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059343-190103 © Acclarent, Inc. 2019. All rights reserved.

BSP In-Office Training Guide

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059343-190103 © Acclarent, Inc. 2019. All rights reserved.

ACCLARENT® Balloon Sinuplasty Devices are intended for use by or under the direction of a physician who is trained in the use of Acclarent

Technology. ACCLARENT® Balloon Sinuplasty Device use has described risks, including tissue and mucosal trauma, infection, or possible orbital injury.

Important information: Prior to use, refer to the instructions for use supplied with this device for indications, contraindications, side effects,

warnings and precautions.

Caution: US law restricts this device to sale by or on the order of a

physician.

This presentation includes a demonstration of the use of a medical

device. The steps demonstrated with respect to the use of any medical device in this presentation may not be the complete steps of the procedure. Individual physician preference and experience, as well as

patient needs, may dictate variation in procedure steps. Before using any medical device, review all the Instructions For Use with particular attention to the indications, contraindications, warnings and precautions.

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Course Agenda

• Anatomy and physiology

• Office Set Up

– Room set up and procedure overview

– Acclarent devices for sinus procedures

• Device setup and procedure practice

– Hands On Training

– Mock procedures

• Creating the patient experience – Best Practices

• Talk Tracks

• Reimbursement

• Office Resources

059343-190103 © Acclarent, Inc. 2019. All rights reserved.3

Anatomy and Physiology


Anatomy Review• The sinuses are a series of

interconnected hollow spaces in the

skull.

• Their walls are lined with mucous

secreting membranes.

• The membranes may become

infected or inflamed and can swell and block the nasal passages.

• Build up of fluid in the sinuses can cause pressure and pain.

• Balloon Sinuplasty can help to relieve the symptoms of sinusitis.


CT Scans

Coronal CT Scan Example Sagittal CT Scan Example


Endoscopic Anatomy

EB

UP

MO

FR

Maxillary Sinus

Frontal Sinus

Sphenoid Sinus


Animated Procedure Video


../../../EOS Final/Approved/Practice Expansion/060742-160926_Balloon Sinuplasty and FESS Animation_with Voiceover....mp4

Office Set Up


Optimizing the Patient Experience

• Patient Talk Tracks

• Pre-Procedure

• Anesthetics

• Equipment

• Procedure Set Up

• Procedure

• Post-Procedure

Mayo Stand with instruments

Chair with Drapes for the Patient

Camera Source with Monitor

Suction

Office Set Up Example


Supplies to Consider for BSP In-Office Cases

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Office Procedure Supply Examples:

❑ Acclarent Balloon Sinuplasty Kit❑ Extra Light Source for the Purple Cord❑ Ball Tip Seeker ❑ Freer elevator❑ Nasal Speculum❑ Bayonet (Forceps)❑ Camera❑ Scope❑ 27 1 ¼” Needle/Needle-less protocol❑ Suction ❑ Anesthesia❑ Pledgets/ Cotton Balls❑ Water/Saline

Additional/Optional:

❑ De-Fog/Alcohol Wipe❑ Basin❑ Towel Clamps for Cords. ❑ Mayo Stand for Instruments ❑ Specimen Cup (for Topical Anesthetic) ❑ Syringe (for irrigation) and a

Bowl/Basin if the MD prefers that the patient lean forward during lavage

❑ Consider gowning or draping to protect the patient’s clothing

See Office Checklist for complete list

This checklist is not meant to be a definitive list of all supplies or preparations for performing Balloon Sinuplasty In-Office procedures. Use your medical judgment and expertise to determine what you need to have before performing these procedures in the office.


Supplies to Consider for BSP In-Office Cases

De-Fog

Scope

Bayonet

Forceps

Ball-Tip

Seekers

Speculum

Freer-

Elevator

Straight

Suction

Basin

Syringe

Gauze

Small Cup for Specimen

or Anesthetic

Syringe and

Needle for Anesthetic

Mayo

Stand or Table

This checklist is not meant to be a definitive list of all supplies or preparations for performing Balloon Sinuplasty In-Office procedures. Use your medical judgment and expertise to determine what you need to have before performing these procedures in the office.


Balloon Sinuplasty Hands On Demonstration

• RELIEVA SPIN Plus® Balloon Sinuplasty System• RELIEVA SCOUT® Multi Sinus Dilation System

Leave Inservice Guides

RELIEVA SCOUT® Multi-Sinus Dilation System

ACCLARENT® SE Inflation Device

RELIEVA SPIN Plus®

Balloon Sinuplasty System

RELIEVA LUMA SENTRY® Sinus Illumination System & Accessories


Lavage Option When the Patient is Sitting Upright

• Is Room temperature saline available?

• The Relieva Vortex®2 or SPIN Plus® is placed in the sinus

• A large basin is placed on the draped patient’s lap

• The patient is then asked to lean forward

• The patient is informed of what will happen

• The physician may also place a Frazier suction near the ostium of the sinus and irrigate slowly


Creating the Patient Experience


Best Practices: Pre-Procedural Considerations

• Talk Track for Front Office and Exam Room

• Dedicated Staff – Reduce anxiety by increasing experience of staff through practice and repetition.

