[HSF] Bioglue - Cyanoacrylate

Tue Nov 7 05:47:12 EST 2006

> The one way to remove it from your skin is to convince your OR nurse to
> give some nail polish remover - acetone removes the glue. 

Aha ... Good advice Prasanna .... Tell me the technique to do that ...!

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Monday, November 06, 2006 8:51 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Bioglue - Cyanoacrylate
> 
> I just read Ben's post which pretty well summarizes it.
> The simple caveat is - dry field dry field - this may involve going on
> bypass. Reclamping or even a short period of circulatory arrest -
> anything to get a dry field.
> I had some years back posted a literature research on this in the HSF.
> Cyanoacrylate glue is inherently sterile - it locks the bacteria/fungi /
> viruses and does not allow them to replicate. In fat it is now used by
> histopathologists for "fixing" there blocks especially if friable.
> You can just keep some Cyanoacrylate glue in glutaraldehyde and use it
> or just ETO the tube or else suck it up with one syringe - change the
> needle and quickly apply it - the name of the game there is speed or
> else the syringe will get "locked " and stuck !!
> It acts basically as an adhesive and can be used to seal small holes. I
> have stuck a ruptured LV apex (post balloon) when the apex was just
> "mish mash" with it I think an original report was by Robiseck.
> Worth keeping in the OR - desperate times need desperate solutions.
> Beware - it sticks to everything - gloves /finger  and worse eyes.
> The one way to remove it from your skin is to convince your OR nurse to
> give some nail polish remover - acetone removes the glue.
> Prasanna
> 
> 
> 
> Nasser F. Abou'Seada wrote:
> > Prasanna
> > I'm very much interested in your use of Cyanoacrylate ... Super glue ...
> > would you elaborate on how you use it, exact technique, sterilization
"of
> > containing tube" ... precautions ... noted adverse effects ... how many
> > cases ... types of cases ???? .... any studies on that ??? histology ?
> > How would you insert your experience of Cyanoacrylate in Ben's
> > classification ???
> >
> > NFA
> >
> >> -----Original Message-----
> >> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> >> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> >> Sent: Monday, November 06, 2006 1:35 PM
> >> To: OpenHeart-L at lists.hsforum.com
> >> Subject: Re: [HSF] Bioglue
> >>
> >> Giulio,
> >>  I have used cyanoacrylate glue (basically super glue ) extensively.
The
> >> one thing that is important is to have a dry field. This may involve
> >> clamping or even a short period of circ arrest. If the area is not dry
> >> and blood free then the blood congeals on the glue  instead of two ends
> >> sticking.
> >> I t works well to sterilize meshes and also for postoperative sinuses
> >> too. I have even glued percutaneously unstable sternums with and
without
> >> fibrous union. It  works well in them too.
> >> Prasanna
> >> Giulio Rizzoli wrote:
> >>
> >>> Thank You Ben for the nice summarization.
> >>> I will add that among the adhesives there are the acrylic glues. Their
> >>> use was proposed in this  forum as a lifesaving maneuver in cases of
> >>> bleedings located in not reachable areas.
> >>> I experienced one of these cases in an aortic root replacement that
> >>> was successfully solved, as proposed by Levinson (I think) on this
> >>> forum by clamping both caval veins followed by clamping of the aortic
> >>> prosthesis and applying the acrylic glue on the blood deprived field.
> >>> The advantage of the glue in this case was in the rapidity of action
> >>> so the heart tolerated without problem the maneuver.
> >>> I don't use the commercially available acrylic glue but a modification
> >>> of it commercialized with the name "Glubran" (you can search it in the
> >>> internet).
> >>> The advantage is that doesn't prohibit the stitching with needles
> >>> because doesn't produce a very hard surface. If You use it on a dry
> >>> suture line you can be sure that you will not loose a single drop of
> >>> blood from that suture line.
> >>>
> >>> Giulio Rizzoli
> >>>
> >>>
> >>>
> >>>
> >>> One needs to look at such things as glues or adhesives and hemostatic
> >>> agents.
> >>>
> >>> GRF and BioGlue are adhesives. They form a firm layer that allows 2
> >>> surfaces to adhere - ie layers of a dissection. The 'curing' that
> >>> happens with the glutaraldehyde or formalin cures the other components
> >>> which glue the surfaces together. They are hemostatic in that they
> >>> provide a firm layer, not that they encourage hemostasis (rather they
> >>> probably discourage it with their toxic nature).
> >>> We have then the biological sealants. These are the various fibrin
> >>> glues Tisseel for one. These rely on naturally occurring fibrinogen
> >>> being converted to fibrin in an area of bleeding. If you can keep the
> >>> layer from floating away it can help. They are naturally absorbed.
> >>> There are the substances that provide a substrate for clotting  e.g.
> >>> Surgicel (oxidised cellulose). Topical thrombin is often used with
this.
> >>> There are a series of similar products such as Tachosil, Tachocomb
> >>> etc. These are not so much as adhesives but sealants.
> >>> There are now a wealth of other synthetic substances. These include
> >>> Hemaderm or Medafor (a starch based compound that absorbs blood and
> >>> promotes clotting as well as providing a degree of tamponade). CoSeal
> >>> and related substances act as sealants with no mechanical strength.
> >>>
> >>> There are also the devices Tomas mentioned a couple of weeks ago.
> >>>
> >>> These all are topical. I have not mentioned any of the drugs that can
> >>> be given internally (lysine analogues and aprotinin etc.)
> >>>
> >>> So, as far as Bioglue goes, not good for stopping bleeding, but useful
> >>> in VSD and LV rupture etc.
> >>> It has a drawback - it solidifies and thus can embolise.
> >>>
> >>> So, there are horses for courses.
> >>> (Sorry for the lecture it is part of a talk on such things)
> >>>
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