COOK Medical EchoTip Ultra Manual page 5

3. Attach device to endoscope accessory channel port by rotating device
handle until fittings are connected .
4. With ultrasound endoscope and device straight, adjust needle to
desired length by loosening thumbscrew on safety ring, and advancing it
until desired reference mark for needle advancement appears in window
of safety ring . (See fig . 4) Tighten thumbscrew to lock safety ring in place .
Note: Number in safety lock ring window indicates extension of needle
in centimeters . Caution: During needle adjustment or extension, ensure
device is attached to accessory channel . Failure to attach device prior to
needle adjustment or extension may result in damage to endoscope .
5. While maintaining position of ultrasound endoscope, extend needle by
advancing needle handle to pre-positioned safety ring .
6. Advance needle into lesion, intra- or extra-hepatic bile ducts,
pancreatic duct, cystic duct or gallbladder .
7. Remove stylet from needle by rotating stylet cap anti clockwise and
gently pulling it back from metal fitting of handle . Preserve stylet for use
if additional punctures are desired later .
8. For maintaining access a 0 .035" wire guide (Cook Medical
recommended) can be advanced through needle . Skip to step 12 . Note:
a 0 .035 wire guide can also be advanced post aspiration . For FNA, attach
Luer lock fitting of previously prepared syringe securely onto fitting on
handle . For FNI, follow manufacturer's guidelines for use of injectable
materials and skip to step 12 .
9. Turn stopcock to "open" position aligned with syringe, allowing
negative pressure in syringe to aspirate cells . Gently move handle in
small increments, back and forth within biopsy site . Note: Do not remove
needle from biopsy site during cell collection
10. Upon completion of FNA, turn stopcock to "close" position .
11. Retract needle into sheath by pulling back on handle shaft . Lock
thumbscrew on safety ring at 0cm mark .
12. Disconnect Luer lock fitting from accessory channel and withdraw
entire device from ultrasound endoscope . Note: If a wireguide has been
advanced, withdraw needle over wireguide .
13. The remaining steps are for FNA only .
14. Unlock thumbscrew on safety ring and extend needle . Exchange
locking syringe for an empty syringe; attach to Luer lock fitting on
handle .
15. Push in plunger to expel aspirate specimen, then prepare per
institutional guidelines .
16. Remaining aspirate may be recovered for examination by reinserting
stylet or flushing device .
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