Integra LifeSciences CODMAN HAKIM Precision Fixed Pressure Valves Mode D'emploi page 14

Once fluid flows from the outlet end of the drainage catheter, occlude the
inlet tubing of the valve system with shod forceps (close to the ventricular
end), and remove the syringe and priming adapter (if applicable).
CAUTION: Avoid unnecessary pumping of the system to prevent
overdrainage of the ventricles. Over-irrigation of the valve system
may damage the internal mechanism.
Record the valve lot number on the patient's chart.
Clearing Obstructions
(Cylindrical with Prechamber Valves only)
To check the patency of the ventricular catheter, occlude the tubing between
the prechamber and the valve unit with finger pressure (Figure 7). Press
the prechamber. If the prechamber does not compress easily and does not
return immediately to its original shape, or if the prechamber compresses
easily but does not refill immediately, the ventricular catheter may be
occluded. To correct this situation, first allow the prechamber to refill. Then,
occlude the tubing between the prechamber and the valve unit with finger
pressure and press the prechamber firmly. This forces fluid back through
the ventricular catheter, helping to remove the obstruction. If necessary,
repeat this procedure.
In some circumstances, the use of a syringe (with 25-gauge Huber type
needle) is necessary to remove the obstruction. Occlude the tubing between
the prechamber and the valve unit with finger pressure. Using light pressure,
inject sterile, nonpyrogenic saline solution into the prechamber (Figure 8).
To test the patency of the tubing between the prechamber and the valve
unit, occlude the tubing between the prechamber and the valve unit
with pressure. Press and release the prechamber. If the prechamber
immediately returns to its original shape after compression, remove finger
from the tubing and press the pumping chamber. If the pumping chamber
compresses readily but does not immediately return to its original shape,
there may be an obstruction between the prechamber and valve unit. To
remedy this situation, occlude the tubing between the prechamber and
the ventricular catheter (Figure 9). Firmly press the prechamber with the
adjoining finger to force fluid forward through the valve unit and drainage
catheter. If necessary, repeat.
Occasionally, it may be necessary to use a syringe with 25-gauge Huber
type needle to dislodge the obstruction. Occlude the tubing proximal to the
prechamber. Using light pressure, inject sterile, nonpyrogenic saline solution
into the prechamber (Figure 10).
To test the patency of the valve outlet or drainage catheter, press on the
pumping chamber. If the pumping chamber resists compression, the valve
outlet or drainage catheter may be obstructed. To dislodge the obstruction,
press the valve unit forcefully, then release it to permit the prechamber
to refill.
Reservoir Injection
(Cylindrical with prechamber Valves)
To inhibit coring of the reservoir cap, use a Huber type needle (24- or
26-gauge) to penetrate the dome. Insert the needle at an oblique angle
to achieve the greatest yield of CSF and to prevent the needle point from
piercing the ventricular catheter (Figure 11).
Troubleshooting
If valve function is adversely affected by accumulations of biological matter,
it may be possible to dislodge the material and restore proper function on
a valve without SIPHONGUARD by flushing and/or pumping the valve.
If this remedial step fails to rectify the problem, replace the valve.
Bibliography
Adams RD, Fisher M, Hakim S, Ojemann RG, Sweet WH: Symptomatic
occult hydrocephalus with "normal" cerebrospinal fluid pressure.
New Eng J Med 273: 117–126, 1965.
Bayston R: Serological surveillance of children with CSF shunting devices.
Supplement 35: 104–110, 1975, to Develop Med Child Neurol 17.
Bayston R, Swinden J: Aetiology & prevention of Shunt Nephritis.
Zeitschrift für Kinderchirurgie 28: 377–384, 1979.
Black P McL, Hakim R, Bailey NO: The Use of the Codman-Medos
Programmable Hakim Valve in the Management of Patients with
Hydrocephalus: Illustrative Cases. Neurosurgery 34: 6, 1994.
Black P McL: Idiopathic normal-pressure hydrocephalus. Results of
shunting in 62 patients. J Neurosurg 53: 371–377, 1980.
Black P McL, Tzouras A, Ojemann RG: CSF shunts for dementia, gait
disturbance, and incontinence, Clinical Neurosurgery.
Cohen SJ, Callaghan RP: A syndrome due to bacterial colonisation of
Spitz-Holter valves. A review of 5 cases, Brit Med J 2: 677–680, 1961.
Drake JM, Kestle JRW, Milner R, et al: Randomized Trial of
Cerebrospinal Fluid Shunt Valve Design in Pediatric Hydrocephalus.
Neurosurgery 43: 2, 1998.
6