Codman Hakim Bedienungsanleitung Seite 15

For those surgeons who wish to perform functional testing, please see
Preimplantation Performance Testing in the Appendix
Surgical Procedure
There are a variety of surgical techniques that can be used to place
a Codman Hakim Precision Fixed Pressure Valve The surgeon must choose
a technique in accordance with his or her own clinical experience and
medical judgment
Irrigation
Hold the valve vertically with the outlet end pointing upward Using
a syringe, or the action of the pumping chamber (if applicable), slowly
and gently fill the entire valve system (Figure 6) with pyrogen-free, sterile
saline solution or appropriate antibiotic solution Note: A priming adapter
is provided with the In-line, Right Angle, and Micro Valve versions to
facilitate irrigation (Cylindrical Valves incorporate a pumping chamber for
this purpose)
CAUTION: Do not fill, flush, or pump the valve with fluid in which
cotton, gauze, or other lint-releasing material has been soaked.
Once fluid flows from the outlet end of the drainage catheter, occlude the
inlet tubing of the valve system with shod forceps (close to the ventricular
end), and remove the syringe and priming adapter (if applicable)
CAUTION: Avoid unnecessary pumping of the system to prevent
overdrainage of the ventricles. Over-irrigation of the valve system may
damage the internal mechanism.
Record the valve lot number on the patient's chart
Reservoir Access
CAUTION: The valve reservoirs are made of silicone elastomer materials
that typically exhibit low tear strength. Use care when inserting and
removing the needle.
To inhibit coring of the reservoir cap, use a 25-gauge or smaller non-coring
needle to penetrate the dome Insert the needle at an oblique angle to
achieve the greatest yield of CSF and to prevent the needle point from
piercing the ventricular catheter (Figure 7)
The reservoirs in the In-line and Right Angle valve configurations as well as
the housing body of the Cylindrical valve and the pre-chamber (in valves
so equipped) can be punctured up to 25 times with a 25-gauge or smaller,
non-coring, needle
For multiple punctures of a Rickham reservoir, take care to insert the needle
at various locations Multiple punctures at a single location increase the risk
of tearing
Valve Flushing (Clearing Obstructions)
(Cylindrical with Prechamber Valves only)
To check the patency of the ventricular catheter, occlude the tubing
between the prechamber and the valve unit with finger pressure (Figure 8)
Press the prechamber If the prechamber does not compress easily and
does not return immediately to its original shape, or if the prechamber
compresses easily but does not refill immediately, the ventricular catheter
may be occluded To correct this situation, first allow the prechamber to
refill Then, occlude the tubing between the prechamber and the valve
unit with finger pressure and press the prechamber firmly This forces fluid
back through the ventricular catheter, helping to remove the obstruction If
necessary, repeat this procedure
In some circumstances, the use of a syringe (with 25-gauge non-coring
needle) is necessary to remove the obstruction Occlude the tubing
between the prechamber and the valve unit with finger pressure Using
light pressure, inject sterile, nonpyrogenic saline solution into the
prechamber (Figure 9)
To test the patency of the tubing between the prechamber and the
valve unit, occlude the tubing between the prechamber and the valve
unit with pressure Press and release the prechamber If the prechamber
immediately returns to its original shape after compression, remove finger
from the tubing and press the pumping chamber If the pumping chamber
compresses readily but does not immediately return to its original shape,
there may be an obstruction between the prechamber and valve unit
To remedy this situation, occlude the tubing between the prechamber and
the ventricular catheter (Figure 10) Firmly press the prechamber with the
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