Preparing For Surgery; Placing A Percutaneous Lead - Medtronic PISCES QUAD 3487A Manual Del Usuario

3487ALead_CH.fm 5/13/04 3:14 pm
UC200xxxxxx EN
4 x 8 inches (101 mm x 203 mm)

Preparing for surgery

Before opening the lead package, verify the model number, use-by date, lead-
length, and connector type.

Placing a percutaneous lead

Cautions:
#
Use only the curved or modified Tuohy needle supplied in the kit.
■
Using other needles may damage the lead.
■ Use the recommended needle-insertion angle for the vertebral
location listed below. An angle other than that recommended
increases the risk of damage to the lead during insertion or
manipulation.
Vertebral location
Lumbar
Thoracic
Cervical
1. Make an incision at the needle-entry site to the depth of the subcutaneous
fascia.
2. Using a paramedial approach and under fluoroscopy, insert the needle (ie,
the curved or modified Tuohy included in the kit) into the epidural space at
the appropriate angle until you encounter resistance from the ligamentum
flavum.
Note: Midline placement may cause passive damage to the lead over time
because of ligament or spinous process movement.
3. Confirm needle location under fluoroscopy.
4. After rotating the needle so that the beveled edge faces cephalad, remove
the needle stylet.
5. Advance the needle and confirm entry into the epidural space (eg, using
the loss-of-resistance technique with air or sterile [United States
Pharmacopeia—USP] water).
Caution: Do not use contrast media or a saline flush. Contrast
#
media may obscure the field of view and a saline flush may increase
the difficulty of lead placement.
6. For a second lead, repeat steps 1 – 5 noting these recommendations:
Implant the second lead parallel to the first lead and approximately
■
1 – 3 mm lateral of the physiological midline.
■ Introduce the second lead one vertebral space below the first lead to
help prevent nicking or cutting the first lead and to allow sufficient
space for suturing both lead anchors.
■ Stagger the lead tips or place them several vertebral spaces apart,
depending on the position that produces the most effective
paresthesia.
7. After inserting the guide wire through the needle, advance the guide wire
no farther than 1 – 3 cm past the needle tip. Next, remove the guide wire
from the needle.
Note: If the guide wire track deviates from the intended pathway, steering
and manipulating the lead will be more difficult.
8. Using fluoroscopy, slowly insert the lead through the needle and advance
the lead to the initial target placement site. A stylet may need to be
reinserted.
Notes:
■ The bent stylet is keyed so that the flat notch of the stylet handle faces
the opposite direction of the distal bent tip.
8 English 3487A, 3887, 3888 2004-05
198855002 Rev A
Medtronic Confidential
NeuroLdExt_R01
Recommended needle-insertion angle
Less than 45° to the skin
Less than 30° to the skin
Greater than 45° to the skin