0022-5347 /79/1223-0287 $02.00/0 Vol. 122, September
THE JOURNAL OF UROLOGY
Copyright© 1979 by The Williams & Wilkins Co.
Printed in U.S.A.
Original Articles NORMAL SALINE SLUSH PREPARATION FOR RENAL SURGERY THOMAS H. STANISIC, PHYLLIS HORAN
AND
MARK A. SILVERT
From the Department of Surgery/Urology, University of Arizona, Tucson, Arizona
ABSTRACT
We describe a simple, rapid method to prepare normal saline slush with commercially available slush mugs that are gas-sterilized in routine fashion and stored in a freezer. Slush can be prepared intraoperatively in 10 minutes with this method. Recently, a variety of methods designed to cool the kidney while the renal artery is clamped during renal operations has been described. Although complex and expensive systems have been developed to apply a cooling source to the kidney surface,'· 2 packing the kidney in saline slush is the most simple, least expensive method presently available that is adaptable to general hospital use. Metzner and Boyce have demonstrated its safety and effectiveness in a large clinical series3 and we have used the method effectively on a regular basis for several years. Although the use of iced saline slush solution is an elegantly simple idea there are several practical problems associated with the preparation of the slush itself. Metzner and Boyce originally recommended that slush be prepared by cooling saline for 4 hours in a freezer, shaking the bottle every 30 minutes during the last 2 hours. 3 We have found this a difficult technique to follow, since operating room personnel are not always available to shake the bottles at the appropriate time and the slush may arrive in the operating room as either a bottle of cold water or as a block of ice, which is difficult to extricate from the bottle. In the past we have used frozen normal saline in polyvinyl chloride bags for slush preparation. However, sterilization of the bags presents a problem since glutaraldehyde diffuses through the bag and contaminates the saline. 4 The manufacturer of the product does not recommend steam sterilization except under carefully controlled conditions. Gas sterilization using ethylene oxide is undesirable since it may result in the formation of ethylene chlorohydrine or ethylene glycol in the solution. 5 Woodside and Borden have described an effective method to sterilize polyvinyl chloride bags using povidine iodine, which does not contaminate the solution within. 6 We have devised an alternative method of obtaining sterile slush, using commercially available soda slush mugs (see figure).*
a sterile spoon at 3 and 8 minutes after filling the mug hastens crystallization. If room temperature saline is used the process takes longer (15 to 20 minutes) and a more watery slush results. The cups may be reused immediately without refreezing to give an additional 75 cc of slush each. The yield of slush is greater if saline placed in the freezer for a few moments is used. Cups sterilized 10 times show no evidence of deterioration or leakage of fluid. The cups are available commercially for $4.95 each and we keep 10 available in our freezer. Saline slush may be made safely in the operating room using this simple inexpensive technique. No deviation from standardized sterilization routine is required. If the slush mugs are kept on hand at -15C slush can be made available with a 10-minute notice for emergency situations, using cooled saline normally kept in most operating room refrigerators. REFERENCES
METHODS
1. Cockett, A. T. K.: The kidney and regional hypothermia. Surgery,
The mugs are simple bilayered drinking cups with a colored solution between the cup layers. The mugs are doubly wrapped, sterilized with ethylene oxide in routine fashion, covered with a plastic dust cover and stored in the freezer at -15C. Normal saline is kept in the refrigerator at 5C. About 10 minutes before the slush is needed the mugs are unwrapped, delivered to the scrub nurse and filled with 250 cc chilled saline by the circulating nurse. Ice rapidly forms and in 10 minutes a slush solution consisting of 200 cc ice and 50 cc water is ready. Briefly scraping the ice from the inner side of the cup and gently stirring with
50: 905, 1961. 2. Wickham, J.E. A., Hanley, H. G. and Joekes, A. M.: Regional renal hypothermia. Brit. J. Urol., 39: 727, 1967. 3. Metzner, P. J. and Boyce, W. H.: Simplified renal hypothermia: an adjunct to conservative renal surgery. Brit. J. Urol., 44: 76, 1972. 4. Swanzy, J .: Feasibility study of sterilization of disposable polyvinyl chloride bags containing physiological irrigating solution with cidex activated dialdehyde solution. Research Division, Arbrook, Inc., 1976. 5. Seese, T. J.: Travenol Laboratories, personal communication, May 1978. 6. Woodside, J. R. and Borden, T. A.: Sterilization of vinyl bags for preparation of ice slush solution for hypothermic renal surgery. Urology, 11: 273, 1978.
