Tube Systems; Implantation - MIETHKE M.blue Mode D'emploi

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M.blue
®
WARNING
Frequent pumping can result in excessive
drainage and thus lead to pressure condi-
tions outside the normal physiological range.
The patient should be informed about this
risk.
Burrhole deflector
Because of the tight fit on the ventricular
catheter, the burrhole deflector makes it possi-
ble to choose the length of catheter penetrating
into the skull prior to implantation. The ventric-
ular catheter is deflected at a right angle in the
burrhole (see chapter "Implantation").

TUBE SYSTEMS

M.blue 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 of 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 pos-
sible after applying the burrhole.
M.blue is available in a range of different
configurations: If a Burrhole Reservoir or a
SPRUNG RESERVOIR is used, then the ventric-
ular catheter is implanted first. Once the intro-
ducing stylet has been removed, the patency of
the ventricular catheter can be tested by check-
ing if cerebrospinal fluid is dripping out. The
catheter is shortened and the burrhole reser-
voir connected, with the connection secured
with a ligature. When using a shunt system with
a CONTROL RESERVOIR, a burrhole deflector
is included. The deflector is used for adjusting
the length of catheter to be implanted and for
INSTRUCTIONS FOR USE | EN
its positioning inside the ventricle. The ventric-
ular catheter is deflected, and the CONTROL
RESERVOIR is put into place. The position of
the ventricular catheter should be inspected
after the procedure by imaging (such as CRT
or MRI).
Positioning of the valve
The adjustable gravitational unit in M.blue is
set to an opening pressure of 20 cmH
upon delivery. This opening pressure can be
changed to a different pressure before implan-
tation. A location behind the ear is suitable as an
implantation position, whereby the implantation
height has no influence on the valve function.
The adjustable valve should be touching the
bone or the periosteum since pressure must
be exerted on the valve during any later adjust-
ment. A large arch-shaped or a small straight
skin incision with a pocket for the valve should
be made. The catheter is then pushed for-
ward from the burrhole to the selected valve
implantation location, shortened if necessary,
and secured to the M.blue with a ligation. The
valve should not be located directly under the
skin incision. The valve unit has an arrow in the
flow direction (arrow towards distal or down-
wards). The embossed blue surface of the valve
with the arrow markings points to the outside.
NOTE
M.blue is position-dependent. For that rea-
son, care must be taken to implant the valve
parallel to the body axis.
Therefore, if a shunt system in which the valve
has been pre-fitted with a Burrhole Reservoir is
being used, only the occipital access should be
used.
WARNING
The adjustable valve should not be implanted
in an area that makes the detection or pal-
pation of the valve difficult (e.g. underneath
heavily scarred tissue).
CAUTION
The catheters should only be blocked with a
sheathed clamp and not directly behind the
valve as they might be damaged otherwise.
O
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