Treatment Recommendations; General; Recommended Settings - Boston Scientific Swiss LithoClast Select Mode D'emploi

TREATMENT RECOMMENDATIONS

General

Intracorporeal lithotripsy by use of ultrasound and pneumatic energies,
used simultaneously or individually, requires experience and skill
in endoscopic technique. A good balance of irrigation through the
endoscope versus suction is important for a proper endoscopic view.
Excessive and badly timed flushing should be avoided in order not to
flush away the stone.
The stone can only be fragmented if the ultrasound probe and/or the
pneumatic probe is/are in direct contact with it. Before releasing a
pulse or activating the ultrasound, touch the stone with the probe tip
and move it slightly to verify contact.
Due to the push back effect, mobile ureteric stones should not to be
treated from below with the probe positioned in the center of the stone.
Best practice is to position the probe tangentially at the stone so that
the lithotripsy pulses will not push it back.
The stone should be hit at the corner or at the edges depending on
its structure.
It is useful to treat the stone by pushing it slightly against the ureter wall
and working with a low pulse rate. Use of a stone migration prevention
device may be indicated.
It is possible to treat impacted stones directly "in situ" using only
pneumatic lithotripsy, because pneumatic lithotripsy does not generate
heat, therefore no risk of thermal damage to surrounding tissues.
20
FB-411_US_ed_2013_10_Not_Swiss LithoClast Select BSC.indd 20

Recommended settings

For each lithotripsy method, whether used individually or in
combination, it is recommended to start fragmentation at medium
power settings of 50 % to 60 %.
The frequency of the pulses should not be higher than 7Hz in individual
mode with a duty cycle set at 100 % at the beginning whether used
alone or in combination with pneumatic lithotripsy, and can be increased
or decreased gradually.
For combined application, it is recommended to set the pneumatic
pulses frequency at 2~3Hz to help controlling the fragmentation.
Working with a duty cycle of less than 100 % can be helpful to
reduce warm-up of the ultrasound instrument if e.g. the endoscopic
procedure requires to reduce suction through the ultrasound instrument.
6/3/2015 2:33:54 PM