Reading The Pressure Setting From An X-Ray Image; Possible Shunt Components - MIETHKE proGAV Instrucciones De Manejo

| INSTRUCTIONS FOR USE
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READING THE PRESSURE SETTING FROM
AN X-RAY IMAGE
The pressure setting of the proGAV should be
measured with the proGAV Verification Tool, but
if there is any discrepancy between the desired
adjustment setting and the setting that is read
by the proGAV Verification Tool, then a radio-
graphic confirmation (x-ray) can be performed
to confirm the actual valve setting. The magnets
are visible in the image as white dots. The direc-
tion of the rotor tip indicates the pressure set-
ting. The rotor tip can take any position outside
region (Fig. 17). Thus, the opening pressure of
the proGAV can be adjusted in increments of
1 cmH O between 0 and 20 cmH
2
In order to avoid misidentification of the adju-
sted opening pressure in the X-ray image, the
valve is flattened on one side.
3
1
0
range not
adjustable
20
19
Fig. 17: Schematic X-ray image
Fig. 18: Radiograph pressure setting 0 cmH
30
O.
2
7
9
11
flat side
O
2

POSSIBLE SHUNT COMPONENTS

The proGAV is available with different shunt
accessories. These variations are comprised of
a variety of components, which are described
briefly introduced below:
The Burrhole Reservoir is position ed in the cra-
nial burrhole. It allows measurement of intra-
ventricular pressure, injection of drugs and ex-
traction of CSF. Its solid titanium base is highly
puncture-resistant. All reservoirs are available
with integrated catheters or connectors. A spe-
cial Burrhole Reservoir is the SPRUNG RESER-
VOIR. An additional new feature of this reservoir
is that CSF can be flushed towards the proGAV
because of a non-return valve in the bottom of
the reservoir. By this mechanism, flow in the di-
rection of the ventricular catheter is avoided du-
ring the pumping procedure. The opening pres-
sure of the shunt system is not increased by
the implantation of the SPRUNG RESERVOIR.
The prechamber is positioned on the craniu m. It
allows measurement of intraventricular pressure,
injection of drugs, extraction of CSF and palpatory
ventricle inspection. Its solid titanium base is highly
puncture-resistant. A puncture of the prechamber
or the CONTROL RESERVOIR should be perfor-
med as perpendicular to the reservoir surface as
possible with a cannula of maximum diameter 0,9
mm. 30 punctures are possible without any re-
strictions. A special prechamber is the CONTROL
RESERVOIR. As an additional new feature of this
reservoir, CSF can be flushed towards the pro-
GAV because of a non-return valve in the proximal
inlet of the reservoir. By this mechanism, flow in
the direction of the ventricular catheter is avoided
during the pumping procedure. The opening
pressure of the shunt system is not increased by
the implantation of the CONTROL RESERVOIR.
Warning note: Frequent pumping can lead
to overdrainage and thus to pressure con-
ditions outside the normal physiological
range. The patient should discuss the risks
(involved) with their surgeon.
Tight tolerancing of the deflector ensures a good
fit with the ventricular catheter. By adjusting the
deflector (prior to implantation) the length of ca-
theter penetrating into the skull can be optimised.
The ventricular catheter is "deflected" at a right
angle in the burrhole (see chapter "Variations").
proGAV