Tube Systems; Implantation - MIETHKE proGAV 2.0 Mode D'emploi

EN | INSTRUCTIONS FOR USE

TUBE SYSTEMS

The proGAV 2.0 can be ordered as an individual
valve unit or as a shunt system with integrated
catheters (interior diameter 1.2 mm, exterior
diameter 2.5 mm). The supplied catheters do
not fundamentally change the pressure-flow
characteristics. If catheters by other manufac-
turers are used, a tight fit must be ensured. In
any case, catheters have to be carefully fixed
with a ligature to the valve's titanium connec-
tors.

IMPLANTATION

Positioning the ventricular catheter
Several surgical techniques are available
for positioning the ventricular catheter. The
required skin incision should be made in form of
a lobule pedicled towards the draining catheter.
If a burrhole deflector is used, the skin incision
should not be located right above the reservoir.
To avoid CSF leakage, care should be taken
that the dura opening is kept as small as possi-
ble after applying the burrhole. The proGAV 2.0
is available in a range of different configurations:
If a burrhole reservoir is used, the ventricular
catheter is implanted first. Once the introduc-
ing stylet has been removed, the patency of the
ventricular catheter can be tested by checking if
cerebrospinal fluid is dripping out. The catheter
is shortened and connected the burrhole reser-
voir connected, with the connection secured
with a ligature.
A shunt system with prechamber comes with
a burrhole deflector. The deflector is used for
adjusting the length of catheter to be implanted
and for its positioning inside the ventricle.
The ventricular catheter is deflected and the
prechamber is put into place. The position of
the ventricular catheter should be checked after
implantation by imaging (such as CT or MRI).
Positioning the valve
The proGAV 2.0 operates depending on its
position. You must therefore ensure that the
gravitational unit is implanted parallel to the
body axis. Therefore, if a Shunt System in which
the valve has been pre-fitted with a burrhole
reservoir, only the occipital access should be
used. A location behind the ear is suitable as an
implantation position, whereby the implantation
height has no influence on the valve function.
The adjustable differential pressure unit should
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be contacting the bone or the periosteum since
pressure must be exerted on the valve during
any later adjustment. A large arch-shaped or a
smaller straight skin incision should be made,
which is then provided with two pockets (prox-
imal from the incision for the adjustable differ-
ential pressure unit and distal from the incision
for the gravitational unit).
The catheter is then pushed forward from the
burrhole to the selected valve implantation loca-
tion, shortened if necessary, and secured to
the proGAV 2.0 with a ligature. Neither the
adjustable differential pressure unit nor the
gravitational unit should be located directly
under the skin incision. Both valve units have
been provided with an arrow in the flow direc-
tion (arrow towards distal or downwards).
WARNING
The adjustable differential pressure unit
should not be implanted in an area which
makes the detection or palpation of the
valve difficult (e.g. underneath heavily
scarred tissue).
WARNING
The catheters should only be blocked with a
sheathed clamp and not directly behind the
valve as they might be damaged otherwise.
Positioning the peritoneal catheter
The place of access site for the peritoneal
catheter is left to the surgeon's discretion. It
can be applied e. g. para-umbilically in a hor-
izontal direction or transrectally at the height
of the epigastrium. Likewise, various surgical
techniques are available for positioning the peri-
toneal catheter. We recommend pulling through
the peritoneal catheter, using a subcutaneous
tunneling tool and perhaps with an auxiliary inci-
sion, from the shunt to the intended position of
the catheter. The peritoneal catheter, which is
usually securely attached to the proGAV 2.0,
has an open distal end, but no wall slits. Fol-
lowing the exposure of, and the entry into, the
peritoneum by means of a trocar, the peritoneal
catheter (shortened, if necessary) is pushed for-
ward into the open space in the abdominal cav-
ity.
proGAV ® 2.0