STERILIZATION The following are GUIDELINES for product sterilization.

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The following are GUIDELINES for product sterilization. Rultract retractor assemblies are reusable instruments. They are supplied non-sterile and must be cleaned and sterilized prior to initial use and all subsequent use. These validated processes should be considered as guidelines only. Time, temperature and other conditions required for sterilization may vary according to type of sterilizer, cycle design, wrapping material, and/or other hospital practices. Sterilization containers must be validated by their manufacturer for use in sterilization process. Validated cycles should be indicated in the container s Instructions for Use. You must validate your own sterilization practice when it differs from the Instructions for Use provided by the device, container or sterilizer manufacturer. Recommendations for sterilization may be obtained from AAMI (Association for Advancement of Medical Instrumentation) at http://www.aami.org/ Rultract s Sterilization guidelines were validated by Biotest Laboratories Inc. of Minneapolis, Minnesota. The guidelines are as follows: Guidelines for Sterilization : Cable should be wound on spool prior to sterilization leaving approximately 1 1/2 to 2 inches exposed. The instruments may be sterilized by the following steam sterilization methods: prevacuum, flash, and steam (gravity) wrapped. The following cycles were verified utilizing a combination of metal instruments and/or metal instruments in a common sterilization tray with a mass up to 40 pounds (18 kg). The wrapped instruments were wrapped with non-woven single use Steriwrap TM. (manufactured by Proper). Option 1: Wrapped instruments Option 2: Wrapped instruments Pre-vacuum Sterilization Parameters: Temperature 132 C (270 F) Exposure Time 5 minutes Steam (Gravity) Sterilization Parameters: Temperature 121 C (250 F) Exposure Time 40 minutes Option 3: Unwrapped instruments "Flash" Sterilization Parameters: Temperature 132 C (270 F) Exposure Time 5 minutes CAUTION: Disassemble unit prior to cleaning. The spool cap nut must be unscrewed to separate the spool, spool cap, crank handle assembly and gearbox assembly. It is not necessary to remove fasteners or roll pins for proper cleaning and sterilization. Further disassembly is not necessary and may void guarantee. IFU_Sterilization 12-29-06 Rev. D page 1

Cleaning: Rultract System 01. Disassemble Ratchet/Rake per instructions. No disassembly of other products required for cleaning. 02. Soak in a neutral-ph disinfecting solution. Do not soak for long periods of time. 03. Use only a neutral ph (6-8) solution. Use of acidic or alkaline detergents will remove chromium oxide from surface of stainless steel causing pitting or breakage of instruments. The Rultract Surgical Products guarantee is void if instruments are exposed to high acid (ph 4 to lower) or high alkaline (ph 10 or higher) solutions, detergents, disinfectants, stain removers, etc. 04. Instrument should be thoroughly rinsed with distilled water after cleaning to remove any residual debris or cleaning agent. 05. Dry immediately after cleaning. 06. If desired, the instrument may be sonicated in a neutral-ph solution. Remove instrument from sonicator and rinse with distilled water to remove any residue of solution. 07. Instruments may be lubricated in standard instrument milk cycle. Let instrument drip dry a few moments before wrapping for sterilization. Cleaning: Clamp Do not disassemble for cleaning. Do not remove retaining screw(s).** Do not open or close handle(s) completely. Jaws should be partially opened. Jaws and handles should have free movement. COMBINATION CLAMP SCRUB/CIRCULATOR APPLIED Cleaning: Tilting Top Posts and Rotating Extender Bar Do not disassemble for cleaning. Do not remove retaining screw(s).** Do not open or close knobs completely. Loosen knobs for partial separation. Sections and knobs should have free movement. ** SCRUB APPLIED CLAMP CIRCULATOR APPLIED CLAMP TILTING POST Retaining Screw ** Retaining Screw ** ** ** ** ROTATING EXTENDER BAR Retaining Screw ** WARNING: Removal of retaining screw(s)** will cause device to come apart. This will result in failure during use. IFU_Sterilization 12-29-06 Rev. D page 2

