Integra CODMAN® HAKIM® Programmable Valves Mode d'emploi

CODMAN® HAKIM®

Programmable Valves

LCN 200570-001 Rev M 06/20 1285496-4

Integra LifeSciences Production Corporation

11 Cabot Boulevard

Mansfield, MA 02048 USA

Integra LifeSciences Services (France)

Immeuble Séquoïa 2

97 Allée Alexandre Borodine

Parc Technologique de la Porte des Alpes

69800 Saint Priest – France 2797

i

CODMAN HAKIM Programmable Valves

1

ENGLISH

Right angle design with

SIPHONGUARD

A. Side view

B. Top view

C. Inlet connector

D. Reservoir

E. Direction-of-flow arrow

F. Inlet valve

G. Valve seat

H. Valve ball

I. Flat spring

J. Spring calibrating fulcrum

K. O-ring

L. Titanium base plate

M. Cam

N. X-ray cam position indicator

(pressure)

O. Right-hand side x-ray

indicator

P. Stepper motor

Q. Antisiphon device

R. Valve seat

S. Valve ball

T. Central passage

U. Spiral passage

FRANÇAIS

Modèle à angle droit avec

SIPHONGUARD

A. Vue latérale

B. Vue supérieure

C. Raccord d’admission

D. Réservoir

E. Flèche indiquant le sens

d’écoulement

F. Valve d’admission

G. Siège de la valve

H. Bille de la valve

I. Ressort plat

J. Pivot pour l’étalonnage du

ressort

K. Joint torique

L. Plaque de suppport en titane

M. Came

N. Indicateur radiologique

de position de la came

(pression)

O. Indicateur radiologique

latéral droit

P. Moteur pas à pas

Q. Dispositif

anti-siphonnage

R. Siège de la valve

S. Bille de la valve

T. Passage central

U. Passage à spirale

DEUTSCH

Rechtwinklige Ausführung mit

SIPHONGUARD

A. Seitenansicht

B. Draufsicht

C. Einlassverbindung

D. Reservoir

E. Flussrichtungspfeil

F. Einlassventil

G. Ventilsitz

H. Ventilkugel

I. Federscheibe

J. Verstellhebel

K. O-Ring

L. Titan-Basisplatte

M. Nocke

N. Röntgenindikator für

Nockenposition (Druck)

O. Röntgenindikator für rechte

Seite

P. Schrittmotor

Q. Antisiphon

R. Ventilsitz

S. Ventilkugel

T. Hauptkanal

U. Spiralkanal

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CODMAN HAKIM Programmable Valves

NEDERLANDS

Haaks ontwerp met

SIPHONGUARD

A. Zijaanzicht

B. Bovenaanzicht

C. Inlaatconnector

D. Reservoir

E. Flowrichtingpijl

F. Inlaatklep

G. Klepzitting

H. Klepkogel

I. Platte veer

J. Kalibreringsdraaipunt voor

veer

K. O-ring

L. Titanium bodemplaat

M. Nok

N. Röntgen-nokpositie-indicator

(druk)

O. Röntgenindicator

rechterzijde

P. Stappenmotor

Q. Antihevelvoorziening

R. Klepzitting

S. Klepkogel

T. Centrale doorgang

U. Spiraalvormige doorgang

ITALIANO

Versione ad angolo retto con

SIPHONGUARD

A. Vista laterale

B. Vista dall’alto

C. Connettore di ingresso

D. Serbatoio

E. Freccia di direzione flusso

F. Valvola di ingresso

G. Sede della valvola

H. Sfera della valvola

I. Molla piatta

J. Fulcro di calibrazione valvola

K. O-ring

L. Piastra con base in titanio

M. Camma

N. Indicatore di posizione della

camma a raggi x (pressione)

O. Indicatore per raggi x destro

P. Motore a passo

Q. Dispositivo antisiphon

R. Sede della valvola

S. Sfera della valvola

T. Passaggio centrale

U. Passaggio a spirale

ESPAÑOL

Diseño de ángulo recto con

SIPHONGUARD

A. Vista lateral

B. Vista superior

C. Conector de entrada

D. Reservorio

E. Flecha de dirección de flujo

F. Válvula de entrada

G. Asiento de la válvula

H. Esfera de la válvula

I. Resorte plano

J. Fulcro de calibración

de resorte

K. Junta tórica

L. Placa de base de titanio

M. Leva

N. Indicador de posición de

leva de rayo X (presión)

