Anterograde Replacement Procedure Using Voluntary Overshooting; Reloading The Provox Smartinserter - Atos Medical PROVOX Vega Bedienungsanleitung

2.3 Anterograde replacement procedure
using voluntary overshooting
(Figures 4a-h)
When the puncture tract is very short, or when mucosa folds over the
posterior part of the prosthesis, or when the esophageal flange is difficult
to develop within the esophagus, overshooting can help to completely
develop the esophageal flange of the prosthesis. Overshooting means
that during the insertion procedure, the Provox Vega voice prosthesis
is pushed entirely through the puncture into the esophagus. The
prosthesis Safety Strap remains thereby attached to the Inserter Pin.
Activating System for replacement using voluntary
overshooting
1. With one hand holding the loading tube, use the other hand to push
the inserter pin partially into the loading tube, until the blue ring
of the prosthesis has passed the step marker of the loading tube
(Figure 4a).
2. Squeeze the Guide between thumb and index finger (Figure 4b).
Push it further into the loading tube (Figure 4c). The Provox Vega
voice prosthesis is now ready for overshoot-insertion.
Inserting the new prosthesis into the puncture -
Overshoot
1. Probing the TE-puncture
Hold the Provox SmartInserter by the Loading Tube. Gently insert
the Tip of the Loading Tube. Proceed with care if you encounter
resistance during insertion of the Loading Tube into the puncture
(Figure 3b). In this case, dilatation and/or lubrication of the puncture
can ease the insertion
2. "Injecting" the prosthesis
With one hand holding the loading tube stable in this position, use
the other hand to advance the Inserter Pin until it is completely
inserted into the SmartInserter (Figure 4d).
As the Guide is being pushed further into the Loading Tube, the
Inserter Pin will advance further and release the Provox Vega
voice prosthesis completely within the esophagus.
3. Pulling the prosthesis back
Pull the Loading Tube out from the puncture (Figure 4e). Pull the
Provox Vega voice prosthesis back into the puncture by grasping
and pulling the tracheal flange of the prosthesis with a non-toothed
hemostat (Figure 4f).
4. Checking the proper fit
Check to see if the prosthesis is in the proper position by rotating
and applying slight traction on the tracheal flange (Figure 4g). The
oval shape of the tracheal flange should be pointed downwards
(Figure 4g).
5. Test proper function
Test proper function of the prosthesis by asking the patient to
speak and by observing the prosthesis while the patient drinks
water (Figure 3f).
6. Cut the Safety Strap with scissors
When the prosthesis is safely in place, use scissors to cut off the
Safety Strap on the outer edge of the tracheal flange (Figure 3g).
The oval end of the tracheal flange should point downwards into
the trachea (Figure 3f). The Provox Vega voice prosthesis is now
ready for use.
CAUTION: If reloading the SmartInserter after Overshooting,
make sure the Folding device and Guide are assembled in proper
way (see section 2.4 below).

2.4 Reloading the Provox SmartInserter

(Figures 5a-i)
If the first attempt to insert the Provox Vega voice prosthesis into the
TE-puncture was unsuccessful, it is possible to reload the Provox Vega
into the SmartInserter.
CAUTION: Do not reload the SmartInserter more than 2 times.
If the Provox Vega voice prosthesis shows any signs of damage, do not
use the prosthesis and obtain a replacement prosthesis.
1. Make sure the prosthesis is still safely attached to the Inserter Pin
(Figure 5b1-5b2). If not, secure the Safety Strap on the Inserter
Pin by leading the Safety Strap through the Attachment Hole in
the Inserter Pin (Figure 5c-d).
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