Integra NeuroSciences OSV II Instrucciones De Uso página 8

Note - Sample CSF at this time if desired by withdrawing fluid from the cannula.
Disengage the catheter from the collar on the cannula, ensuring that the catheter's position is maintained. Remove the
introducer cannula from the burr hole. For instructions on the use of the RAG, refer to Steps 4 and 5 of the
"Ventriculoperitoneal Approach" procedure.
Ventriculoatrial Approach
Caution - The procedure is based on the use of a separate ventricular catheter. If a valve with an integral ventricular
catheter is used, follow the procedure " Introduction of Integral Ventricular Catheter".
Position the patient and open the skull as described in Steps 1 and 2 of the "Ventriculoperitoneal Approach"
1.
procedure above.
Using blunt dissection, create a small pocket under the skin to avoid unnecessary pull strength on the drainage
catheter when positioning the shunt.
Make a neck incision over the point where the angle of the mandible crosses the anterior edge of the
2.
sternocleidomastoid muscle. If the internal jugular vein is used, facilitate entry by mobilizing the common facial vein
at its junction with the internal jugular vein.
Tunnel the drainage catheter from the skull subcutaneous pocket to the neck incision. Position the valve under
3.
the skin.
Insert the ventricular catheter following the Steps 4, 5, and 6 of the "Ventriculoperitoneal Approach" procedure.
4.
Trim the drainage catheter at the neck incision. Fill the distal part with sterile apyrogenic saline solution. Clamp
5.
the proximal end. Introduce the drainage catheter into the vein. Position the distal end of the drainage catheter in the
heart's right atrium at the level of the 6th or 7th thoracic vertebra. Determine the exact location of the catheter by X-
ray, radioscopy, ECG, pressure analysis or echography.
Note - To enhance X-ray visualization, the atrial catheter may be filled with contrast.
Carefully maintaining the catheter in place, trim its proximal part, and the valve outlet tubing to length. Connect
6.
the two together using a straight connector. Tie securely using appropriate sutures.
Close incisions.
7.
Note - X-ray the complete system just after implantation for future reference to determine whether system
components have shifted.
Valve Pumping after Implantation
Percutaneous depression of the antechamber with the finger will force CSF out of the valve in both the proximal and
distal directions. Occlude either the distal or proximal side of the antechamber by finger pressure (according to
Figure 5), then depress the antechamber. This will push the fluid in the direction opposite to the occlusion.
Warning - Shunt obstruction may occur in any component of a shunt system and should be diagnosed by clinical
symptoms and X-rays. Valve pumping testing may not be adequate to diagnose occlusion of catheters.
Injection into the Valve System
The antechamber can be used to access CSF for injections. Use of 25G or smaller beveled needles is recommended.
Care must be taken during insertion and removal of the needle to avoid tearing the silicone material. It is also advised to
avoid puncturing several times at the same place. Taking into account the above recommendations, the antechamber is
qualified to sustain up to 40 punctures without leaking.
Caution - Do not overpressurize the valve system. Excessive flushing pressures may lead to valve damage.
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