EQUIPMENT NEEDED

• Tornado Fiducial 3mm x 7mm x 0.035mm (Cook, G47522,MWCW-35-7/3-TORNADO-01)
• ICG 25mg vial and 10ml sterile water
• superDimension Delivery Device, 150cm (Covidien, SDMDK1000) 
• 10ml and 3ml syringes
• 19G needle

INSTRUCTIONS

Dying Tornado Coil

• Using 10ml syringe, draw 10ml sterile water and add to ICG vial to get a solution of 2.5mg/cc. 
• Using 3ml syringe, aspirate 0.5ml of diluted ICG.
• Remove proximal wire from the Luer Lock tip of Tornado Cartridge Sheath. (Important: Keep distal wire in place so ICG maintains inside sheath while soaking!)

• Slowly inject 0.5ml of ICG through Leur Lock tip. Note: Excess ICG will escape from distal end even if distal wire is in place.
• Let ICG sit in the coil within its original Tornado Cartridge Sheath for 10 min. before loading into delivery device.

Preparing Fiducial Delivery Device (While waiting for 10 min. ICG Soak)

• Insert flimsy end of Green Pusher inside Proximal end of Blue Delivery Device.
• Slide Green Pusher until tip is flushed at distal end of Blue Delivery Device.
• Bend Green Pusher at proximal end to mark.
• Remove Green Pusher, set aside.

Backload Tornado Coil into Delivery Device

• Remove protective plastic and wire from Tornado Cartridge Sheath. 
• Insert the Tornado Cartridge Sheath into the proximal end of deliver device, making sure tip-to-end is secure together. (Note: Must hold together flushed with one hand while inserting coil pusher.)

• Insert Coil Pusher (flimsy side) half-way to push Soaked Fiducial Coil into superDimension Delivery Device.
• Remove Tornado Cartridge Sheath and Coil Pusher from superDimension Delivery Device.

Inserting Coil

• Insert superDimension Delivery Device with ICG-soaked Tornado Coil into bronchoscope.
• Insert Coil Pusher until the marked bend created prior
• Under Fluoroscopy, confirm coil is fully deployed and outside the tip before pulling back the superDimension delivery device.

This protocol has been kindly provided by Dr. Wilson Tsai of Prometheus Medical Innovations and Director of the Thoracic Surgical Program at John Muir Health. 

A very similar protocol with minor differences and complete with videos has been described in the Annals of Thoracic Surgery and can be accessed here: https://doi.org/10.1016/j.atssr.2023.02.010