O. Indicador de rayos X del

lado derecho

P. Motor por pasos

Q. Dispositivo antisifón

R. Asiento de la válvula

S. Esfera de la válvula

T. Pasaje central

U. Pasaje en espiral

PORTUGUÊS

Concepção em ângulo recto

com SIPHONGUARD

A. Vista lateral

B. Vista de cima

C. Conector de entrada

D. Reservatório

E. Seta de direcção do fluxo

F. Válvula de entrada

G. Apoio da válvula

H. Esfera da válvula

I. Mola plana

J. Fulcro de calibração de mola

K. Anel em “O”

L. Placa de base em titânio

M. Came

N. Indicador de posição do

came para radiografia

(pressão)

O. Indicador direito para

radiografia

P. Motor escalonador

Q. Dispositivo antisiphon

R. Base da válvula

S. Esfera da válvula

T. Passagem central

U. Passagem em espiral

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CODMAN HAKIM Programmable Valves

ENGLISH

Programmable valve

configurations

A. In-line with SIPHONGUARD

Device

B. In-line with SIPHONGUARD

Device and Platform with

Proximal Tube

C. In-line

D. Right angle with

SIPHONGUARD Device

E. Right angle

F. Cylindrical with prechamber

G. Cylindrical with RICKHAM

Reservoir

H. Cylindrical

I. Micro with RICKHAM reservoir

J. Micro

FRANÇAIS

Configurations de la valve

programmable

A. En-ligne avec l’appareil

SIPHONGUARD

B. En ligne avec le dispositif

SIPHONGUARD avec tubulure

proximale

C. En-ligne

D. Appareil SIPHONGUARD avec

angle droit

E. Angle droit

F. Cylindrique avec préchambre

G. Cylindrique avec réservoir

RICKHAM

H. Cylindrique

I. Micro avec réservoir RICKHAM

J. Micro

DEUTSCH

Konfigurationen des

programmierbaren Ventils

A. In-line mit SIPHONGUARD

Durchflussregler

B. In-line-Ventil mit

SIPHONGUARD

Durchflussregler und Plattform

mit proximalem Schlauch

C. In-line

D. Rechtwinklig mit

SIPHONGUARD

Durchflussregler

E. Rechtwinklig

F. Zylindrisch mit Vorkammer

G. Zylindrisches Ventil mit

RICKHAM Reservoir

H. Zylindrisch

I. Mikro mit RICKHAM Reservoir

J. Mikro

NEDERLANDS

Configuraties programmeerbare

klep

A. Inline met SIPHONGUARD

regelaar

B. Inline met SIPHONGUARD

regelaar en platform met

proximale buis

C. Inline

D. Haaks met SIPHONGUARD

regelaar

E. Haaks

F. Cilindervormig met voorkamer

G. Cilindervormig met RICKHAM

reservoir

H. Cilindervormig

I. Micro met RICKHAM reservoir

J. Micro

ITALIANO

Configurazioni della valvola

programmabile

A. Versione lineare con dispositivo

SIPHONGUARD

B. Lineare con dispositivo

SIPHONGUARD e piattaforma

con tubo prossimale

C. Versione lineare

D. Angolo retto con dispositivo

SIPHONGUARD

E. Angolo retto

F. Cilindrica con precamera

G. Cilindrica con serbatoio

RICKHAM

H. Cilindrica

I. Micro con serbatoio RICKHAM

J. Micro

2

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CODMAN HAKIM Programmable Valves

