Build Me Up
Knock Me Back Down Again
In the Thick of It
Shooting Off-Target
Potpourri
100
The setup wizard isn't just for good looks… be sure to follow its prompts for the safest IceFX setup method and do *this* with the gas regulator cable prior to connecting it to an argon tank.
Secure the loose end of high-pressure cable to back of machine.
100
Fantastic! The case is over. Be sure to do this prior to venting the system so the next person the following week will know if they can use a particular tank again. The final active thaw is a great time to do this!
Look at gas gauge (on console or on regulator), label tank.
100
Sucked a tank dry? Time to switch to your secondary tank. Follow this process to do so!
Close empty tank valve, open full tank valve slowly & entirely.
Alternative: During active freeze cycle, slowly open new tank while closing empty tank simultaneously.
100
Needle shafts are insulated to prevent skin frostbite… but if you're not careful, frostbite skin injury can still happen if one of these events occur but aren't noticed.
Skin involvement in iceball, or
Needle cables touching skin during treatment (or not enough thermal break in between)
100
The cautery function is great to use to prevent track seeding. Be sure to stop the cautery and wait 10 seconds for cooling once you see this thick black mark at the skin level.
Active zone indicator
200
A full argon tank comes with 6,000 psi worth of gas. A tank is "empty" & should be switched for a full one when it hits this level (not zero?). Avoid starting a case with a tank that has less than this much gas remaining.
3,000 psi,
3,500 psi
200
Thoroughly venting the system after a case is important - never cut this part short! But if you disconnect these while the argon is actively venting, you might regret it next case…
Disconnect needles from needle ports.
200
It's like "sticking" your tongue to a cold metal pole in the wintertime. Using this gas intensity/program cycle to temporarily "lock" a needle(s) in place prior to treatment. Don't let it run too long!
"Stick" intensity
"Stick 27 min" cycle
All channels or individual channels.
200
Bowel a little too close for comfort? This technique can be used to keep it safely at bay while you freeze a renal tumour (white arrows).
Hydrodissection
200
Some needles can be thirstier than others but you notice that one is being a little stubborn and isn't getting down to operating temperature. There might be some ice that has developed inside the line. Try these steps to resolve the issue.
1. Active thaw for ~2-3 minutes. Then try freezing again.
2. Try changing needle to different channel if active thaw isn't successful.
300
You have a large case where you'll need to use more than one argon tank... or more. No problem! You have a few full tanks and a partial tank and you're going to connect both the primary regulator and the auxiliary gas line. Ideally, the primary regulator would be connected to a _______ tank and the auxiliary gas line would ideally be connected the _______ tank.
Despite its name, the tank connected to this cable would start as your primary operating tank.
Primary line/regulator to full tank.
Auxiliary line to partial tank.
Operate primarily off tank connected to auxiliary line.
300
The darn nut on the gas regulator won't unscrew from the argon tank! Did you remember that the threads on the nut & tank are _________-threaded?
Reverse-threaded
(Righty…loosey, Lefty… tighty?)
300
A person with good forethought astutely labeled the needle handles with steri-strips according to the channel number into which they were to be inserted. Another person in a not-so-astute moment realized later that they inserted the cables into different channels than was intended. Good thing this can be done without issue to correct for it.
Move needles around between channels.
(Be sure to stop any active freeze/thaw function first!)
300
If this structure is within the ablation zone during a renal tumour cryoablation, a narrowing can occur, causing problems for the patient later. Preventative measures can be performed before a cryo procedure if it's expected that ablation of this structure can't be avoided to achieve a complete treatment.
Ureter
(Bonus for naming the pre-procedure intervention!)
300
Machine is powered on, cables are securely connected, all systems are "go". The argon tank is opened only to reveal… the system didn't pressurize? Somebody probably didn't check this… and it'll get them on the "blue"per reel!
Blue argon inlet valve is in "off" position
400
Using multiple needle types (eg. IceForce + IceRod) in the same cryoablation procedure is no issue... but user beware! Gas level estimates may be inaccurate and gas flow to certain needles may not be optimal unless they're connected to the system in the manner.
Group needles of same type together within the same channel.
400
You turned the white valve to "vent," just like Gas Venting Wizard told you to, but the console won't depressurize… the gas just keeps coming! It's probably because somebody missed this crucial step…
Closing the valve on the gas tank.
400
Mid-treatment imaging reveals that the iceball needs some adjustment. You want to keep running the loaded treatment program cycle but freezing at 100% is no longer desirable. Thankfully, we can make an adjustment to this without having to stop the treatment cycle.
Gas intensity
(to some or all of the needles)
400
Cryoablation of these structures is desirable when it's deliberately targeted. But if it is mistakenly located within an ablation zone, the consequences could be minor and annoying to major and debilitating.
Nerve
400
You can see the visible margin of your iceball on imaging - a huge advantage of cryo! This is the temperature at that visible margin (it's not lethal…).
0 Deg C
500
Dr. Cool said he would only use 4 needles so you connected one needle to each of the 4 available channels. All needles have now been tested but now he has decided to add a 5th needle before treating. I guess *this* will have to be done to test the new needle independently of the existing ones.
Stop any/all active functions in channel accepting new needle. Unlock channel, remove existing needle. Set aside temporarily.
Insert new needle & perform test. Unlock channel, re-insert original needle.
500
Try as you might, you're absolutely unable to disconnect the gas line from the back of the IceFX console… it's stuck! It's probably because you forgot to do this first…
Vent/depressurize the system.
500
Most cryoablation procedures will employ this many freeze-thaw cycles… except for lesions located in one of these aerated organs, which require an additional cycle.
2 cycles
Lungs (3 cycles)
Bonus… why??
500
Ruh Roh, Shaggy! That iceball is getting a little closer to that non-target structure than I'd like… better drop the gas intensity to this % to stop the iceball growth but maintain its current size & temp!
40%
500
All needles for a case have been successfully tested for 2 minutes & inserted into a patient, when… OH NO!! There's a power outage and the IceFX console loses power (or the power switch gets flipped). Good thing the needles don't need to be tested again because of this feature!
Microchip with 8-hour memory