Integra Codman CERTAS Plus Mode D'emploi page 22

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• flushing and/or pressing the valve (only for those valves
without the SIPHONGUARD feature)
• multiple attempts to adjust the setting
Confirming the Current Valve Setting
The setting of an implanted valve can be determined by
using the CERTAS Tool Kit, (refer to the Tool Kit IFU for more
information).
An alternate method is to x-ray the valve. A proper x-ray is
generated when the film is shot perpendicular to the plane of the
valve with the non-implanted side of the patient's head resting on
the plate. The film must be taken in relation to the valve and not
the patient's anatomy. See Figure 3 for x-ray views of the valve at
each setting.
When viewing the x-ray film or screen to confirm the valve
setting, use the X-Ray Overlay Tool (refer to the Tool Kit IFU for
more information).
Reading the Valve Setting with the X-Ray Overlay Tool
See Figure 4.
Note: Position the X-Ray Overlay Tool flush against the x-ray
image.
1 . Align RED centerline of valve on overlay with the centerline
of the valve x-ray under review. This can be accomplished
by aligning the proximal and distal connectors of the x-ray
image with those on the overlay.
2 . Ensure that the numbers on the overlay that depict the
performance settings are properly oriented for viewing. In
this orientation the right-hand side (RHS) marker red line
extends to the right of the RED centerline. This ensures
proper overlay orientation.
3 . Align rotating construct (RC) center dot on overlay with the
center of the RC of the x-ray image.
4 . Ensure RHS marker red line containing red dot is aligned with
the RHS marker of the x-ray image (if present).
5 . The valve setting is determined by identifying the region of
the overlay that contains the majority of the image of the
magnet that has the tantalum ball adjacent to it.
Injection
If hypodermic injection is required, inject with a 25-gauge or
smaller non-coring Huber type needle into the reservoir only.
The reservoir can be punctured up to 25 times with a 25-gauge or
smaller non-coring Huber type needle.
CAUTION: A needle guard has been included in the valve
housing to provide tactile feedback during needle insertion but
is not intended to prevent puncturing through the back of the
valve under forceful pressure .
Valve Flushing
(Valves without SIPHONGUARD only)
CAUTION: While flushing may be used as a method for
determining patency, it is not recommended . Use clinical
judgment and imaging studies or other techniques to confirm
suspected cases of shunt malfunction .
To flush the ventricular (proximal) catheter:
• Occlude the catheter distal to the reservoir with finger
pressure, then depress the reservoir.
• Failure of the reservoir to refill might indicate proximal
catheter blockage.
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