Surgical Technique; Section C: Post-Implantation Adjustment Procedure - Codman CERTAS Plus Manual Del Usario

Note: The SIPHONGUARD device is intended to
reduce the rapid flow of CSF. It also reduces the
ability to prime the shunt system during implantation
to a rate of approximately 0.5 mL/minute.
3. Once fluid flows from the distal connector barb of the
valve (or the distal catheter, on unitized models), and
air has been evacuated from the valve, remove the
syringe and the priming adapter (if used).

Surgical Technique

There are a variety of surgical techniques that can be
used to place the valves. The surgeon should choose
in accordance with his or her own clinical experience
and medical judgment. It is required that the valve
be irrigated as outlined in Irrigation, to help ensure
proper performance.
CAUTION: Placement of the valve can impact the
performance of the tool kit and should be taken
into account for proper patient therapy. Select a
location where the implanted valve can be positioned
horizontally for use with the tool kit (See Figure 6).
Avoid placement too close to structures, such as the
ear. It is also important to choose an implantation site
where the tissue over the valve is not too thick (>10 mm)
otherwise locating, reading and adjusting with the
CODMAN CERTAS Tool Kit may not be possible.
It is recommended to record the setting of the valve
in the patient records and on the patient I.D. wallet
card. Labels are provided with each valve to record the
product lot number information in the patient records.
I.D. wallet cards are available from the local Codman
sales representative.
SECTION C: Post-implantation
Adjustment Procedure
Adjust the valve at any time after the implantation
surgery. If needed, apply a sterile drape over the incision
site. The drape will not interfere with the magnetic
coupling of the adjustment procedure.
CAUTION: Excessive swelling or thick tissue may make
it difficult to determine and/or adjust the performance
setting. See Step 4 in this section for instructions for
using the Low Profile Locator Tool in these instances.
If difficulty correctly positioning both Locator
Tools persists, wait until the swelling is reduced or
confirm the valve setting with x-ray. See SECTION D:
Troubleshooting and SECTION E: Confirming the
Current Valve Setting for more information.
1. Position the patient so that the implanted valve
and tools are horizontal, to optimize Indicator Tool
performance (See Figure 6).
CAUTION: If Indicator Tool is not horizontal, an
inaccurate reading might result.
2. Locate the valve by palpation. Palpate and mark the
center of the valve mechanism i.e., the hard portion
of the valve distal to the reservoir. Palpate and mark
the position of the inlet and outlet connector barbs/
catheters (See Figure 7).
3. Select the appropriate Locator Tool (Adjustable
Height Locator Tool or Low Profile Locator Tool).
If the tissue in the area of the valve is thick tissue or
if edema is present (>10 mm above the valve), use
the Low Profile Locator Tool (Figure 8). Otherwise,
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