Codman UNI-SHUNT, Руководство пользователя

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To inject fluids into the ventricular catheter, occlude
the reservoir dome nearest the distal tubing with
finger pressure. While that dome is depressed,
inject the desired fluid into the dome nearest the
ventricular catheter, remove the needle and pump
the chamber several times to flush the fluids into
the ventricular catheter. To inject distally, occlude
the dome nearest the ventricular catheter while
injecting and pumping the other dome.
To flush or check the patency of the ventricular
catheter, occlude the reservoir dome nearest the
distal outlet tubing with finger pressure. Then pump
the reservoir dome nearest the ventricular tubing.
To flush or check the patency of the distal catheter,
occlude the reservoir dome nearest the proximal
inlet tubing while pumping the dome nearest the
distal catheter. Failure of the reservoir to pump
easily may indicate catheter blockage.
Implantation Technique
In Figure 5 the child is shown in the correct
position for a ventriculo-peritoneal shunt. Padding
is placed under the thoracolumbar vertebrae, the
shoulder and the neck. The head is turned fully
to the contralateral side and the neck extended,
thereby placing the abdomen, the thorax, the neck
and the skull in a line so as to eliminate ridges and
valleys. Tunneling from abdomen up to the head
is effected in one step. The leader must then be
reversed within the guide shaft so the catheter may
be drawn distally.
An alternate method of tunneling is suggested for
use in exceptional circumstances when patient
positioning is such that one cannot straighten
out the body to allow the catheter passer to pass
without an interposing incision. In such cases,
it may be necessary to carry out the tunneling
in two steps: tunneling and passing the catheter
distally from head to shoulder; tunneling upward
from abdomen to shoulder, reversing the leader
within the guide shaft so catheter may be drawn
down to abdomen. In Figure 5 the path the
catheter will follow is represented by a broken
line; approximate incision sites are shown in
continuous line.
The subcutaneous guide shaft is malleable and
may, accordingly, be formed into any contour
desired. One must be cautious not to bend the
tubing, or form it quickly, since it may kink, thereby
rendering impossible the passage of the leader and
the catheter. Rather, gentle forming is best effected
by holding the guide firmly in both hands, and
curving it to the desired form between the thumbs.
This should be done before inserting the guide into
the subcutaneous space since forming it thereafter
may cause skin damage.
An additional, Ionger passer is included with
the 90 cm and 102 cm length UNI-SHUNT with
Reservoir Kits to help facilitate passage of the
longer catheter.
Positioning the Catheter from Scalp
Incision to Abdominal Incision
1. One-Step Tunneling
After scalp and abdominal incisions are made,
carefully form guide shaft into desired contour.
Insert catheter passer directly into subcutaneous
compartment at abdominal incision. Tunnel
upwards, holding the passer at either shaft or
handle. Direct the tip of passer by trapping it
between thumb and index finger of left hand,
as shown in Figure 6.
Advance tip and guide shaft 3–4 cm through
scalp opening. Unsnap leader clasp from handle
so handle may be removed. Reverse leader within
guide shaft so clasp is at scalp opening. Nestle
distal tip of catheter in leader clasp as shown
in Figure 7.
Gently pull leader tip to draw leader through
guide shaft until the distal end of the catheter is
entirely drawn through. The guide now rests in the
subcutaneous space and the catheter is within it,
as shown in Figure 8. Remove leader clasp from
catheter. Place gentle pressure on catheter at head
incision and gently withdraw guide shaft distally
through abdominal incision. The catheter now rests
within the subcutaneous space.
2. Two Step Tunneling
The following procedure is suggested in
exceptional circumstances when patient positioning
is such that one cannot straighten out the body to
effect one-step tunneling with the catheter passer.
After scalp and abdominal incisions are made,
carefully form guide shaft into desired contour.
Insert catheter passer directly into subcutaneous
compartment at scalp incision. Tunnel downwards
toward an appropriate area behind the ear, holding
passer at either shaft or handle. Direct tip of passer
with thumb and forefinger as shown in Figure 6.
When leader tip reaches the intended space, make
incision large enough to permit exit of the leader tip
and the guide shaft itself.
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