Percutaneous Lead Placement In The Epidural Space - Boston Scientific Precision Manuel

Precision™ Spinal Cord Stimulator System Clinician Manual
Percutaneous Lead
Placement in the Epidural
Space
1. Position, prep and drape the patient in the
usual accepted manner. Inject a local an-
esthetic at the needle insertion site.
2. Under fluoroscopic guidance, place the in-
sertion needle into the epidural space with
the bevel facing up using an angle of 45°
or less.
CAUTION: Use only an insertion needle
provided by Boston Scientific. Other nee-
dles may damage the lead. The stamped
number "14" on the needle hub (or the
triangle on the hub of the curved Epimed
needle, sold separately) corresponds to
the orientation of the bevel, which must
face up. Turning the bevel ventral (down)
may result in lead damage. An angle of
more than 45° increases the risk of lead
damage.
WARNING: The angle of the insertion nee-
dle should be 45° or less. Steep angles in-
crease the insertion force of the stylet and
also present more of an opportunity for the
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stylet to pierce the lead and cause tissue
damage.
3. Remove the needle stylet from the inser-
tion needle and verify entry into the epi-
dural space using the standard technique.
4. OPTIONAL. Under fluoroscopic guidance,
insert the lead blank through the insertion
needle and into the epidural space. Ad-
vance the lead blank to verify entry into the
epidural space, then withdraw the blank.
5. While holding the lead stylet handle, place
the steering cap over the proximal end of
the stylet handle with moderate force until
it is held in place. Then slowly insert the
lead, with stylet, through the insertion nee-
dle. The lead stylet should extend to the
tip of the lead.
6. OPTIONAL. If exchange of the lead stylet
is desired, carefully pull out the existing
stylet and insert the preferred stylet. While
inserting the stylet into the lead, if resis-
tance is encountered, withdraw the stylet
approximately 3 cm, rotate the lead and/
or stylet, and gently advance the stylet. If
resistance is still encountered, repeat the
above procedure until the stylet can be
fully inserted.
WARNING: Do not exchange the lead
stylet while the electrode array of the lead
is in the bevel of the insertion needle. If
the electrode array is in the bevel area,
remove the lead from the insertion needle
before exchanging the stylet. Inserting
the lead stylet in the lead while the elec-
trode array is in the bevel of the insertion