Valve Test - MIETHKE M.blue Instrucciones De Manejo

GB | INSTRUCTIONS FOR USE
M.blue is available in a range of different
configurations: If a Burrhole Reservoir or a
SPRUNG RESERVOIR is used, then the ven-
tricular catheter is implanted first. Once the
introducing stylet has been removed, the
patency of the ventricular catheter can be
tested by checking if cerebrospinal fluid is
dripping out. The catheter is shortened and
the burrhole reservoir connected, with the
connection secured with a ligature. When
using a shunt system with a CONTROL
RESERVOIR, a burrhole deflector is included.
The deflector is used for adjusting the length
of catheter to be implanted and for its posi-
tioning inside the ventricle. The ventricu-
lar catheter is deflected, and the CONTROL
RESERVOIR is put into place. The position of
the ventricular catheter should be inspected
after the procedure by imaging (such as CRT
or MRI).
Positioning of the valve
The adjustable gravitational unit in M.blue is
set to an opening pressure of 20 cmH
upon delivery. This opening pressure can
be changed to a different pressure before
implantation. A location behind the ear is suit-
able as an implantation position, whereby the
implantation height has no influence on the
valve function. The adjustable valve should
be touching the bone or the periosteum since
pressure must be exerted on the valve dur-
ing any later adjustment. A large arch-shaped
or a small straight skin incision with a pocket
for the valve should be made. The catheter
is then pushed forward from the burrhole
to the selected valve implantation location,
shortened if necessary, and secured to the
M.blue with a ligation. The valve should not
be located directly under the skin incision.
The valve unit has an arrow in the flow direc-
tion (arrow towards distal or downwards). The
embossed blue surface of the valve with the
arrow markings points to the outside.
NOTE
M.blue is position-dependent. For that rea-
son, care must be taken to implant the valve
parallel to the body axis.
24
Therefore, if a shunt system in which the valve
has been pre-fitted with a Burrhole Reservoir is
being used, only the occipital access should
be used.
WARNING
The adjustable valve should not be implanted
in an area that makes the detection or pal-
pation of the valve difficult (e.g. underneath
heavily scarred tissue).
CAUTION
The catheters should only be blocked with a
sheathed clamp and not directly behind the
valve as they might be damaged otherwise.
Positioning of the peritoneal catheter
The access site for the peritoneal catheter is
left to the surgeon's discretion. For example,
it can be applied paraumbilical or at the height
of the epigastrium. Likewise, various surgical
techniques are available for positioning the
peritoneal catheter. The recommendation is
to pull the peritoneal catheter using a subcu-
O
2
taneous tunnelling tool from the valve to the
intended position, if necessary with the aid an
auxiliary incision. The peritoneal catheter that
is usually securely attached to M.blue has an
open distal end and no wall slits. Following the
exposure of the peritoneum or with the aid of
a trocar, the peritoneal catheter (shortened if
necessary) is pushed forward into the open
space of the abdominal cavity.

VALVE TEST

Preoperative valve test
M.blue should be vented before implantation
and checked for permeability. The most care-
ful way of filling the valve is by aspiration
through a sterile single-use syringe attached
to the distal end of the catheter. The distal end
of the valve is connected and immersed in a
sterile physiological salt solution. The valve is
continuous if saline solution can be extracted
(fig. 19).
WARNING
Contamination in the solution used for test-
ing can impair the product's performance.