Hemostasis Flashcards
What is Hemostasis?
Hemostasis is the cessation of bleeding
What is angiogenesis?
The formation of new blood vessels
What features are the same between Mantis & the Resolution family?
Mantis will feel comfortable to the physicians and hospital staff because it is built on the same platform as our Resolution portfolio.
- Catheter Design: It has familiar design with 32 braided wires. There are 16 wires braided in each direction, allowing for physician controlled rotation in both directions. Mantis can be rotated by turning the control knob in either of the two direction. Typically this is done by the nurse or technician. Or by turning the catheter in either direction where it enters the scope channel. Typically this would be done by the physician.
- The deployment system: The same snap, crackle, pop deployment
- Trusted locking mechanism: Our locking tabs allow for retention. This is why we can say prophylactic clipping in the indication. Our locking tabs greatly reduce risk of delayed bleeding because they stay closed. Your body needs angiogenesis.
What are the jaw sizes of Res 360, Res 360 ULTRA, and Mantis?
Resolution 360: 11mm
Resolution 360 ULTRA: 17mm (largest* through-the-scope hemoclip on the market)
Mantis: 11mm
What size defects can Mantis close?
While Mantis only opens 11mm, it can mobilize and close a 3cm defects. It is 21% stronger than Resolution Ultra. We don’t need to keep getting bigger. We decided to end the arms race for biggest clip.
When would you choose Mantis over Resolution?
An ulcer possibly - Mantis prongs can help with slippage if you are comfortable with the 3 step approach (anchor, mobilize, close).
Deliberately designed for closing large (<3cm) defects because of tissue approximation (bring one end of tissue to another).
But they rely on healthy tissue right outside the defect.
What makes the Mantis clip unique?
TruGrip Anchor Prongs: Only available with MANTIS, introduce grasping capabilities designed to allows users to achieve tissue apposition during defect closer through a novel anchor, mobilize, and close approach / minimizes slippage.
There is a 60 degree backwards angle of the anchor prongs. They scoop the tissue (vs. cutting it).
Where does bleeding tend to occur in the GI tract?
90% of GI bleeding occurs in the upper GI tract and peptic ulcer is the most common cause
What is a peptic ulcer?
Peptic ulcers are open sores that develop in the lining of the duodenum, lower end of the esophagus, or the stomach (usually along the lesser curvature).
What causes a variceal bleed?
Varices are dilated blood vessels. They are caused by portal hypertension and are primarily found in the esophagus and stomach.
What is portal hypertension? What causes it?
Portal Hypertension is high blood pressure. One reason for hypertension is a blockage of normal blood flow in the liver due to a clot or scar tissue. That forces more blood into smaller blood vessels.
What is the most common cause of overt lower GI bleeding?
Diverticular disease is caused by diverticula, which are pouches or protrusions in the colonic wall. Bleeding associated with these pouches is the most common cause of overt lower GI bleeding in adults.
Diverticula can result in massive bleeding. The bleeding may also be occult, which means there is no evidence of visible blood.
What are the common methods to achieve hemostasis?
- Thermal Coagulation
- Injection Therapy / Sclerotherapy
- Mechanical (Clipping)
What is Sclerotherapy?
Injection therapy agents (Epi, saline, sclerosants, vasoactive drugs, cyanoacrylate glues, fibrin, thrombin) are injected at the site.
Injection therapies are considered inferior to other options for controlling upper GI bleeding and are not currently recommended as standalone therapies. Injection therapy is typically used in conjunction with other modalities such as mechanical or thermal
As an example of this approach, sclerosant (an irritant) injected directly into a vein causes blood clots to form and stops the bleeding. Alternatively, injection into the area besides the distended vein stops the bleeding by thickening and swelling the vein to compress the blood vessel.
Which product of ours do we use to introduce a vasoconstrictor into a site to control the bleeding?
Interject Needle. Use the black catheter in this case to contrast the blood.
But it also is used for EMR and ESD procures. Use the clear catheter in this case so you can see the coloring dye.