• A smooth procedural flow reduces stress for patient and staff

• Reducing stress may help improve the patient experience

• Patient Guide

• Music in the background – Have the patient choose – allows for patient interaction


• Verbal Anesthesia Communication

• Patients should be informed about what to expect from start to finish

• Awake patients require more perioperative preparation/coaching

• SNOT 22 Survey

• Establish patient flow for multiple procedures

Best Practices: Pre-Procedural Considerations

The anesthetic, anxiolytic and analgesic examples in this presentation are for informational purposes only and do not represent an affirmative instruction as to which protocol to use for a particular patient or procedure. Acclarent does not make any recommendations regarding the use of a specific anesthesia protocol or regimen for a patient or procedure. The actual selection and use of an anesthesia protocol are at the sole discretion of the treating physician.


Patient Verbal Anesthesia Communication Examples

• Before the Procedure:

– “The room lights may go off and on during the procedure.”

– “It is normal for you to hear the physician and staff talking to one another and asking questions during your procedure.”

– “The topical medication may make your teeth numb pre-procedure, during and post-procedure. This is normal.”

– “Some of the anesthetic liquid may drip into your throat. Swallowing and breathing are not affected.”

– “Some of the medications that help numb you, may make you feel nervous or anxious. This is normal. Please let us know if you experience this.”

• During the Procedure:

– “You may see a light inside your nose or head; this is normal.”

– “As the sinus is dilated you may hear a crackling sound. This sound is normal, and it means the sinus is opening.”

– “Pressure is normal, let the surgeon know if there is any additional discomfort.”


SNOT 22 Collection and Review

• SNOT 22 delivered to all allergy and sinusitis patients.

• SNOT 22 follow up 6-8 weeks after the procedure.

• Utility: To show outcomes

– To PCPs

– To Future Patients

– Of Treatment Algorithm

– Of Quantified Symptoms

– For Patient Identification

Reference SNOT 22 Training Presentation


Best Practices: Additional Considerations

• Instrument Set Up:

– Cover any intimidating instruments with a towel/cloth (needles, scissors, etc.) so the patient isn’t looking at them.

– Set up the Balloon System in front of the patient so that they know that it was opened specifically for them.

• Hand endoscope and other instruments to Physician as requested

• Turn on endoscope and Relieva Luma Sentry™ light sources

• Be ready to turn on suction system

• Pledgets can be re-inserted after dilation if needed for minor bleeding

• Additional injection or oral pain medication may be given


Best Practices: Additional Considerations

• Have patient CT in the room for reference

• Limit the number of staff members in the procedure room

• Ensure balloon pressure is not counted out loud during inflation

• Utilize distraction techniques during procedure

– Keep patient informed of how the procedure is going

• Dim room lighting and/or cover windows

• Post-procedural follow up is essential

– Review post-care instructions and schedule follow up visits

– Establish a protocol for patient follow-up

• Feedback - Listen to the patient and learn how to make each case better


Optimizing the Office Experience

Best Practices:

❑ Brochures and Posters in the waiting room❑ Exam Room Posters❑ Patient Testimonials: Website, TV, Book in Waiting Room❑ Practice offerings or educational videos on TV

Acclarent Support and Educational Opportunities:

❑ Product Training on Site❑ Product Inservice Guides❑ SNOT 22 upon check in for sinus/allergy patients❑ ICD 10 Review❑ Acclarent Representative – Case Support❑ Preceptorships – Peer to Peer Programs❑ Procedure Video Links ❑ Reimbursement Hotline❑ Market Development Resources


Talk Tracks


Balloon Sinuplasty Patient Talk Track Example

For the Front Office:

Balloon Sinuplasty uses a small balloon to quickly open and expand blocked sinuses.

This procedure is now available as an In Office procedure which can be performed under local anesthesia.

Please ask the surgeon if you would be a good candidate for this procedure.

The procedure is:• Minimally Invasive • Safe and Effective • With a Short Recovery Time*

*Karanfilov, B., Silvers, S., Pasha, R., et al.(2013). Office-based balloon sinus dilation: a prospective, multicenter study of 203 patients. Int Forum Allergy Rhinol, 3; 404-411.


Balloon Sinuplasty Patient Talk Track Example

For the Surgeon:

There are four options to open up the blocked passageways leading to your sinuses.

Endoscopic Sinus Surgery (ESS) or Traditional Sinus Surgery

Balloon Sinuplasty with some Traditional Sinus Surgery (called a Hybrid procedure)

Balloon Sinuplasty Only in the OR for patients that are anxious and want to be put to sleep for the procedure.

Balloon Sinuplasty In–Office

The procedure is:• Minimally Invasive • Safe and Effective • With a Short Recovery Time*

*Karanfilov, B., Silvers, S., Pasha, R., et al.(2013). Office-based balloon sinus dilation: a prospective, multicenter study of 203 patients. Int Forum Allergy Rhinol, 3; 404-411.


Reimbursement


Reimbursement: Resources

• Reimbursement Hotline

• Reimbursement Guide

• Coverage Summary

• Reimbursement Updates


Reimbursement: Reimbursement Guide


Office Resources


Resources for the Office

Office Resources

In-service GuidesReimbursement


Resources for the Office

Waiting Room Poster Exam Room Poster

Brochure StandInsert

Brochure

Waiting Room Banner Poster


Thank you for your participation!Questions?


bsp in-office training guide › sites › default › files › 2019...balloon sinuplasty patient...

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