Testing Stimulation Intraoperatively - Medtronic PISCES QUAD 3487A Manual Del Usuario

3487ALead_CH.fm 5/13/04 3:14 pm
UC200xxxxxx EN
4 x 8 inches (101 mm x 203 mm)
When using a bent stylet and resistance is encountered during lead
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advancement, exchange the bent stylet for the straight stylet and use
short, firm movements to advance the lead.
9. After verifying the lead position under fluoroscopy (anterior-posterior and
lateral views), compare that location with the location that has the highest
recommended probability of paresthesia coverage.
Notes:
To increase lead stability, insert enough lead length to extend at least
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three vertebral bodies into the epidural space.
■ Position the lead so that the center bipole electrodes (eg, electrodes 1
and 2 on a quadripolar lead) will be active. If lead migration occurs,
effective stimulation may be regained through programming
adjustments instead of surgical repositioning.

Testing stimulation intraoperatively

Caution: To prevent an abrupt change in stimulation, which some
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patients have described as uncomfortable stimulation (jolting or shocking
sensation):
■ Program parameter changes in small increments above the
perception threshold (the amplitude value at which the patient first
perceives paresthesia).
■ Decrease the amplitude to 0.0 V before:
– changing electrode polarities.
– connecting the screener cable to the screener.
– turning ON the neurostimulator or screener.
1. After connecting the screener cable to the patient's implanted lead, pass
the plug end out of the sterile field.
Note: When testing two leads, mark the Lead 1 and Lead 2 screener
cables to ensure placement in the correct receptacle of the screener.
2. After verifying that the screener is turned OFF, connect the screener cable
plug to the appropriate receptacle of the screener.
Warning: Maintain adequate slack in the screener cable. If there is
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not enough slack and the cable is pulled, the percutaneous
components may be dislodged.
3. Identify optimal stimulation parameters, beginning at a pulse width of
210 – 240 µs and a rate of 30 Hz.
Note: Ensure that the patient can provide immediate feedback.
4. Increase the amplitude beginning from 0.0 V while asking the patient
close-ended questions to identify the perception threshold (the amplitude
at which the patient first perceives paresthesia), the discomfort threshold
(the amplitude at which paresthesia is beyond the patient's tolerance), and
the paresthesia coverage.
Note: If good paresthesia coverage is not attained, change electrode
settings before repositioning the lead to confirm the direction of lead
movement.
5. If two leads were placed, repeat steps 1–4 for the second lead; optimize
paresthesia coverage using both leads.
6. In the patient's chart, document the lead position that provided
appropriate stimulation coverage (ie, record the settings and patient
responses and include a fluoroscopic image of the final lead position).
7. Disconnect the screener cable from the lead. Leave the screener cable in
the sterile field for additional parameter testing before closing.
Caution: Do not pull directly on the cable to disconnect the
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connector because this may lead to wire breakage and inadequate
or discontinuous stimulation.
198855002 Rev A
Medtronic Confidential
NeuroLdExt_R01
3487A, 3887, 3888 2004-05 English 9