DISASSEMBLE RATCHET FOR CLEANING STEP 1 UNWIND CABLE: While holding the Ratchet by the Spool Cap, shift Ratchet Lever to reverse direction (Fig. 01). Pull down on Snap Clip or Rake Plate to completely unwind the cable, approximately 16" (Fig. 02). If cable is jammed or will not unwind freely, proceed to the next step and remove the Spool Cap. Note: Worn or Damaged cable must be replaced at this time with a new Rultract Cable. Spool Cap Crank Handle Fig. 01 Fig. 02 Gearbox Snap Clip Rake Plate Ratchet Lever STEP 2 REMOVE SPOOL CAP AND CRANK HANDLE ASSEMBLY: Holding the Crank Handle as shown, unscrew and remove the Spool Cap Nut using a counter clockwise rotation (Fig. 03 & 04). Slide Spool Cap from shaft of Crank Handle (Fig. 05). Slide Crank Handle out of Gearbox. At this time, note square of shaft and square hole in Gearbox (Fig. 06). Fig. 03 Spool Cap Pin shown in groove of gearbox Spool Cap Nut Fig. 04 Fig. 05 Shaft of Crank Handle Square Shaft to Square Hole Fig. 06 IFU_Sterilization 12-29-06 Rev. D page 3

DISASSEMBLE RATCHET FOR CLEANING (continued) STEP 3 REMOVE SPOOL CAP FROM SPOOL: To remove Spool Cap from Spool, line up Cable Guide with Pin and Cable Access Plate of Spool (Fig. 07). This will align flat on Spool with Cable Guide and allow the two pieces to separate (Fig. 08). Slide Spool Cap along cable to rest on hub (Fig. 09). Fig. 09 Fig. 07 Fig. 08 Spool Cap Cable Guide Pin Cable Access Plate Cable Guide Flat on Spool STEP 4 RAKE PLATE: Rake Plate can be disconnected from Snap Clip Hub Do not disassemble Rake Plate from Pivot Hub IFU_Sterilization 12-29-06 Rev. D page 4

REASSEMBLE RATCHET FOR AND USE STEP 1 INSTALL CRANK HANDLE: Slide the shaft of Crank Handle into square hole of Gearbox located above the Ratchet Lever (Fig. 01). Note: Both squared sections of the shaft must be completely inserted and flush in gearbox (Fig. 02). Squared sections of shaft to square hole Fig. 01 Flush Fig. 02 STEP 2 REASSEMBLE SPOOL AND SPOOL CAP: Align the Cable Guide with the flat surface of the Spool (Fig. 03). Slide Spool and Spool Cap together (Fig. 04). Fig. 03 Cable Guide Fig. 04 Flat Surface Spool and Spool Cap Assembled STEP 3 SPOOL CAP ASSEMBLY: While holding the Gearbox and Crank Handle together, line up Spool Cap Pin with the groove in the Gearbox. Slide the Spool Cap onto the shaft (Fig. 05). Spool Cap Pin must be inserted into groove of Gearbox. While holding Crank Handle and Gearbox firmly, screw the Spool Cap Nut onto the shaft by turning clockwise. Hand tighten securely (Fig. 06). Spool Cap Pin into groove of gearbox Fig. 05 Spool Cap Pin into Groove Fig. 06 Spool Cap Nut Shaft IFU_Sterilization 12-29-06 Rev. D page 5

RATCHET/RAKE FASTENERS: CHECK FOR TIGHTNESS PRIOR TO ** 4 pcs 4100-33 Rake Clamp Screw to mount Rake Clamps to Rake Plate. ** 2 pcs 4100P-05 Ratchet Cover Plate Screw to retain the Cover Plate on the Gearbox. ** 1 pc 4100-15 Spool Cap Nut to retain Spool Cap. ** 1 pc 4100P-11 Cable Access Plate Screw to retain Cable Access Plate. ** 1 pc 4100-03A Cable Set Screw to retain Cable in hub. The following two items should not be removed. If these fasteners are removed a bolt retaining compound must be reapplied. ** 1 pc 4100-18 Crank Handle Screw to mount Crank Handle to Crank Arm. ** 1 pc 4100P-08 Crank Arm Screw to mount Crank Arm to Ratchet Shaft. CAUTION: ** Check and tighten all fasteners on the Ratchet/Rake. Failure to do so may result in components to loosen or disassemble during use. CAUTION: ** Do not remove Roll Pins (4100P-16) which capture Lock Knob (4100-10B). 4100-50 Gear Box 4100-52 Rake Plate 4100-53 Crank Handle 4100-54 Cover Plate 4100-IMR-41 Ratchet IFU_Sterilization 12-29-06 Rev. D page 6