Tube Systems; Surgical Procedure - MIETHKE proGAV 2.0 Instrucciones De Manejo

| INSTrUcTIONS fOr USe
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Tight tolerancing of the deflector ensures a good
fit with the ventricular catheter. By adjusting the
deflector (prior to implantation) the length of ca-
theter penetrating into the skull can be optimised.
The ventricular catheter is "deflected" at a right
angle in the borehole (see chapter "Variations").

tube systems

The proGAV 2.0 has been designed to ensure
the optimal ventricular pressure. It is available as
a shunt system or as individual valve units with or
without an integrated distal catheter (internal di-
ameter 1.2 mm, external diameter 2.5 mm). Indi-
vidual valve units should be used with catheters
of approx. 1.2 mm internal diameter and approx.
2.5 mm external diameter. The connector on the
valve allows using catheters of 1.0 mm to 1.5
mm internal diameter. The external diameter of
the catheter should be about double the internal
diameter. regardless, the catheters must be ca-
refully fixed, with a ligature, to the valve connec-
tors. It is essential that kinks in the catheter are
avoided.The included catheters have virtually no
effect on the Pressure-flow characteristics.

surgIcal Procedure

Positioning the ventricular catheter
Several surgical techniques are available for po-
sitioning the ventricular catheter. The necessary
skin incision should be carried out, preferably,
in the shape of a lobule pedicled towards the
draining catheter or as a straight skin incision.
To avoid cSf leakage, care should be taken
that the dura opening is kept as small as possi-
ble after applying the borehole. The ventricular
catheter is stiffened by the introducing stylet
supplied with the product.
The proGAV 2.0 is available in different shunt
variations:
when using a proGAV 2.0 SHuntSYStEM
with borehole reservoir, SPRunG RESERVOIR
or McLAnAHAn RESERVOIR, the ventricular
catheter is implanted first. Once the introducing
stylet has been removed, the patency of the
ventricular catheter can be tested by checking
if cSf is dripping out. The catheter is shortened
and the borehole reservoir is connected, with
the connection secured with a ligature. The skin
incision should not be located directly above
the reservoir.
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The proGAV 2.0 SHuntSYStEM with (pedi-
atric) prechamber or COntROL RESERVOIR
comes with a Ventricular Catheter with de-
flector. This deflector is used for adjusting the
position of deflection before implantation of the
ventricular catheter. The catheter is deflected;
the prechamber is put into place. The position
of the ventricular catheter should be inspected
again by postoperative cT or mr imaging.
Positioning the valve
The adjustable dP-unit of the proGAV 2.0 is
supplied with a factory setting of 5 cmh
This opening pressure can be set to a different
value prior to implantation (see chapter "Adju-
sting the proGAV 2.0"). The gravitational unit of
the proGAV 2.0 is a posture-dependent valve.
Therefore, care must be taken that the unit is
implanted parallel to the body axis. A suitable
implantation site is behind the ear.
After the skin incision and tunneling un-
der the skin, the catheter is pushed for-
ward, from the borehole to the intended
shunt implantation site. The catheter is
shortened, if necessary, and secured at the
proGAV 2.0 with a ligature. The shunt should
not be located directly under the skin incision.
The valve is marked with arrows pointing in the
direction of flow (arrows pointing to distal or
downward).
Warning note: The adjustable DP-unit must
be placed over a hard boney surface and
should not be implanted within an area,
which makes finding and feeling the valve
more difficult (e. g. under a scar).
Frequent pumping can lead to overdrainage and
thus to unphysiological pressure conditions.
The patient should be informed about the risk
Positioning the peritoneal catheter
The 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 epigastri-
um.likewise, various surgical techniques are
available for positioning the peritoneal catheter.
we recommend pulling through the peritoneal
catheter, using a subcutaneous tunneling tool
and perhaps with an auxiliary incision, from the
shunt to the intended position of the catheter.
The peritoneal catheter, which is usually securely
attached to the proGAV 2.0, has an open distal
end, but no wall slits. following the exposure of,
O.
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