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

proGAV 2.0
Burrhole Deflector
Because of the tight fit on the ventricular
catheter, the Burrhole Deflector makes it pos-
sible to choose the length of catheter pen-
etrating into the skull prior to implantation.
The ventricular catheter is deflected at a right
angle in the burrhole (see chapter "Implanta-
tion").

TUBE SYSTEMS

The proGAV 2.0 can be ordered as an individ-
ual valve unit or as a shunt system with inte-
grated 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 manufacturers are used, a tight fit must
be ensured. In any case, catheters have to be
carefully fixed with a ligature to the valve's tita-
nium connectors.

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 drain-
ing 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 possible 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 introducing stylet has
been removed, the patency of the ventricu-
lar catheter can be tested by checking if cere-
brospinal 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
INSTRUCTIONS FOR USE | GB
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 differen-
tial pressure unit should 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 (proximal from
the incision for the adjustable differential pres-
sure unit and distal from the incision for the
gravitational unit).
The catheter is then pushed forward from the
burrhole to the selected valve implantation
location, 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 tis-
sue).
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 horizontal direction or transrectally at the
height of the epigastrium. Likewise, various
surgical techniques are available for position-
ing the peritoneal catheter. We recommend
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