- Prepare the fistula tract
- Clean and debride the tract with gentle curettage or irrigation
- Confirm tract patency with a probe
- Identify internal and external openings
- May use hydrogen peroxide or methylene blue to delineate
- Dry the tract thoroughly
- Important for adhesion of glue
- Mix fibrin glue components (fibrinogen and thrombin)
- Usually provided in a dual-syringe applicator
- Inject glue from internal to external opening using cannula or catheter
- Fill the tract without excess pressure
- Optionally, close the internal opening with suture
- Improves success rate in some protocols
- External opening is usually left open for drainage
