Ligation of oesophageal varices
- Lubricate the scope and exterior part of the band barrel ensuring that no lubricant has entered the barrel.
- Roll back the big wheel 180˚ to permit that the tracking wires is not fully straightened so that no band is shot while inserting the endoscope into the patient.
- When in place, tension again the tracking wire using the small wheel to prepare for the shooting (be sure that the alignment arrows on the handle are facing each other).
- Locate the selected varix and aspirate it into the band barrel.
- To fire the band, slowly rotate 180º forward the big wheel. More than one ligation band for each varix might be needed to control acute bleeding.
- Release the suction button of the scope, insufflate air and then withdraw the scope slightly to release the ligated varice.
- Repeat the procedure until the last varix is banded.
- The luer-lock connection is available to ensure irrigation of the scope biopsy channel if required. After removing the blue cap, attach the luer-lock connector to a syringe filled with sterile water and irrigate.
- After irrigation put back the blue cap to ensure good suction.
- In case additional bands are needed, remove the scope and attach a new Multiband Ligator starting back from the mounting steps.
Removing the Multiband Ligator
- Once the ligation procedure is completed, remove the scope from the patient.
- Dismantle the the Multiband Ligator as follows:
- If any unused bands are still on the barrel shoot all remaining bands.
- Remove the Multiband Ligator handle from the biopsy channel by pulling it, the remaining tracking wire attached with the handle should be removed also.
- Remove the band barrel from the scope tip.
- Dispose all parts per institutional guidelines for biohazardous medical waste.
- If all bands have been used, you can remove the Multiband Ligator from the biopsy channel and continue using the scope and its biopsy channel while still inside the patient.
Reloading the Multiband Ligator
- Once the complete system is out of the patient and removed as described above, you may start the reloading process.
- Loosen completely the tracking wire by turning backwards the big wheel.
- Remove the blue luer-lock cap.
- Press the locking clip towards the center of the handle.
- Remove the used L-shape reloading unit.
- Remove the blue luer-lock cap from the new reloading units.
- Insert the new L-shape reloading unit through the hole of the handle (see picture aside). You should hear a “click” once it is correctly in place.
- Put back the blue luer-lock cap.
- Attach the tracking wire loop through the shaft hook as indicated aside.
- While holding with your thumb the tracking wire inside the hook, turn the small wheel forward until the tracking wire is slightly tensioned.
- The reloaded unit is now ready for use and you may follow the instructions from “Mounting the Multiband Ligator”.