Integra Camino Flex Ventricular VTUN Mode D'emploi page 8

4. The insertion site incision should be 1-1.5
cm in length and carried to the bone (see
Fig. 4 Step 1, Step 2).
5. Once the incision has been made, expose
the bone with a self-retaining type retractor,
or similar.
6. Drill a hole through the skull using the drill
bit provided in the Accessories Kit included
with the Catheter. Ensure that the twist drill
hole extends through the inner table of the
skull exposing the dura.
7. Open the dura by making a cruciate
incision, using an 11-blade scalpel, 18
gauge spinal needle, or similar.
8. Irrigate the skull hole with sterile saline and
make sure that the entry site in the dura is
of adequate size to allow the catheter to
pass through without bending, and that it is
cleared of any debris.
Tunneling the Catheter
To tunnel the Catheter in preparation for
inserting into the patient's ventricle, follow one
of the two techniques described on this page.
Tunneling Anterior to Posterior:
Using the trocar with tunneling sheath
provided, and beginning at the drill hole
incision, pass the trocar between the scalp and
skull toward and out from the scalp exit site.
Puncture the scalp at the exit site and pull the
trocar through until approximately 10 cm of the
plastic tunneling sheath is exposed at the exit site.
Cut the sheath perpendicular to its length,
approximately 1 cm from the scalp.
This will leave a tunnel running about 7 cm
from the drill hole site to the scalp exit site.
Ensure the sheath is unobstructed and free of
debris that may damage the pressure sensor,
and that all of the tapered section of the sheath
has been removed. Do not force the Catheter
through the sheath. Carefully feed the Catheter
through the sheath from the scalp exit site to
the incision site, ensuring that there is at least
20 cm of Catheter pulled through the sheath
toward the insertion site.
Slide the sheath out from under the scalp, over
the tip of the Catheter.
Tunneling Posterior to Anterior
Position the tip of the catheter within the
trocar's plastic sheath, and use the trocar to
tunnel the Catheter under the scalp toward the
drill hole, starting from the scalp exit site (see
Fig. 4 Step 3).
8
Continue pulling the trocar and feeding the
Catheter through the tunnel until at least 20 cm
of the catheter is beyond the scalp. Remove
the trocar with sheath from the Catheter (see
Fig. 4 Step 4).
Once the Catheter tunneling procedure is
completed, follow the instructions for inserting
the Catheter into the ventricle.
Insertion of the Catheter into the ventricle
1. Insert the stylet into the Catheter. The
stylet is placed in a dedicated lumen,
designed to prevent communication of
CSF from the drainage lumen to the stylet.
The stylet insertion point is located at an
opening on the Catheter with a black arrow
on the white stripe with depth markings at
the 10 cm mark. Gently insert the stylet to
the bottom of its lumen at the Catheter tip.
Do not force the stylet beyond this point
(see Fig. 4, Step 5).
2. Insert the Catheter by holding the Catheter
and stylet together. The depth insertion may
be gauged using the centimeter markings
on the Catheter (see Fig. 4, Step 6).
NOTE: If the ventricles of the patient are
enlarged, it may be appropriate to advance the
Catheter by several millimeters beyond the
point where fluid is first obtained; this will
assist keeping the Catheter tip in the ventricle
as decompression occurs.
3. Remove the protective cap from the luer
fitting at the end of the drainage line. Verify
ventricular placement by looking for the
flow of cerebrospinal fluid along the length
of the Catheter and at the drainage port.
4. While holding the Catheter in place at the
insertion site, remove the stylet, and then
gently pull on the connector end of the
Catheter until it makes a right angle bend
and lies flat against the skull (Fig. 4 Step 7)
5. Attach the Catheter to the External
Ventricular Drainage system luer lock
connector. The Catheter may be connected
to a variety of CSF drainage systems.
Ensure that flow of CSF continues after
pulling the connector end. If the bend
created at the twist drill hole is too tight,
CSF flow may be restricted.
6. Connect the Catheter to the Camino Flex
Extension Cable. At this time, the Camino
Monitor should begin displaying mean ICP
(mmHg) and a pressure waveform.