ARTISS must be applied only to application sites that are visible. Individualize the amount to be applied based on the size of the surface to be covered. Prior to applying ARTISS, dry the site of application using standard techniques (e.g., intermittent application of compresses, swabs, use of suction devices). Do not use pressurized air or gas for drying the site. Apply ARTISS as a thin layer.
The approximate surface areas covered by each package size are:
Table 3Approximate area requiring skin graft fixation | Required package size of ARTISS |
100 cm2 200 cm2 500 cm2 | 2 mL 4 mL 10 mL |
When applying ARTISS using a spray device, utilize the recommended gas, pressure and distance from tissue within the ranges recommended by the manufacturer as follows:
Table 4: Recommended Application Equipment, Gas and Parameters.Surgery | Spray set / Applicator tips to use | Pressure regulator to use | Gas | Distance | Spray Pressure |
Open surgery | Tisseel / Artiss Spray Set | EasySpray Regulator | CO2 CO2 is the preferred gas for application, however Medical Air or Nitrogen are acceptable gasses for administration of ARTISS in open surgery. , Medical Air or Nitrogen | 10-15 cm | 1.5-2.0 bar (21.8-29.0 psi) |
Application with Spray Device
Apply using the EasySpray and Spray Set, or an equivalent device cleared by FDA for application of ARTISS. See additional instructions for use provided with the spray set. Artiss must not be used with the EasySpray / Spray set system in enclosed body cavities.
Ensure that parts of the body outside the desired application area are sufficiently covered to prevent tissue adherence at undesired site.
Apply as a thin layer to avoid the formation of excess granulation tissue and to ensure gradual absorption of the polymerized fibrin sealant. Excessive clot thickness may delay the natural wound healing process. Ensure that the amount applied is sufficient to entirely cover the intended application area.
The aerosolized sealant should be applied to the wound in a painting motion from side to side to achieve an even thin layer. The wound bed will glisten in the area to which fibrin sealant has been applied. Any areas not covered by fibrin sealant will be clearly visible.
Attach the skin flap or graft to the wound bed immediately after ARTISS has been sprayed. Wet gloves with normal saline before product contact to prevent adherence. The surgeon has up to 60 seconds to manipulate and position the flap or graft prior to polymerization.
Repeat application, if necessary, to any small areas that may not have been previously treated.
Hold the flap or graft in the desired position by gentle compression for at least 3 minutes to ensure ARTISS sets properly and firmly adheres the skin graft or flap to the underlying tissue. The solidified fibrin sealant reaches its final strength in approximately 2 hours after application.
Application with DUO Set A
The cannulas included with the DUO Set A may be used for small wounds or for edges of a skin graft that did not adhere to the wound bed [see Warnings and Precautions (5.3)]. Immediately before application, expel and discard the first several drops from the application cannula to ensure adequate mixing of the Sealer Protein and Thrombin solutions in cases where very small volumes (1-2 drops) are administered.
DUO Set A Instructions (see Figure 1 below):
- 1.Insert plunger into syringe barrel.
- 2.Firmly connect the two syringe nozzles to the joining piece and secure it by fastening the tether strap to the syringe.
- 3.Fit an application cannula to the joining piece.
Note: Interruption of application causes clogging in the cannula. Replace the cannula immediately prior to resuming application. If the opening of the joining piece (Y connector) facing the cannula is clogged, use the spare joining piece provided in the package.
Figure 1: Duo Set A (Image 01)
Figure 1 DUO Set APre-filled syringes are for single use only. Discard unused contents.