ESPAÑOL

Configuraciones de la válvula

programable

A. En línea con dispositivo

SIPHONGUARD

B. En línea con dispositivo

SIPHONGUARD y plataforma

con tubo proximal

C. En línea

D. Ángulo recto con dispositivo

SIPHONGUARD

E. Ángulo recto

F. Cilíndrica con antecámara

G. Cilíndrica con reservorio

RICKHAM

H. Cilíndrica

I. Micro con reservorio RICKHAM

J. Micro

PORTUGUÊS

Configurações da válvula

programável

A. Válvula em linha com

dispositivo SIPHONGUARD

B. Em linha com o dispositivo

SIPHONGUARD e plataforma

com tubo proximal

C. Em linha

D. Válvula de ângulo recto com

dispositivo SIPHONGUARD

E. Ângulo recto

F. Válvula cilíndrica com

antecâmara

G. Cilíndrica com reservatório

RICKHAM

H. Cilíndrica

I. Microválvula com reservatório

RICKHAM

J. Micro

3B

A

ENGLISH

A. Ventricular Catheter

B. Right Angle Adapter

FRANÇAIS

A. Cathéter ventriculaire

B. Adaptateur à angle droit

DEUTSCH

A. Ventrikelkatheter

B. Rechtwinkliger Adapter

NEDERLANDS

A. Ventrikelkatheter

B. Haakse adapter

ITALIANO

A. Catetere ventricolare

B. Adattatore ad angolo retto

ESPAÑOL

A. Catéter ventricular

B. Adaptador en ángulo recto

PORTUGUÊS

A. Cateter ventricular

B. Adaptador de ângulo recto

4

A. Priming adapter

A. Adaptateur d’irrigation

A. Starteradapter

A. Pompadapter

A. Adattatore di irrigazione

A. Adaptador cebador

A. Adaptador de irrigação

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CODMAN HAKIM Programmable Valves

6

ENGLISH

A. Directional arrows

B. START button

C. Illuminated center hole

FRANÇAIS

A. Flèches de direction

B. Bouton START

C. Orifice central lumineux

DEUTSCH

A. Richtungspfeile

B. START-Taste

C. Beleuchtetes Mittelloch

NEDERLANDS

A. Richtingspijlen

B. START-knop

C. Verlichte centrale opening

ITALIANO

A. Frecce direzionali

B. Pulsante START

C. Foro centrale illuminato

ESPAÑOL

A. Flechas de dirección

B. Botón START

C. Orificio central iluminado

PORTUGUÊS

A. Setas direccionais

B. Botão START

C. Orifício central iluminado

8

7

5

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CODMAN HAKIM Programmable Valves

9

10

11

A. White marker

B. Pressure indicator

A. Marqueur blanc

B. Indicateur de pression

A. Weiße Markierung

B. Druckanzeiger

A. Witte markering

B. Drukindicator

A. Marcatore bianco

B. Indicatore di pressione

A. Marca blanca

B. Indicador de presión

A. Marcador branco

B. Indicador de pressão

vii

CODMAN HAKIM Programmable Valves

12

13

ENGLISH

A. Valve outlet

B. Priming adapter with tubing

C. Pyrogen-free sterile saline or

antibiotic solution

FRANÇAIS

A. Évacuation de la valve

B. Adaptateur d’irrigation avec tube

C. Sérum physiologique stérile ou

solution antibiotique apyrogène

DEUTSCH

A. Ventilauslass

B. Starteradapter mit Schlauch

C. Pyrogenfreie sterile

Kochsalzlösung oder

antibiotische Lösung

NEDERLANDS

A. Klepuitlaat

B. Pompadapter met lijnmateriaal

C. Niet-pyrogene steriele

zoutoplossing of antibiotische

oplossing

ITALIANO

A. Uscita valvola

B. Adattatore di irrigazione con

tubo

C. Soluzione sterile salina

apirogena o soluzione antibiotica

ESPAÑOL

A. Salida de válvula

B. Adaptador cebador

con tubo

C. Solución salina estéril apirógena

o solución antibiótica

PORTUGUÊS

A. Saída da válvula

B. Adaptador de irrigação com

tubagem

C. Solução salina esterilizada

apirogénica ou antibiótica

viii

CODMAN HAKIM Programmable Valves

14

15

16

17

18

ENGLISH

IMPORTANT INFORMATION

Please Read Before Use

CODMAN® HAKIM® Programmable Valves

Description

The CODMAN® HAKIM® Programmable Valve includes a valve mechanism

(Figures 1 & 2) that incorporates a flat 316L stainless steel spring in

which the calibration is accomplished by a combination between a pillar

and a micro-adjustable telescoping fulcrum. The valve chassis is made

of titanium. The ball and cone are manufactured from synthetic ruby.

Intraventricular pressure is maintained at a constant level by the ball

and cone valve seat design.

The pressure setting of the spring in the inlet valve unit is noninvasively

adjusted by the use of an external programmer, which activates the

stepper motor within the valve housing. The programmer transmits a

codified magnetic signal to the motor allowing eighteen pressure settings,

ranging from 30 mm to 200 mm H2O (294 to 1960 Pa) in 10 mm (98 Pa)

increments. These are operating pressures of the valve unit and have been

determined with a flow rate of 15–25 mL H2O per hour.

