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