I am giving below the step by step process of reconstituting Tisseel Lyo when you do not have access to Fibronotherm Machine.
Things you need to have outside the sterile area.
• One 200ml bowl.
• 150ml of water measuring 36 to 37.5deg centigrade.
• Long kitchen thermometer (Easily available in Amazon)
Allow the kit to lay outside the refrigerator and keep them in room temperature.
Open the Tisseel Lyo Kit. You will find that the vials are neatly arranged inside the box. There will be 4 vials: Two with Blue caps, two with black caps.
Take these vials one at a time and roll them between your bare ungloved palms so that it comes closer to human body temperature.
Also you will be provided with Syringes with long needles. Use these syringes and draw the solution from the Blue cap vial and inject into the blue cap vial which has lyophilised powder and start shaking vigorously and place it in the water(immerse till neck of the vial)
Repeat this for black capped vials.
After about 5 min in the water, check if the solutions have mixed properly and moves freely inside the vial.
Now hold out these vials to the scrub nurse. Using two fresh syringes provided, nurse can draw out these vials till it is empty.
Now we have two syringes. These syringes have to be carefully assembled into the Duploject system. Some tips for doing this step easily. Keep the plunger height uniform in both the syringes. Also keep the head of the plunger head in similar direction. When these two are done, both the syringes fit neatly into the duploject system. As a last step connect the mixing nozzle to both these syringes.
Now apply mild pressure at the head of Duploject Plunger and check if the mixed solution comes out from both the syringes. Keep it in a corner of scrub trolley with needle side facing up.
Once reconstituted, the solution should be used within 4 hours.
What can go wrong:
The reconstituted solution gets hardened. This happens when the temperature of the water is higher that 37.5deg. Or when the solution is not mixed properly. That’s the reason we recommend vigorous shaking of the vial.
The solution does not stick. This happens when only one component comes out the Duploject system. We need both fibrin and thrombin for the good adhesive action.
Also have in mind, using more solution than what is required will be counter productive. Its like using a table spoon of gum for sticking a small postage stamp to the envelope.