm that the broken piece is outside of the surgical cavity.
WARNING 4.4
Breakage of ultrasonic tips will result in sharp edges that can be harmful to soft tissue even without activation of ultrasound. Tips can bend or deform before they actually brake. Tips showing signs of deformation or cracking should be replaced immediately since tip breakage is otherwise imminent. Do not bend or twist the ultrasonic tips since it reduces the structural integrity and can result in tip breakage during use. Dispose of deformed or broken tips immediately in a sharps container.
CAUTION 4.2
Insufficient irrigation and high tip pressure (loading) under extended exposure, e.g. in tight cavities, are to be avoided in BoneScalpel hard tissue removal. It is recommended to withdraw and re-insert the ultrasonic tip repeatedly to reestablish adequate cooling and lubrication.
NOTE 4.2
Loose tip/tissue contact upon an initial bone incision can cause a thin tip to resonate not only longitudinally but also transversely. This can cause a thin tip to break. It is necessary to engage bone actively and with a minimal tip pressure greater than zero in order to prevent the shattering.
NOTE 4.3
Contact of the ultrasonic tip or the exposed extension with metal, surgical instruments or other objects during ultrasound use must be avoided. Such contact can damage the ultrasonic components very easily and may result in compromised performance, including failure. Discard any extensions or tips that show signs of damages like gouges, nicks or fractures. External aspiration may be used but it is recommended that a plastic suction tip should be used when in proximity with the probe tip.
4.3.
SOFT Tissue Use
Recommended Settings For Soft Tissue Use The following settings are general guidelines and should be adjusted based on indication, anatomy, pathology and surgeon’s preference.
Highest Very High Factory default High Moderate Low Very low Lowest Table 4.2
Amplitude 10 8 7 6 5 4 3 2
Pulse 100% 100% 100% 100% 100% 100% 100% 100%
Flow ≥10% ≥10% 70% ≥10% ≥10% ≥10% ≥10% ≥10%
Recommended settings for soft tissue debridement
A high amplitude setting results in more aggressive tissue removal, a low setting in less aggressive tissue removal. A lower amplitude setting in combination with higher irrigation results in less aggressive tissue removal with an increased ability to wash debris from the wound.
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BoneScalpel™ with SonicOne® Technology
Instructions For Use
5. System Overview 5.1.
Principle Of Operation
The BoneScalpel system is designed to ultrasonically dissect and fragment hard (osseous) and soft tissues. The system consists of an ultrasonic console with handpiece and accessories. The console features an integrated irrigation pump.
Figure 5.1
BoneScalpel Console
Figure 5.2
BoneScalpel Handpiece
The console produces an electrical signal that is fed into the handpiece and its piezoelectric transducer. The transducer converts the electrical signal into mechanical vibrations. The vibratory motion is amplified all the way down to the tip’s distal end. Various tip shapes and sizes are available to achieve desired tissue effects.
Hard Tissue Applications: Specialized hard tissue tips are utilized to cut hard, osseous structures. o
o o
BoneScalpel blades, typically used for performing osteotomies, are usually flat and have a blunt active edge. A compression cut is achieved through repetitive impacts on the bone at an ultrasonic frequency. Bone shaving tips are used for sculpting bone. They have an abrasive surface for bone removal through abrasion under ultrasonic oscillation. BoneScalpel multi-function tips can have a combination of blunt and abrasive cutting surfaces.
Soft Tissue Applications: Specialized soft tissue tips are utilized to cut and fragment soft tissue structures (SonicOne technology). o
Debridement tips are typically used for contact wound debridement. Tissue excision and fragmentation are achieved through cavitation and other mechanical and hydrodynamic effects.
A peristaltic pump, integrated into the BoneScalpel console, provides irrigant (sterile physiological saline) to the operative site during use.
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BoneScalpel™ with SonicOne® Technology
Instructions For Use
5.2.
Reusable System Components
The following system components represent the minimum requirements for performing hard and soft tissue procedures. They can be ordered as a system or individually. Required System Components BCM-GN
BoneScalpel console
1 ea.
Includes IV pole, power cord, footswitch, peristaltic pump and instructions for use BCM-HP
BoneScalpel handpiece - universal, for hard and soft tissue applications
BCM-CW
Counter wrench - for BoneScalpel handpiece
1 ea.
Compatible with
1 ea.
BCM-HP
BCM-BW
T-Wrench - for hard and soft tissue tips
Compatible with
1 ea.
MXB-10 MXB-20 MXB-B1 MXB-B30 MXB-S1 MXB-10LC MXB-10LS MXB-20LC MXC-C1 MXC-R1 MXC-X1 BCM-SS
Probe cover - for hard tissue tips
Compatible with
1 ea.
MXB-10 MXB-20 MXB-B1 MXB-B30 MXB-S1 MXB-10LC MXB-10LS MXB-20LC BCM-H2
Probe cover - for soft tissue tips
Compatible with
1 ea.
MXB-C1 MXB-R1 MXB-X1
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BoneScalpel™ with SonicOne® Technology
Instructions For Use Table 5.1
Required system components
Components and quantities included with the system may change over time, please check with your Misonix representative for the most current configuration.
5.3.
Single-use, Sterile Components
At least one irrigation tubeset must be available for each surgical procedure. Irrigation Tubeset MXB-T
Table 5.2
Irrigation Tubeset
1 ea.
Irrigation tubeset
Ultrasonic tips are supplied sterile and are for single use only. At least one of the following tips must be available for each surgical procedure.
Hard Tissue Tips MXB-10
Bone Scalpel – 10mm, Blunt
Requires
1 ea.
BCM-SS probe cover Includes blade, short extension, and silicone sleeve MXB-20
Bone Scalpel – 20mm, Blunt
Requires
1 ea.
BCM-SS probe cover Includes blade, short extension, and silicone sleeve MXB-B1
Bone Scalpel – 20mm, Unilateral Serrations
Requires
1 ea.
BCM-SS probe cover Includes blade, short extension, and silicone sleeve MXB-B30
Bone Scalpel – 30mm, Unilateral Serrations
Requires
1 ea.
BCM-SS probe cover Includes blade, short extension, and silicone sleeve MXB-S1
Bone Shaver – Micro Hook
Requires
1 ea.
BCM-SS probe cover Includes shaver tip, short extension and silicone sleeve MXB-10LS
Bone Scalpel – 10mm, Blunt, Long Straight
Requires
1 ea.
BCM-SS probe cover
Includes blade, long straight extension and silicone sleeve MXB-10LC
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Bone Scalpel – 10mm, Blunt, Long Curved
Requires
1 ea.
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