Ethicon Echelon Flex PCEE45A Manual Del Usuario página 10

a. At any time, if the knife reverse switch does not return the knife to home position and the jaws will not open:
i. First, ensure the battery pack is securely installed and the instrument has power (Illustration 9); then, try the
knife reverse switch again (Illustration 7).
ii. If the knife still does not return, use the manual override.
Caution: After the manual override system is used, the instrument is disabled and cannot be used for any subsequent
firings. To use the manual override, remove the access panel labeled "Manual Override" on the top of the instrument
handle. The manual override lever will be exposed. Move the lever forward and backward until it can no longer be moved
(Illustration 10). The knife will now be in the home position. This can be verified by viewing the position of the knife blade
indicator on the underside of the reload jaw (Illustration 11). Discard the instrument.
Once in the cavity, squeeze the closing trigger, then simultaneously press the anvil release button on either side of the instrument
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(Illustration 8a). While pressure is still on the anvil release button, slowly release the closing trigger to reopen the jaws and return the
closing trigger to its original position (Illustration 8b).
If needed, rotate the jaws by pushing on the fins of the rotating knob with the index finger using a downward or upward pressure
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(Illustration 12). The instrument shaft will rotate freely in either direction.
To articulate the jaws inside the body cavity, select an appropriate surface (a body structure, organ, or another instrument) to use as
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a grounding surface to bend the jaws, ensuring that it stays within the field of view. Rest the lateral side of the jaws that are opposite
to the desired direction of articulation against the grounding surface (the jaws must be open in order to articulate the instrument)
(Illustration 13).
WARNING: Do not attempt to articulate by pressing the front of the jaws against the grounding surface as tissue damage or tissue
trauma may occur (Illustration 14).
Pull the fins of the rotating knob back with the index finger and apply a sweeping motion towards the side articulation is wanted
while gently pushing the instrument handle towards the grounding surface. Maintain the jaws pressed against the grounding surface
during this action. Once the desired articulation angle is reached, release the rotating knob to lock the angle (the instrument will only
lock at pre-determined angles – 15º, 30º and 45º).
Caution: The instrument can only achieve a maximum articulation angle of 45º. When using body structures or organs as a
grounding surface, particular attention should be placed to the visual cues and tactile feedback received from the instrument. When
the maximum angle is reached, the force will increase indicating the maximum angle has been reached. Avoid applying excessive
pressure to the tissue as tissue damage or tissue trauma may occur.
Position the instrument around the tissue to be stapled.
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Caution: Ensure that the tissue lies flat and is positioned properly between the jaws. Any "bunching" of tissue along the reload,
particularly in the crotch of the jaws, may result in an incomplete staple line.
The distal black lines on the anvil and reload channel designate the ends of the staple line. The line on the reload channel that reads
"cut" references the cut line on the device (Illustration 1).
Caution: When positioning the stapler on the application site, ensure that no obstructions such as clips, stents, guide wires, etc. are
within the instrument jaws. Firing over an obstruction may result in incomplete cutting action, improperly formed staples, and/or
inability to open the instrument jaws.
After positioning the instrument jaws, close the jaws by squeezing the closing trigger until it locks (Illustration 5). An audible click
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indicates that the closing trigger and the jaws are locked. When the jaws of the instrument are closed, the red firing trigger lock and
firing trigger are exposed. Holding the jaws in place for 15 seconds after closing and prior to firing may result in better compression
and staple formation.
Caution: Ensure tissue has not extended (extruded) proximal to the proximal black line on the instrument (Illustration 1). Tissue
forced into the instrument proximal to the black line may be transected without staples.
Caution: If the closing trigger is difficult to lock, reposition the instrument and take a smaller amount of tissue. Ensure that the
proper reload selection has been made. (Refer to the Reload Product Codes Table.)
Caution: If the clamping mechanism becomes inoperative and the jaws do not clamp on tissue, do not fire the instrument. Remove
and do not continue to use instrument.
Caution: The use of staple line buttressing materials with the instrument may require an increased force to close. When using staple
line reinforcement material, the instructions of the manufacturer of the material should be followed.
Pull back the red firing-trigger lock to enable the firing trigger to be pulled (Illustration 15).
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Fire the instrument by pulling the firing trigger; the motor will activate audibly (Illustration 16). Continue to depress the trigger until
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the motor stops (audible feedback). The motor will slow down when device encounters more force. Alternatively, for enhanced tissue
compression, the user may pulse the firing trigger throughout the firing cycle until the transection is completed.
Caution: Since the motor may stop if it stalls, it is important to do a visual check to ensure that the knife blade indicator, on the
underside of the reload jaw, has reached the end of the transection.
Caution: Attempting to force the device to complete the firing stroke with too much tissue between the jaws, or with dense/thick
tissue between the jaws, may result in motor stall and the knife will stop. If this happens, release the firing trigger, slide the knife
reverse switch forward, and remove and reload the instrument (Illustration 7). Then, position the instrument around a smaller tissue
section or use a more appropriate reload (refer to the Reload Product Codes Table).
To complete the firing sequence, release the firing trigger to activate the motor and automatically return the knife to home position
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where the motor will stop. In this position, the instrument is locked out until the jaws are opened and re-closed.
a. If it is necessary to interrupt the firing sequence or it is interrupted inadvertently by releasing the trigger during the firing
sequence, pull the firing trigger again to continue. The status of the transection can be determined by observing the knife
blade indicator on the underside of the reload jaw at the beginning and end of the firing (Illustration 1). Once the knife
reaches the end of the firing, releasing the trigger automatically returns the knife to home position.
Caution: If the instrument locks out, the motor will stop. Release the firing trigger and slide the knife reverse switch
forward to return the knife to the home position (Illustration 7). In this position, the instrument should be removed, opened,
and reloaded in order to continue. To open the jaws, squeeze the closing trigger, then simultaneously press the anvil release
button on either side of the instrument (Illustration 8a). While pressure is still on the anvil release button, slowly release the
closing trigger (Illustration 8b). Follow the instructions for Reloading the Instrument.
b. At any time, if the knife reverse switch does not return the knife to home position and the jaws will not open:
i. First, ensure the battery pack is securely installed and the instrument has power (Illustration 9). Then, try the
knife reverse switch again (Illustration 7).
ii. If the knife still does not return, use the manual override.
Caution: After the manual override system is used, the instrument is disabled and cannot be used for any
subsequent firings. To use the manual override, remove the access panel labeled "Manual Override" on the
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