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• To optimize
Indicator Tool
performance, ensure that
the patient is positioned so that the valve is horizontal
and the tool kit components are used horizontally.
See Figure 6.
• Use fluoroscopy or x-ray to locate the position and
orientation of the valve mechanism for adjustment and/
or to determine the performance setting of the valve.
A fiducial mark may be helpful for this technique.
It may be challenging to get the correct position of the
Locator Tool above the implanted valve. Consider using
the
Low Profile Locator Tool.
• Palpate to feel for the hard valve mechanism and
make sure the black lines on the
Low Profile
Locator Tool
are aligned with the center of the
valve mechanism.
• Mark the patient’s skin in the center of the valve
mechanism between the two black lines. Also mark
the location of the valve barbs/catheters on the
proximal and distal ends (See Figure 7). This will
facilitate the proper position and orientation of either
Locator Tool
above the implanted valve.
• Make sure the black lines on the
Locator Tool
line up
with the mark for the center of the valve mechanism
and that the direction of flow arrow is aligned with the
marks for the proximal and distal barbs/catheters.
If these remedial steps fail to rectify the problem, replace
the valve.
SECTION E: Confirming the Current
Valve Setting
The setting of an implanted valve can be determined
by using the CODMAN CERTAS Tool Kit, and following
SECTION C:
Post-Implantation Adjustment Procedure,
Steps 1 through 6.
An alternate method is to x-ray the valve. A proper x-ray
is generated when the film is shot perpendicular to the
plane of the valve with the non-implanted side of the
patient’s head resting on the plate. The film must be taken
in relation to the valve and not the patient’s anatomy. See
Figure 14 for x-ray views of the valve at each setting.
When viewing the x-ray film or screen to confirm
the valve setting, use the X-Ray Overlay Tool (See
SECTION F:
Reading the Valve Setting with the X-Ray
Overlay Tool
, Steps 1–5).
SECTION F: Reading the Valve Setting with the
X-Ray Overlay Tool
See Figure 15.
Note:
Position the
X-Ray Overlay Tool
flush against the
x-ray image.
1.
Align
RED
centerline of valve on overlay with the
centerline of the valve x-ray under review. This
can be accomplished by aligning the proximal and
distal connectors of the x-ray image with those on
the overlay.
2.
Ensure that the numbers on the overlay that depict
the performance settings are properly oriented for
viewing. In this orientation the right hand side (RHS)
marker red line extends to the right of the
RED
centerline. This ensures proper overlay orientation.
3.
Align rotating construct (RC) center dot on overlay
with the center of the RC of the x-ray image.
