Surgical Technique; Section C: Post-Implantation Adjustment Procedure - Codman Neuro CERTAS Plus Manual De Instrucciones De Uso

3. Once fluid flows from the distal connector barb of the

Surgical Technique

There are a variety of surgical techniques that can be
used to place the valves. The surgeon should choose
in accordance with his or her own clinical experience
and medical judgment. It is required that the valve
be irrigated as outlined in Irrigation, to help ensure
proper performance.
CAUTION: Placement of the valve can impact the
performance of the tool kit and should be taken
into account for proper patient therapy. Select a
location where the implanted valve can be positioned
horizontally for use with the tool kit (See Figure 6).
Avoid placement too close to structures, such as the
ear. It is also important to choose an implantation site
where the tissue over the valve is not too thick (>10 mm)
otherwise locating, reading and adjusting with the
CODMAN CERTAS Tool Kit may not be possible.
It is recommended to record the setting of the valve
in the patient records and on the patient I.D. wallet
card. Labels are provided with each valve to record the
product lot number information in the patient records.
I.D. wallet cards are available from the local Codman
sales representative.
SECTION C: Post-implantation
Adjustment Procedure
Adjust the valve at any time after the implantation
surgery. If needed, apply a sterile drape over the incision
site. The drape will not interfere with the magnetic
coupling of the adjustment procedure.
CAUTION: Excessive swelling or thick tissue may make
it difficult to determine and/or adjust the performance
setting. See Step 4 in this section for instructions for
using the Low Profile Locator Tool in these instances.
If difficulty correctly positioning both Locator
Tools persists, wait until the swelling is reduced or
confirm the valve setting with x-ray. See SECTION D:
Troubleshooting and SECTION E: Confirming the
Current Valve Setting for more information.
1. Position the patient so that the implanted valve
2. Locate the valve by palpation. Palpate and mark the
3. Select the appropriate Locator Tool (Adjustable
206521-001-H-INS.indd 14
valve (or the distal catheter, on unitized models), and
air has been evacuated from the valve, remove the
syringe and the priming adapter (if used).
and tools are horizontal, to optimize Indicator Tool
performance (See Figure 6).
CAUTION: If Indicator Tool is not horizontal, an
inaccurate reading might result.
center of the valve mechanism i.e., the hard portion
of the valve distal to the reservoir. Palpate and mark
the position of the inlet and outlet connector barbs/
catheters (See Figure 7).
Height Locator Tool or Low Profile Locator Tool).
If the tissue in the area of the valve is thick tissue or
if edema is present (>10 mm above the valve), use
the Low Profile Locator Tool (Figure 8). Otherwise,
use the Adjustable Height Locator Tool. Optimal
placement is achieved when the selected Locator
Tool is stable on the patient's head and the tissue that
covers the valve mechanism is just below the cut-out
in the Locator Tool (Figures 9A and 9C).
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