How To Use Chitogel

Easy, Efficient and Effective

Everything you need to prepare, mix and apply Chitogel is found in the Chitogel Endoscopic Sinus Surgery Kit.

The Gel preparation and setting time will take approximately 20 minutes, so preparation must start sufficiently in advance of when the Gel is expected to be used in surgery.

Watch our step-by-step mixing video to see how Chitogel is used in practice.

Using Chitogel follows a simple, three step process. These three steps are Preparation, Mixing & Application

How to apply Chitogel

Watch Dr. Daniel E Braby elegantly demonstrate the seamless process of applying Chitogel into the sinuses, as well as the significant ostial area improvements and wound healing benefits experienced by the patient after sinus surgery.

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When applying Chitogel, it is important to apply the Gel to all areas in a specific sequence.

10 mL of Chitogel is to be applied to each side.
Apply the Gel to the sinuses in order, firstly applying to the frontal sinus.
Bend the tip of the malleable cannula for the angle required to place accurately into the frontal ostium. Next, place Chitogel into the sphenoid sinus, then fill the ethmoid sinuses in a posterior to anterior direction, and then around the maxillary ostium.
Lastly, apply to the space between the anterior end of the middle turbinate and the lateral nasal wall. It’s important to leave space in the floor of the nose so the patient will have a bilateral nasal airway.

Post-Operative Care

The patient should be advised to undertake nasal washes 4-6 times per day for two weeks following surgery.
The patient should be advised that the nasal washing should be conducted using a normal nasal saline washing solution and each wash should use approximately 8 ounces/240 mL.
The patient must have a post-operative review by the surgeon, within 1-2 weeks of the surgery. At the first post-operative review by the surgeon, any remaining Gel in the sinus cavity should be removed, ideally with suction.

Trouble Shooting

COMPLICATIONS ASSOCIATED WITH NOT IRRIGATING SINUSES POST-OPERATIVELY

It is imperative that the sinuses are irrigated on a regular basis from the first post-operative day. We advise using 240 mL of saline douche, 4-6 times daily for the first 2 weeks after surgery. Failure to do so can result in the Gel forming into a crust.

If this occurs, then careful debridement of the crust and removal should be performed by the surgeon at the 2 week post-operative review, and saline irrigations commenced.

MAINTAIN CLEAR BREATHING PASSAGES

If after application of the Gel there is too much Gel in the floor of the nose for the patient to breathe through, careful suctioning along the floor of the nose is recommended to remove the excess Gel.

CONTROL EXCESSIVE BLEEDING BEFORE APPLYING

At the end of the surgery, it is important that any active bleeding is controlled, as you would normally, prior to application of the Gel. Bipolar cautery is used to control active bleeding. This must be done before the placement of the Gel, to avoid the risk that the Gel may be “washed” out of the sinuses by significant bleeding.

Precautions

Verify that the surgical field is not bleeding excessively. Control excessive bleeding, as you would normally, prior to application of the Chitogel Endoscopic Sinus Surgery Kit material.
Inspect the packaging to be sure that it is intact and undamaged prior to use. Do not use the product if the packaging is opened or damaged.
Do not reuse or resterilise the Chitogel Endoscopic Sinus Surgery Kit.
Inspect the Kit contents prior to use. Do not use the product if any of the sealed vials appear to have been opened or to have leaked, or if any of the components of the Kit appear to be damaged.

Warnings

Chitogel Endoscopic Sinus Surgery Kit contains Chitosan from shellfish and should not be used in patients with known allergic responses to shellfish. Physicians should test for shellfish allergic response if status is unknown, prior to use.
The Chitogel Endoscopic Sinus Surgery Kit should not be used in surgery involving any of the following complications:
- Any form of cerebrospinal fluid leak
- Any form or ophthalmic complication, including but not limited to orbital hemorrhage or haematoma and exposure of the orbital tissues.
In rare instances, the physiochemical condition associated with Functional Endoscopic Sinus Surgery (FESS), both with and without material application, may present a risk of toxic shock syndrome (TSS). Warning signs of TSS include: sudden fever (usually 39℃ or more), vomiting, diarrhoea, dizziness, fainting (or near fainting when standing up), and/or a rash that looks like a sunburn.
Foreign body reaction may occur as with most surgical adjuvant treatments.
Chitogel Endoscopic Sinus Surgery Kit must be used according to the instructions for use. Read instructions prior to use.