Tube Systems; Surgical Procedure - MIETHKE proGAV Instrucciones De Manejo

proGAV

TUBE SYSTEMS

The proGAV has been designed to ensure the
optimal ventricular pressure. It is available as a
shunt system or as individual valve units with or
without an integrated distal catheter (internal di-
ameter 1.2 mm, external diameter 2.5 mm). Indi-
vidual valve units should be used with catheters
of approx. 1.2 mm internal diameter and approx.
2.5 mm external diameter. The connector on the
valve allows using catheters of 1.0 mm to 1.5
mm internal diameter. The external diameter of
the catheter should be about double the internal
diameter. Regardless, the catheters must be ca-
refully fixed, with a ligature, to the valve connec-
tors. It is essential that kinks in the catheter are
avoided.The included catheters have virtually no
effect on the Pressure-flow characteristics.

SURGICAL PROCEDURE

Positioning the ventricular catheter
Several surgical techniques are available for po-
sitioning the ventricular catheter. The necessary
skin incision should be carried out, preferably,
in the shape of a lobule pedicled towards the
draining catheter or as a straight skin incision.
To avoid CSF leakage, care should be taken
that the dura opening is kept as small as pos-
sible after applying the burrhole. The ventricular
catheter is stiffened by the introducing stylet
supplied with the product.
The proGAV is available in different shunt va-
riations:
When using a proGAV SHUNTSYSTEM with
Burrhole Reservoir or SPRUNG RESERVOIR,
the ventricular catheter is implanted first. Once
the introducing stylet has been removed, the
patency of the ventricular catheter can be te-
sted by checking if CSF is dripping out. The ca-
theter is shortened and the Burrhole Reservoir
is connected, with the connection secured with
a ligature. The skin incision should not be loca-
ted directly above the reservoir.
The proGAV SHUNTSYSTEM with prechamber
or CONTROL RESERVOIR comes with a de-
flector. This deflector is used for adjusting the
position of deflection before implantation of the
ventricular catheter. The catheter is deflected;
the prechamber is put into place. The position
of the ventricular catheter should be inspected
again by postoperative CT or MR imaging.
INSTRUCTIONS FOR USE |
Positioning the valve
The adjustable DP-unit of the proGAV is sup-
plied with a factory setting of 5 cmH
opening pressure can be set to a different value
prior to implantation (see chapter "Adjusting the
proGAV"). The gravitational unit of the proGAV
is a posture-dependent valve. Therefore, care
must be taken that the unit is implanted parallel
to the body axis. A suitable implantation site is
behind the ear.
After the skin incision and tunneling un-
der the skin, the catheter is pushed for-
ward, from the burrhole to the intended
shunt implantation site. The catheter is
shortened, if necessary, and secured at the
proGAV with a ligature. The shunt should not
be located directly under the skin incision. The
valve is marked with an arrow pointing in the
direction of flow (arrow pointing to distal or
downward).
Warning note: The adjustable DP-unit must
be placed over a hard boney surface and
should not be implanted within an area,
which makes finding and feeling the valve
more difficult (e. g. under a scar).
Frequent pumping can lead to overdrainage and
thus to unphysiological pressure conditions.
The patient should be informed about the risk.
Positioning the peritoneal catheter
The access site for the peritoneal catheter is left
to the surgeon's discretion. It can be applied
e. g. para-umbilically in a horizontal direction or
transrectally at the height of the epigastrium.
Likewise, various surgical techniques are availa-
ble for positioning the peritoneal catheter. We
recommend pulling through the peritoneal ca-
theter, using a subcutaneous tunneling tool and
perhaps with an auxiliary incision, from the shunt
to the intended position of the catheter. The pe-
ritoneal catheter, which is usually securely atta-
ched to the proGAV, has an open distal end, but
no wall slits. Following the exposure of, and the
entry into, the peritoneum by means of a trocar,
the peritoneal catheter (shortened, if necessary)
is pushed forward into the open space in the ab-
dominal cavity.
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O. This
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