Reamer-Irrigator-Aspirator (RIA)

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Reamer-Irrigator-Aspirator(RIA)

• Michelle Whitlow, CST
• Indiana University Health
• Surgical Technology Program
• Clinical Coordinator

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Objectives

• Identify the purposes/uses of the RIA system.
• Identify the safety aspects of the RIA system,
  the good and the bad.
• How to assemble the RIA system.
• Look at results obtained by the use of the RIA
  system.

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The Original Purpose for the RIA

• Originally, the RIA was designed to be a single
  pass Intramedullary Reamer.
• By providing irrigation and aspiration during the
  reaming
• The RIA decreased OR time spent gradually reaming
  up the desired diameter.

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What the RIA came to be

• Doctors noticed all of the good bone being wasted
  by going into the suction canister.
• They found a new way to get Autogenous Cancellous
  Bone Graft
• With much less pain than from the Iliac crest,
  the Gold Standard for bone grafts.
• And they could obtain more bone graft with the
  RIA than from the Iliac crest.
• They also found the RIA to be an excellent way to
  debride the canal after removing an infected
  nail.

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Safety Concerns for the better

• The RIAs irrigation cools as it reams therefore
  minimizing the chance for thermal necrosis.
• The RIA creates a negative pressure, decreasing
  the possibility of a Pulmonary fat embolism.

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Safety Concerns to watch for

• The Reamer tip is extremely sharp!
• When placing the Guide Rod, the surgeon must be
  sure that it is in the center of the canal.
• If it is not, the RIA will follow the Guide rod,
  not the bone canal.
• The surgeon needs to make sure they do not choose
  too large of a reamer tip.

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RIA Parts

• Instrument Tray
• Tissue Protector
• Guide wire
• Opening Drill Bit
• Measuring Device
• For width of bone canal
• For length of bone
• Reamer Shaft
• T-Handle chuck

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Disposable Single use items

• Drive Shaft Seal
• Tube Assembly (2 sizes)
• 360mm (Tibia)
• 520mm (Femur)
• Reamer Heads (sizes 12-19 by .5 sizes)
• 2.5 Ball Tipped Guide Rod
• Gravity fed irrigation
• Irrigation and Aspiration Tubing
• With a fine meshed filter to capture the bone
  graft

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How to Assemble the RIA

• Once the appropriate reamer head is selected,
  attach it to the tube assembly.
• The reamer head is very sharp.
• When attached correctly, the reamer head can spin
  freely while retained by the tube assembly.
• Insert the correct sized drive shaft to match the
  size of tube assembly.

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Assembly cont.

• The hexagonal ends of the RIA drive shaft need to
  mate with the recess in the reamer head.
• You can do this by visually watching through the
  aspiration holes of the tube assembly.
• The drive shaft is properly engaged in the reamer
  when the retaining groove is hidden.
• Push the outer sleeve of the drive shaft forward
  to engage the body of the tube assembly.
• The tan/gray plastic coupling shaft should no
  longer be visible.

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• Attach the drive shaft seal.
• Attach drive unit to power.
• Either quick coupling for DHS/DCS or Jacobs
  Chuck with key.
• Connect irrigation
• Be sure the irrigation is clamped off until you
  are ready to start reaming.
• Irrigation port is the smaller of the two ports
  and is indicated by an I.

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• Connect aspiration
• Connect the aspiration tube (non-flared end) to
  the aspiration port which is the larger of the
  two and indicated by an A.
• Connect the graft filter to the aspiration port
  if doing a bone graft.

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• Supplied by Weber MD (2008)

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GRAFT OBTAINED

• Supplied by Weber MD (2008)

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RESULTS

• VOLUMES
• FEMUR
• AVE 70cc
• RANGE 50 - 110
• TIBIA - 4 CASES
• AVE 30
• RANGE 25 - 40

• Supplied by Weber MD (2008)

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Special Thanks to Dr. T. Weber and Steve Voivodas
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Resources

• Weber MD, Timothy, Ortho Indy Trauma The
  Evolution of the Reamer-Irrigator-Aspirator as a
  Bone Graft Instrument. MSU Grand Rounds, 2008
  Nov 7
• Synthes Product Literature Reamer/Irrigator/Aspir
  ator Technique Guide. us.Synthes.com/Products/Tra
  uma
• http//www.ncbi.nlm.nih.gov/pubmed/20035177 J
  Orthop Trauma. 2010 Jan 24
• http//journals.lww.com/jorthotrauma/Abstract/2010
  /01000/Use_of_the_Reamer_Irrigator_Aspirator_for_B
  one.8.aspx