autologous pericardium step-by-step instructions - … · autologous pericardium step-by-step...

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Autologous Pericardium Step-by-Step Instructions Please Read the Autologous Pericardium Information for Physicians And Hospital Staff Included in the Cooler Wet Ice Sterile Normal Saline Sterile Specimen Cup Receipt and Preparation Your Autologous Pericardium Cooler Kit comes with the following: • Shipping box with clear poly bag liner • Cooler with clear poly bag liner • 2 Forms • 1 sheet with 5 labels • 1 Autologous Pericardium Information for Physicians and Hospital Staff (PLEASE READ) • Two zip bags • One wrap tie What You Will Need Packaging 1. Place pericardium into sterile specimen cup. Completely submerge in sterile normal saline. 2. Fill and attach provided label to specimen cup. 3. Place specimen cup in zip bag and close. Place zip bag into the lined cooler. 4. Fill with wet ice to cover completely. Wrap tie the cooler liner. Close the cooler lid. Place cooler into lined shipping box. 5. Complete and Sign the Recovery Form. Place into another zip bag. Place on top of closed cooler. 6. Fold outer liner bag. Seal box for shipping. Call for Pick-up Call CryoLife Donation Support (24 hours, 365 days a year) at 800.438.8285 or 770.419.3355 to arrange for pick up as soon as possible. Call-in information provided in Autologous Pericardium Information for Physicians and Hospital Staff. Complete Patient Form Fill out the provided Autologous Pericardium Patient Form. Note: Additional barcode labels are available for you to use for traceability. Tissue Status Monitoring • Website link, user name and password provided by CryoLife during hospital set-up. • Tissue status updated once a day. Tissue Tracking Application * Archived Records Search by Donor ID Donor ID Status Recovery Date Hospital ID Hospital Name AXXXX1 Quarantine 11/15/2017 001 Test Hospital AXXXX2 Processing 11/10/2017 001 Test Hospital AXXXX3 Implantable 11/11/2017 001 Test Hospital search clear search *Example of web page Tissue Return Order Cryopreserved autologous pericardium is ready for you to implant after 30-45 days of being shipped to CryoLife. Call CryoLife Customer Service (24 hours, 365 days a year) to order tissue return: 888.427.9654 (Patient Copy) (Hospital Copy – Keep with patient’s medical record) A portion of your child’s pericardium has been removed and cryopreserved for possible use in a future cardiac surgical procedure. Please maintain a copy of this for your records. If you have any questions, please call CryoLife at 800-438-8285. Surgeon Name: _____________________ A portion of this patient’s pericardium has been removed and cryopreserved for possible use in a future cardiac surgical procedure. To order this patient’s pericardium, please contact CryoLife Customer Service at 888-427-9654. CryoLife recommends calling at least 5 days prior to the scheduled surgery. Affix extra specimen cup label, provided by CryoLife, in recovery kit. Affix extra specimen cup label, provided by CryoLife, in recovery kit. Recovery Date : Surgeon Name: _____________________ Recovery Date :

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Page 1: Autologous Pericardium Step-by-Step Instructions - … · Autologous Pericardium Step-by-Step Instructions ... Recovery Form. Place into another zip bag. Place on top of closed cooler

Autologous Pericardium Step-by-Step InstructionsPlease Read the Autologous Pericardium Information for Physicians And Hospital Staff

Included in the Cooler

Wet Ice Sterile Normal SalineSterile Specimen Cup

Receipt and Preparation

Your Autologous Pericardium Cooler Kit comes with the following:

• Shipping box with clear poly bag liner

• Cooler with clear poly bag liner

• 2 Forms

• 1 sheet with 5 labels

• 1 Autologous Pericardium Information for Physicians and Hospital Staff (PLEASE READ)

• Two zip bags

• One wrap tie

What You Will Need

Packaging

1. Place pericardium into sterile specimen cup. Completely submerge in sterile normal saline.

2. Fill and attach provided label to specimen cup.

3. Place specimen cup in zip bag and close. Place zip bag into the lined cooler.

4. Fill with wet ice to cover completely. Wrap tie the cooler liner. Close the cooler lid. Place cooler into lined shipping box.

5. Complete and Sign the Recovery Form. Place into another zip bag. Place on top of closed cooler.

6. Fold outer liner bag. Seal box for shipping.

Call for Pick-up

Call CryoLife Donation Support (24 hours, 365 days a year) at 800.438.8285 or 770.419.3355 to arrange for pick up as soon as possible. Call-in information provided in Autologous Pericardium Information for Physicians and Hospital Staff.

Complete Patient Form

Fill out the provided Autologous Pericardium Patient Form.

Note: Additional barcode labels are available for you to use for traceability.

Tissue Status Monitoring

• Website link, user name and password provided by CryoLife during hospital set-up.

• Tissue status updated once a day.

Tissue Tracking Application* Archived Records

Search by Donor ID

Donor ID Status Recovery Date Hospital ID Hospital Name

AXXXX1 Quarantine 11/15/2017 001 Test Hospital

AXXXX2 Processing 11/10/2017 001 Test Hospital

AXXXX3 Implantable 11/11/2017 001 Test Hospital

search clear search

*Example of web page

Tissue Return Order

Cryopreserved autologous pericardium is ready for you to implant after 30-45 days of being shipped to CryoLife. Call CryoLife Customer Service (24 hours, 365 days a year) to order tissue return:

888.427.9654

(Patient Copy)

(Hospital Copy – Keep with patient’s medical record)

A portion of your child’s pericardium has been removed and cryopreserved for possible use in a future cardiac surgical procedure. Please maintain a copy of this for your records. If you have any questions, please call CryoLife at 800-438-8285.

L09143.002

L09143.002

Surgeon Name: _____________________

A portion of this patient’s pericardium has been removed and cryopreserved for possible use in a future cardiac surgical procedure. To order this patient’s pericardium, please contact CryoLife Customer Service at 888-427-9654. CryoLife recommends calling at least 5 days prior to the scheduled surgery.

The snowflake design, CryoLife and Life Restoring Technologies trademarks are owned by CryoLife, Inc.

The snowflake design, CryoLife and Life Restoring Technologies trademarks are owned by CryoLife, Inc.

Affix extra specimen cup label, provided by CryoLife,

in recovery kit.

Affix extra specimen cup label, provided by CryoLife,

in recovery kit.

Recovery Date :

Surgeon Name: _____________________ Recovery Date :