Discover the Optimal Technique for Opening and Implanting GLIADEL® Wafer (carmustine implant)

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Surgeon wearing full surgical scrubs and wearing magnifying glasses, operating on a patient. Actor portrayal.Surgeon wearing full surgical scrubs and wearing magnifying glasses, operating on a patient. Actor portrayal.Surgeon wearing full surgical scrubs and wearing magnifying glasses, operating on a patient. Actor portrayal.
Actor Portrayal

Discover the Optimal Technique for Opening and Implanting GLIADEL® Wafer (carmustine implant)

See How GLIADEL Wafer Is Implanted

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How to Implant GLIADEL Wafer1

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Surgical Preparation

  • Resect tumor
  • Obtain hemostasis
  • Confirm pathological diagnosis of high-grade glioma or glioblastoma
  • GLIADEL Wafer pouches should remain unopened and in the freezer until ready for implantation
  • Communication between resection cavity and ventricular system should be avoided. Any communication larger than a wafer should be closed prior to implantation
Surgeon making an incision.Surgeon preparing surgical site.
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Administer GLIADEL Wafer

  • Up to 8 wafers may be placed to cover as much of the resection cavity as possible
  • Slight overlapping of wafers is acceptable
  • Wafers broken in half may be used, but discard and properly dispose of wafers broken in >2 pieces
  • Surgicel® may be placed over the wafers to secure them against the cavity surface
Gliadel Wafer being implantedGauze being placed in the surgical site.
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Ensure Cavity Integrity

  • After wafer placement, irrigate cavity
  • Close dura in a water-tight fashion to minimize the risk of cerebrospinal fluid leakage
Surgical site being stitched close.
Download Opening and Implantation Instructions

For demonstrative purposes only.

Photos courtesy of Henry Brem, MD, Johns Hopkins School of Medicine.

Instructions to Carefully Open GLIADEL Wafer Packaging1

Handling with double-layer surgical gloves is recommended.
Healthcare professional opening a pouch.

Remove nonsterile outer pouch. Slowly pull corners outward.

Healthcare professional opening a pouch. Image is struck through indicating incorrect method to open pouch.

Do NOT pull in a downward motion rolling knuckles over the pouch. This may exert pressure on the wafer, causing it to break.

Pouch being held open so that an inner pouch can be removed with a sterile instrument.

Grab crimped edge of inner pouch using a sterile instrument and pull upward.

Hand holding a pouch, while the pouch is being cut open.

Open sterile inner pouch.

  • Gently hold the crimped edge
  • Cut inner pouch in an arc-like fashion around the wafer
Gliadel Wafer being removed from pouch with forceps.

Remove wafer.

  • A dedicated surgical instrument should be used for wafer handling
  • Gently grasp wafer with forceps
  • Place onto a designated sterile field
Download Opening and Implantation Instructions

For demonstrative purposes only.

Ensure Proper Handling and Storage of GLIADEL Wafer1

Follow the instructions provided for correct handling and storage procedures during implantation

Icon: Box of Gliadel wafers.

How GLIADEL Wafer is supplied

  • Supplied in a single-dose treatment box containing 8 individually pouched wafers
  • Each wafer contains 7.7 mg of carmustine and is packaged individually in 2 aluminum foil laminate pouches (total of 61.6 mg per single-use box)
    • The inner pouch is sterile and designed to maintain product sterility and protect from moisture
    • The outer pouch is a peelable overwrap, and the outside surface of the outer pouch is not sterile
Icon: Refrigerator with an icicle

How to store GLIADEL Wafer

  • GLIADEL Wafer in unopened outer foil pouches is stable at room temperature for 6 hours at a time for up to 3 cycles within a 30-day period
  • Store the GLIADEL Wafer box in the freezer (≤-20ºC) until the treatment plan has been confirmed and the wafers are ready for implantation. Maintaining frozen storage may help preserve the product’s labeled shelf life
Icon: Gloves

How to handle GLIADEL Wafer

  • Use double gloves when handling GLIADEL Wafer
  • Discard the outer gloves into a biohazard waste container after use
  • Use a dedicated surgical instrument for wafer implantation
  • Any wafer remnants or residual wafers should be handled and disposed of as potential cytotoxic agents

Postoperative Monitoring Considerations

Icon: Clipboard with a checklist.

Treatment guidelines indicate sufficient use of steroids and antiepileptics in the perioperative period to prevent adverse events2

Icon: Patient in a hospital bed, with a healthcare professional checking on them

Monitor patients postoperatively for impaired neurosurgical wound healing1

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.