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Uses
THROMBIN-JMI is topical bovine thrombin indicated to aid hemostasis whenever oozing blood and minor bleeding from capillaries and small venules is accessible and control of bleeding by standard surgical techniques (such as suture, ligature, or cautery) is ineffective or impractical.
In various types of surgeries, solutions of THROMBIN-JMI may be used in conjunction with an Absorbable Gelatin Sponge, USP for hemostasis.
History
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Other Information
THROMBIN-JMI, Thrombin, Topical (Bovine), is a protein substance produced through a conversion reaction in which prothrombin of bovine origin is activated by tissue thromboplastin of bovine origin in the presence of calcium chloride. It is supplied as a sterile powder that has been freeze-dried in the final container. Also contained in the preparation are mannitol and sodium chloride. Mannitol is included to make the dried product friable and more readily soluble. The product contains no preservative.
THROMBIN-JMI has been chromatographically purified and further processed by ultrafiltration. Analytical studies demonstrate the current manufacturing process' capability to remove significant amounts of extraneous proteins, and result in a reduction of factor Va light chain content to levels below the limit of detection of semi-quantitative Western Blot assay (<92 ng/mL, when reconstituted as directed). The clinical significance of these findings is unknown.
Sources
Thrombin-jmi Manufacturers
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Pfizer Laboratories Div Pfizer Inc
Thrombin-jmi | Pfizer Laboratories Div Pfizer Inc
For topical use on the surface of bleeding tissue only. Do not inject.
2.1 Reconstitution For routine use, reconstitute THROMBIN-JMI with sterile isotonic saline at a recommended concentration of 1,000 to 2,000 International Units per mL. Where bleeding is profuse, as from abraded surfaces of liver or spleen, concentrations of 1,000 International Units per mL may be required. For general use in plastic surgery, dental extractions, skin grafting, etc. solutions containing approximately 100 International Units per mL are frequently used. Prepare intermediate strengths to suit the needs of the case by diluting the contents of the THROMBIN-JMI container with an appropriate volume of sterile isotonic saline. THROMBIN-JMI can be used in a dry form on oozing surfaces. In instances where a concentration of approximately 1,000 units per mL is desired, the contents of the vial of sterile isotonic saline diluent may be transferred into the THROMBIN-JMI container with a sterile syringe or sterile transfer device.If the transfer device is used for reconstitution, transfer the diluent in the following manner:
Remove the plastic cap off of the diluent vial. Remove the Tyvek cover from the transfer device container. Do not remove the device from the package. Seat the blue end of the device on the diluent vial, pushing down until the spike penetrates the diaphragm and the device snaps in place.CAUTION: Solutions should be used promptly upon removal from the container. However, the solution may be refrigerated at 2°C – 8°C for up to 24 hours, or may be stored at room temperature for up to 8 hours after reconstitution.
THROMBIN-JMI PUMP SPRAY KIT
Refer to THROMBIN-JMI Pump Spray Kit instructions for spray pump assembly and use.
Each spray kit contains one vial of THROMBIN-JMI, one vial of diluent and one spray pump and actuator.
Remove the outer lid by pulling up at the indicated edge. The inner tray is sterile and suitable for introduction into any operating field. Remove the cover on inner tray to expose sterile contents. Reconstitute the THROMBIN-JMI to desired potency by introducing sterile isotonic saline with a sterile syringe or a sterile transfer device. If the transfer device is used, follow the previously described procedure. When the THROMBIN-JMI is completely dissolved, open vial by flipping up metal and tearing counterclockwise. Remove the rubber diaphragm from vial. Remove pump with protective cap from tray and snap onto vial.THROMBIN-JMI SYRINGE SPRAY KIT
Refer to THROMBIN-JMI Syringe Spray Kit instructions for spray syringe assembly and use. Each syringe kit contains one vial of THROMBIN-JMI, one vial of diluent and one spray tip and syringe.
Remove the outer lid by pulling up at the indicated edge. The inner tray is sterile and suitable for introduction into any operating field. Remove the cover on the inner tray to expose sterile contents. Using the sterile syringe equipped with a transfer device, draw the desired amount of saline diluent from the vial into the syringe. Inject the saline diluent into the THROMBIN-JMI thrombin vial from the syringe to reconstitute the THROMBIN-JMI thrombin powder. When the THROMBIN-JMI powder is completely dissolved, draw the THROMBIN-JMI Thrombin solution into the syringe. Remove the syringe from the transfer device by turning syringe counterclockwise.THROMBIN-JMI EPISTAXIS KIT
Refer to THROMBIN-JMI Epistaxis Kit instructions for accessory assembly and use.
Each epistaxis kit contains one vial of THROMBIN-JMI, one vial of diluent and one nasal drug delivery device.
Remove the outer lid by pulling up at the indicated edge. The inner tray is sterile and suitable for introduction into any operating field. Remove the cover on the inner tray to expose sterile contents. Using the sterile syringe equipped with a transfer device, draw the desired amount of saline diluent from the vial into the syringe. Inject the saline diluent into the THROMBIN-JMI thrombin vial from the syringe to reconstitute the THROMBIN-JMI thrombin powder. When the THROMBIN-JMI powder is completely dissolved, draw the THROMBIN-JMI Thrombin solution into the syringe. Remove the syringe from the transfer device by turning syringe counterclockwise.Topical application of THROMBIN-JMI
The recipient surface should be sponged (not wiped) free of blood before THROMBIN-JMI is applied. A spray may be used or the surface may be flooded using a sterile syringe and small gauge needle. The most effective hemostasis results occur when the THROMBIN-JMI mixes freely with the blood as soon as it reaches the surface. Sponging of the treated surfaces should be avoided to assure that the clot remains securely in place.Use in conjunction with Absorbable Gelatin Sponge
Consult the Absorbable Gelatin Sponge, USP labeling for complete information for use prior to utilizing the following thrombin saturated sponge procedure.
Prepare THROMBIN-JMI solution to desired strength. Immerse sponge strips of the desired size in THROMBIN-JMI solution. Knead the sponge strips vigorously with moistened, gloved fingers to remove trapped air, thereby facilitating saturation of the sponge. Apply saturated sponge to bleeding area. Hold in place with a pledget of cotton or a small gauze sponge until hemostasis occurs.Use in conjunction with FloSeal™ NT
THROMBIN-JMI may also be used with FloSeal™ NT according to the directions for use in the FloSeal™ NT package insert.
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