inhealth Blom-Singer Instructions For Use Manual page 7

INSTRUCTIONS FOR USE
PRIMARY TRACHEOESOPHAGEAL PUNCTURE AND
VOICE PROSTHESIS PLACEMENT
The following procedural instructions are provided by Stephen
B. Freeman, M.D., F.A.C.S. and Eric D. Blom, Ph.D. for primary
tracheoesophageal
tracheoesophageal tract dilation and voice prosthesis placement.
1. Primary tracheoesophageal puncture and voice prosthesis
placement is undertaken following standard wide field total
laryngectomy prior to a three layer closure of the pharynx in
a T or Y fashion.
2. Insert the pharynx protector deeply enough into the
esophagus to ensure protection of the posterior esophageal
wall at the level of the puncture (Diagram 1).
3. The sheath of the trocar should be completely covering all
but the cutting tip of the curved needle and positioned so
that the multi-color bands are closest to the tip of the curved
needle.
4. Use the trocar to carefully puncture the tracheoesophageal
wall at the midline 10-15mm below the mucocutaneous
juncture into the lumen of the esophagus.
5. Penetration into the esophagus is carefully observed and
immediately terminated when the leading edge of the
white band marker on the needle sheath is observed.
Simultaneously, the color association band on the sheath
where it enters the puncture on the tracheal side of the
tracheoesophageal wall approximates the wall thickness
and appropriate length voice prosthesis to be placed. (White
band 8mm, Blue band 10mm, Orange band 12mm, and
Green band 14mm). (Diagram 2)
6. Securely grasp the needle sheath with a hemostat with
sufficient force to stabilize it securely in its position of
penetration into the esophagus and withdraw and discard
the puncture needle.
Blom-Singer ® Voice Prosthesis Placement Surgical Kit
puncture followed by simultaneous
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