Boston Scientific AMS 800 Mode D'emploi page 12

Figure 20. Assess the size of the urethra
Figure 21. Assess the size of the urethra
b. The cuff sizer only provides approximate size of urethral circumference. Urethral
tissue thickness is patient specific and requires a physician's assessment
to determine its impact on cuff sizing. Cuff length size describes the outside
circumference of cuff when it encircles the urethra.
Cuff Preparation, Placement, and Filling
1. Prepare the cuff so that the cuff is aspirated of fluid and air.
a. Select appropriate cuff.
b. Attach a 15 gauge, blunt tip needle to a 30 ml syringe.
c. Fill the syringe with approximately 10 ml of filling solution.
d. Hold the cuff with one hand and squeeze it until the air is removed.
e. Insert the needle into the end of the cuff tubing.
f. Fill with solution and aspirate air from the cuff until air bubbles are removed.
Manipulate the cuff as needed, taking care not to overfill or stretch the cuff.
(Figures 22, 23).
Note: The amount of fluid needed to fill a cuff will vary depending on the cuff size
(approximately 1-5 ml). Larger cuffs require more fluid than smaller cuffs.
Figure 22. Manipulate cuff
Figure 23. Do not overfill the cuff
g. Inspect for bubbles. If air remains in either the cuff or the tubing, repeat the
above steps.
h. Pull back on the plunger and squeeze the cuff to aspirate the fluid.
CAUTION: Do not over-aspirate the cuff because air can be drawn into the
system through the semi-permeable silicone membrane.
i. With the air and fluid removed from the cuff, and keeping the needle within the
tubing, clamp one shod hemostat (one notch only) 3 cm below the needle. Clamp
a second shod hemostat (one notch only) 3 cm below the first (Figure 24).
Black (K) ∆E ≤5.0
Figure 24. Aspirate air from cuff, then clamp
j. Remove the 15 gauge blunt tip needle from the cuff tubing.
k. For an Inhibizone ™ treated cuff, place the prepared cuff onto an empty sterile
tray or kidney basin and cover with a sterile drape.
CAUTION: Soaking antibiotic treated devices in saline will cause the antibiotics
to diffuse off the device into the solution. This will cause the solution to turn
orange and will reduce the concentration of antibiotics on the device.
l. For a non-InhibiZone treated cuff, submerge the cuff in a kidney basin of filling
solution until the surgeon is ready to implant the cuff.
2. Implant the cuff.
a. Prior to implanting, the cuff should be inspected for entrapped air.
b. Position the cuff at the implant site with the mesh backing toward the outside
and the inflatable side toward the urethra (Figures 25, 26).
Note: The tubing should be on the patient's preferred pump side.
Figure 25. Implant cuff
c. Pass the prepared cuff, tab first, under the urethra and grasp the cuff tab with a
shod hemostat to wrap the cuff around the urethra.
CAUTION: To avoid damage to the cuff, grasp the cuff tab with a shod hemostat.
d. Pass the end of the cuff tubing through the hole until the hemostat meets the
hole. Clamp a hemostat onto the cuff tubing on the opposite side of the hole, and
then release the first hemostat, so air does not enter the cuff.
Note: Flushing the tubing before clamping the second hemostat prevents air from
entering the cuff.
e. Pull the remainder of the tubing through the hole and close the cuff by pulling the
tab over the tubing adaptor (button). Ensure that the edges of the hole fit into the
slot of the adaptor.
f. Rotate the cuff so the adaptor tubing avoids contact with the cuff.
PRB Preparation, Placement, and Filling
1. Select the appropriate PRB.
Note: The surgeon usually selects the lowest PRB pressure needed to maintain
closure of the bladder neck or bulbous urethra.
2. Prepare the PRB.
a. Attach a 15 gauge, blunt tip needle to a 30 ml syringe.
b. Fill the syringe with approximately 25 ml of filling solution.
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Figure 26. Implant cuff