Accepted for publication December 22, 1978. * Geni, Inc., Subsidiary of Avon Products, Inc., 12836 E. Alondra Blvd., Cerritos, California 90701. 287
THE JOURNAL OF UROLOGY
Copyright© 1979 by The Williams & Wilkins Co.
Printed in U.S.A.
Original Articles NORMAL SALINE SLUSH PREPARATION FOR RENAL SURGERY THOMAS H. STANISIC, PHYLLIS HORAN
AND
MARK A. SILVERT
From the Department of Surgery/Urology, University of Arizona, Tucson, Arizona
ABSTRACT
We describe a simple, rapid method to prepare normal saline slush with commercially available slush mugs that are gas-sterilized in routine fashion and stored in a freezer. Slush can be prepared intraoperatively in 10 minutes with this method. Recently, a variety of methods designed to cool the kidney while the renal artery is clamped during renal operations has been described. Although complex and expensive systems have been developed to apply a cooling source to the kidney surface,'· 2 packing the kidney in saline slush is the most simple, least expensive method presently available that is adaptable to general hospital use. Metzner and Boyce have demonstrated its safety and effectiveness in a large clinical series3 and we have used the method effectively on a regular basis for several years. Although the use of iced saline slush solution is an elegantly simple idea there are several practical problems associated with the preparation of the slush itself. Metzner and Boyce originally recommended that slush be prepared by cooling saline for 4 hours in a freezer, shaking the bottle every 30 minutes during the last 2 hours. 3 We have found this a difficult technique to follow, since operating room personnel are not always available to shake the bottles at the appropriate time and the slush may arrive in the operating room as either a bottle of cold water or as a block of ice, which is difficult to extricate from the bottle. In the past we have used frozen normal saline in polyvinyl chloride bags for slush preparation. However, sterilization of the bags presents a problem since glutaraldehyde diffuses through the bag and contaminates the saline. 4 The manufacturer of the product does not recommend steam sterilization except under carefully controlled conditions. Gas sterilization using ethylene oxide is undesirable since it may result in the formation of ethylene chlorohydrine or ethylene glycol in the solution. 5 Woodside and Borden have described an effective method to sterilize polyvinyl chloride bags using povidine iodine, which does not contaminate the solution within. 6 We have devised an alternative method of obtaining sterile slush, using commercially available soda slush mugs (see figure).*
a sterile spoon at 3 and 8 minutes after filling the mug hastens crystallization. If room temperature saline is used the process takes longer (15 to 20 minutes) and a more watery slush results. The cups may be reused immediately without refreezing to give an additional 75 cc of slush each. The yield of slush is greater if saline placed in the freezer for a few moments is used. Cups sterilized 10 times show no evidence of deterioration or leakage of fluid. The cups are available commercially for $4.95 each and we keep 10 available in our freezer. Saline slush may be made safely in the operating room using this simple inexpensive technique. No deviation from standardized sterilization routine is required. If the slush mugs are kept on hand at -15C slush can be made available with a 10-minute notice for emergency situations, using cooled saline normally kept in most operating room refrigerators. REFERENCES
METHODS
1. Cockett, A. T. K.: The kidney and regional hypothermia. Surgery,
The mugs are simple bilayered drinking cups with a colored solution between the cup layers. The mugs are doubly wrapped, sterilized with ethylene oxide in routine fashion, covered with a plastic dust cover and stored in the freezer at -15C. Normal saline is kept in the refrigerator at 5C. About 10 minutes before the slush is needed the mugs are unwrapped, delivered to the scrub nurse and filled with 250 cc chilled saline by the circulating nurse. Ice rapidly forms and in 10 minutes a slush solution consisting of 200 cc ice and 50 cc water is ready. Briefly scraping the ice from the inner side of the cup and gently stirring with
50: 905, 1961. 2. Wickham, J.E. A., Hanley, H. G. and Joekes, A. M.: Regional renal hypothermia. Brit. J. Urol., 39: 727, 1967. 3. Metzner, P. J. and Boyce, W. H.: Simplified renal hypothermia: an adjunct to conservative renal surgery. Brit. J. Urol., 44: 76, 1972. 4. Swanzy, J .: Feasibility study of sterilization of disposable polyvinyl chloride bags containing physiological irrigating solution with cidex activated dialdehyde solution. Research Division, Arbrook, Inc., 1976. 5. Seese, T. J.: Travenol Laboratories, personal communication, May 1978. 6. Woodside, J. R. and Borden, T. A.: Sterilization of vinyl bags for preparation of ice slush solution for hypothermic renal surgery. Urology, 11: 273, 1978.
Accepted for publication December 22, 1978. * Geni, Inc., Subsidiary of Avon Products, Inc., 12836 E. Alondra Blvd., Cerritos, California 90701. 287
