Sophysa PRESSIO PSO-PVT Manual De Instrucciones página 8

Use the insertion accessories supplied by Sophysa in the Pressio® monitoring kit.
The surgeon will choose the technique depending on his own experience and
the clinical status of the patient. The fi nal implantation of the device should satisfy
the conditions for optimal positioning of the sensor in the ventricle.
P :
RECAUTION
D
O NOT PERFORM THE IMPLANTATION OF A MONITORING CATHETER WITHOUT HAVING A REPLACEMENT
.
KIT AVAILABLE IN CASE IT IS REQUIRED
Choice of implantation area
Indication for implantation area: the standard right and left prefrontal areas are
the main implantation areas. This region allows the patient to turn his/her head
while remaining in the decubitus position without interfering with the intracranial
pressure monitoring function. Additionally, in most cases, the incision is made behind
the hairline, which is acceptable from an esthetic point of view.
It is recommended that the catheter be tunneled under the scalp to improve its
fi xation and reduce the risks of infection.
The site where the catheter emerges is generally found 5cm from the burr hole
in a posterior position.
Intracranial access
Once the implantation site has been chosen, the area is shaved and prepared
aseptically. A local anesthetic is applied in the incision area. This is generally
2 to 3 centimeters in front of the coronal suture on the mid-pupillary line.
An incision of about one centimeter is made down to the bone.
Make sure the bony plate is well exposed and perform hemostasis on the wound edges.
The adjustable stop on the drill bit supplied in the kit may be positioned as required
by loosening the locking screw with the Allen wrench.
Position the adjustable stop depending upon the drilling depth chosen and retighten
the locking screw to maintain this position.
W :
ARNING
I
NCOMPLETE TIGHTENING OF THE LOCKING SCREW WILL PREVENT THE ADJUSTABLE STOP FROM PLAYING
,
ITS ROLE WITH THE RISK OF DRILLING TOO DEEPLY
The drill bit is then fi xed to a helical drill and the perforation is performed through
the internal and external skull plates. The surgeon must ensure that any possibility
of a parenchymal lesion when he crosses the internal plate is avoided.
After having crossed the internal plate, the drill bit is withdrawn and the hole
is irrigated with sterile normal saline.
Incise the dura mater.
Technique recommended for tunneling
- Insert the proximal end of the catheter in the tunneling trocar sheath.
- Make a small incision at the site chosen for the emergence of the catheter (Figure 3.1).
- Starting at the site chosen for the emergence of the catheter, insert the tunneling
trocar between the scalp and the skull towards the burr hole (Figure 3.2).
- Pull the catheter out of the tunnel making sure that a length of at least 30 cm comes
out of the implantation site, and remove the trocar with the sheath (Figure 3.3).
P :
RECAUTION
T
HE END OF THE TUNNELING TROCAR IS SHARP
.
:
INTRODUCE THE CATHETER VERY CAREFULLY
Catheter implantation
W :
ARNING
L
IMIT THE REPETITION OF INTRACEREBRAL CATHETER IMPLANTATIONS
INTO THE BRAIN TO ENABLE THE INSERTION OF THE CATHETER COULD PREDISPOSE IT TO EDEMA
AND INTRACEREBRAL HEMORRHAGE
Ensure that the pressure sensor has been zeroed beforehand (cf. § "Preparation
of a Pressio® catheter BEFORE IMPLANTATION: zeroing the pressure sensor").
W :
ARNING
D
O NOT PERFORM THE
"SENSOR ZERO"
TO PERFORM THE
.
PRESSURE
- Holding it by the stylet pre-inserted in the specifi cally designed lumen, implant the
catheter in the direction of the ventricle in accordance with standard techniques.
- Remove the protective cap from the Luer-Lock connector, at the end of the catheter
drainage tubing. Check correct positioning in the ventricle by observing the return
of the cerebro-spinal fl uid at the drainage connector opening.
- If a series of air bubbles and liquid segments appear in the catheter, purge
it by letting possible air bubbles move down to the end of the drainage tubing.
If the ventricles of the patient are swollen, it could be wise to move the catheter
forward by several millimeters beyond the point where the fi rst liquid sample
was taken. In this way the end of the catheter will remain in the ventricle during
decompression.
- If the ventricular approach fails it is, however, possible to monitor the ICP by
leaving the catheter in place in the parenchyma it has traversed. The ICP values
measured will be the intra-parenchymal pressure values where the sensor
is located. In this case, close the Luer-Lock to limit the risk of infection.
- While holding the catheter in place at the implantation site, remove the stylet by
gently bending the catheter between the two arrow-shaped markers (Fig. 3-5).
Connection to an external drainage system
- The catheter can be connected to various external CSF drainage systems.
Connect the catheter to the external drainage tubing using a Luer-Lock
connector.
- If the catheter is not connected to an external drainage system, close the Luer-
Lock to limit the risk of infection.
P :
RECAUTIONS
R
EFER TO THE EXTERNAL DRAINAGE SYSTEM INSTRUCTIONS FOR ITS CONDITIONS FOR USE
Catheter fi xation
- Hold the catheter in place at the implantation site and pull very gently on the
end located at the side of the connector until it forms a right angle and rests fl at
against the skull.
- Close the incision above the burr hole in compliance with standard hospital
procedures.
- Use the fi xation tab supplied to fi x the catheter on the scalp at the site where
it emerges (Figure 3.6).
- To keep the catheter in place and reduce the tension, roll the catheter and attach
the loop thus formed. Make sure no traction is exercised on the fi xation tab during
.
these stages.
8
,
RESULTING IN A RISE IN INTRACRANIAL PRESSURE
"SENSOR ZERO"
ONCE THE CATHETER IS IMPLANTED
BEFORE IT IS IMPLANTED TO CALIBRATE IT WITH ATMOSPHERIC
:
FREQUENT INCISIONS
.
;
IT IS ESSENTIAL
.