Integra LifeSciences Codman HOLTER A Manual Del Usuario página 6

6. Thread the introducer of the Introducer and Cone Set, catalog
no. 82-1690, into the inlet adapter of the valve, and place the cone
over the adapter (Figure 2). While grasping the serrated end of the
introducer with forceps, draw the introducer and attached assembly
through to the scalp.
7. After removing the Introducer and Cone Set, place the ventricular
components of the shunt system. Then connect the ventricular
components to the inlet adapter of the valve, and secure with two
nonabsorbable ligatures.
8. After verifying that cerebrospinal fluid is flowing through the
system, clamp the catheter at the neck incision with a rubber-shod
clamp.
9. Placement of the atrial portion of the catheter can be made by
one of the following means:
CAUTION: Placement of the atrial portion of the catheter must take
into account head mobility, which can cause significant catheter
movement which may result in cardiac or venous complications.
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a. When placement is to be determined by intracardiac
electrocardiogram, insert a styIet in the entire length of tubing.
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After attaching leads to the stylet, incise the vein with a nick that is
smaller than the outside diameter of the tubing. Gently insert the
tubing until acceptable placement is achieved. Remove the stylet
and clamp the tubing.
b. Fill the tubing with sterile saline and clamp it at the proximal
end. After incising the vein, insert the tubing. Confirm acceptable
placement by fluoroscopy or X-ray films.
10. Trim the ends of the catheter as is appropriate.
11. Connect both portions of the catheter together by inserting the
Type "A" connector (Figure 3). It may be necessary to pull the atrial
portion of the catheter a short distance out of the vein to complete
connection. Remove the clamps from both portions.
12. Place a nonabsorbable ligature over the tubing at each end of
the connector in the tubing. A tie between the ligatures will further
secure the connector in the catheter.
13. If fixation to avoid movement of the atrial portion of the catheter
is desired, place a ligature around the vein at the point where the
connector is located.
14. After checking that all connections are secure and that there is
no leakage, close the incisions.
References
1. Nulsen FE, Becker DP: Control of hydrocephalus by valve-
regulated shunt. J Neurosurg 26:361–374, 1967.
2. Forrest DM, Cooper DGW: Complications of ventriculo-atrial
shunts. J Neurosurg 29:506–512, 1968.
3. Tsingoglou S, Forrest DM: Complications from HOLTER
ventriculo-atrial shunts. Brit J Surg 58:372–377, 1971.
4. Nugent GR, et al: Thrombo-embolic complications of ventriculo-
atrial shunts: angiocardiographic and pathologic correlations.
J Neurosurg 24:34–42, 1966.
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