Surgical Procedure; Reservoir Injection - Integra LifeSciences Codman HAKIM Mode D'emploi

1.
Program the valve with the valve programmer at the 200 valve
pressure setting.
2. Calculate the following: 210 (constant) minus the desired pressure
setting equals the programming pressure setting. For example, where
70 is the desired pressure setting: 210 – 70 = 140.
3. Push the button for the programming pressure setting (in this
example, 140) on the programmer; hold the transmitter in place for
approximately 5 seconds until the confirmation tone is heard. If the
surgeon is unsure whether the reprogramming took place, he or she
must repeat the complete process, Steps 1 through 3, otherwise the
programming will be incorrect.
Note: When the valve is inverted, pressure settings of 190 and 200
are not possible to program.

Surgical Procedure

There are a variety of surgical techniques, which can be used to place
the CODMAN HAKIM Programmable Valves. The surgeon should choose
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 13) with pyrogen-free, sterile saline
solution or appropriate antibiotic solution. Note: A priming adapter with
inlet tubing is provided with the In-line, Right Angle, and Micro 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 any unnecessary pumping of the system to prevent
overdrainage of the ventricles. Over irrigation of the valve system may
damage the internal mechanism.
Please record the valve lot number on the patient's chart.
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 14).
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 Huber type
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 15).
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 16). Firmly press the prechamber with the
adjoining finger to force fluid forward through the valve unit and drainage
catheter. If necessary, repeat.
Occasionally, it may be necessary to use a syringe with 25-gauge Huber
type needle to dislodge the obstruction. Occlude the tubing proximal to
the prechamber. Using light pressure, inject sterile, nonpyrogenic saline
solution into the prechamber (Figure 17).
To test the patency of the valve outlet or drainage catheter, press on the
pumping chamber. If the pumping chamber resists compression, the valve
outlet or drainage catheter may be obstructed. To dislodge the obstruction,
press the valve unit forcefully, then release it to permit the prechamber
to refill.

Reservoir Injection

These instructions apply to the following valve configurations:
In-line with SIPHONGUARD Device
In-line with SIPHONGUARD Device and Platform with Proximal Tube
In-line
Right Angle with SIPHONGUARD Device
Right Angle
Cylindrical with Prechamber
Cylindrical with RICKHAM Reservoir
Micro with RICKHAM Reservoir
To inhibit coring of the reservoir cap, use a Huber type needle
(24- or 26-gauge) 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 18).
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