Boston Scientific Precision Spinal Cord Stimulator System, Clinical Manual

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Percutaneous Lead Placement in the Epidural Space
Clinician Manual
90607862-30 15 of 309
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Percutaneous Lead
Placement in the Epidural
Space
1. Position, prep and drape the patient in
the usual accepted manner. Inject a local
anesthetic at the needle insertion site.
2. Under fluoroscopic guidance, place the
insertion needle into the epidural space
with the bevel facing up using an angle of
45° or less.
CAUTION: Use only an insertion needle
provided by Boston Scientific. Other
needles may damage the lead. The
stamped number “14” on the needle
hub (or the triangle on the hub of the
curved Epimed needle, sold separate-
ly) corresponds to the orientation of
the bevel, which must face up. Turning
the bevel ventral (down) may result in
lead damage. An angle of more than
45° increases the risk of lead damage.
WARNING: The angle of the insertion
needle should be 45° or less. Steep
angles increase the insertion force of
the stylet and also present more of an
opportunity for the stylet to pierce the lead
and cause tissue damage.
3. Remove the needle stylet from the
insertion needle and verify entry into
the epidural space using the standard
technique.
4. OPTIONAL. Under fluoroscopic guidance,
insert the lead blank through the inser-
tion needle and into the epidural space.
Advance the lead blank to verify entry
into the epidural space, then withdraw the
blank.
5. While holding the lead stylet handle, place
the steering cap over the proximal end
of the stylet handle with moderate force
until it is held in place. Then slowly insert
the lead, with stylet, through the insertion
needle. The lead stylet should extend to
the tip of the lead.
6. OPTIONAL. If exchange of the lead stylet
is desired, carefully pull out the existing
stylet and insert the preferred stylet. While
inserting the stylet into the lead, if resis-
tance is encountered, withdraw the stylet
approximately 3 cm, rotate the lead and/
or stylet, and gently advance the stylet. If
resistance is still encountered, repeat the
above procedure until the stylet can be
fully inserted.
WARNING: Do not exchange the lead
stylet while the electrode array of the lead
is in the bevel of the insertion needle. If
the electrode array is in the bevel area,
remove the lead from the insertion needle
before exchanging the stylet. Inserting the