The valve is classified by its working pressure with a specified flow rate

and not by the opening and closing pressures. The pressure that a valve

sustains with a given flow is the parameter that reflects the working

pressure of the valve once it is implanted. Before shipment, each valve

is calibrated with special equipment. Duplication of these test procedures

cannot be accomplished in the operating room.

The valve is marked with an x-ray detectable direction-of-flow indicator.

Indications

The CODMAN HAKIM Programmable Valves are implantable devices that

provide constant intraventricular pressure and drainage of CSF for the

management of hydrocephalus.

Contraindications

The CODMAN HAKIM Programmable Unitized Valve Systems are not

recommended for atrial placement. Use the nonunitized versions for

this procedure.

These devices are contraindicated in patients receiving anticoagulants or

known to have a bleeding diathesis.

Avoid shunt implantation if infection is present within the body. Delay the

shunt procedure when infections such as meningitis, ventriculitis, peritonitis,

bacteremia, and septicemia are present.

WARNINGS

Subjecting the valve to strong magnetic fields may change the setting

of the valve.

• The use of Magnetic Resonance (MR) systems up to 3 T will not

damage the valve mechanism, but may change the setting of the valve.

Confirm the valve setting after an MRI procedure. See Programming the

Programmable Valve.

• Common magnets greater than 80 gauss, such as household magnets,

loudspeaker magnets, and language lab headphone magnets, may affect

the valve setting when placed close to the valve.

• Magnetic fields generated from microwaves, high-tension wires, electric

motors, transformers, etc., do not affect the valve setting.

Read MRI Information before performing an MRI procedure on a patient

implanted with the programmable valve.

Any magnet may experience a degradation of magnetic field strength as a

consequence of exposure to the significantly stronger magnet field induced

in an MRI procedure.

• Based on the coercivity of the CHPV magnet material, the valve is

resistant to magnetic degradation in a 1.5T MRI.

• Testing of the CHPV valve following exposure to 10 simulated MRI

procedures at 3T indicates there may be demagnetization that,

subsequently, could lead to a reduction in the ability to program the

valve. Please refer to Troubleshooting section should any difficulty in

programming occur.

The SIPHONGUARD® device is intended to reduce the rapid flow of CSF.

It also reduces the ability to prime the shunt system during implantation to

a rate of approximately 0.5 mL/minute.

MRI Information

Do not use the programmer in the MR suite.

1

The CODMAN HAKIM Programmable Valve is considered “MR Conditional”

according to ASTM F 2503. The valve demonstrates no known hazards

when an MRI is performed under the following conditions:

• MRI can be performed at any time after implantation

• Use an MR system with a static magnetic field of 3 T or less

• Use an MR system with a spatial gradient of 720 gauss/cm or less

• Limit the exposure to RF energy to a whole-body-averaged specific

absorption rate (SAR) of 3 W/kg for 15 minutes

• Verify the valve setting after the MRI procedure (see Programming the

Programmable Valve)

In non-clinical testing, the valve produced a temperature rise of 0.4°C at a

maximum whole-body-averaged specific absorption rate (SAR) of 3.0 W/kg

for 15 minutes of MR scanning in a 3 T EXCITE™ General Electric

MR scanner.

MR image quality may be compromised if the area of interest is relatively

close to the device. Distortion may be seen at the boundaries of the artifact.

Therefore, optimization of the MR imaging parameters may be necessary.

The following chart provides a comparison between the signal void and

imaging pulse sequence at 3 T:

Signal Void Pulse Sequence

1590 mm2T1-SE

1022 mm2T1-SE

2439 mm2GRE

2404 mm2GRE

Precautions

The programmable valves are supplied without a specific programmed

pressure and must be programmed prior to use.

Inspect the sterile package carefully. Do not use if:

• the package or seal appears damaged,

• contents appear damaged, or

• the expiry date has passed.

This is an adjustable valve and the surgeon must take that into account

when evaluating patients. It is important to verify the current pressure

setting as part of any treatment plan.

Do not allow the programming unit or transmitter unit to remain in

environmental extremes.

After exposure of the programming unit or the transmitter unit to

environmental extremes, such as those found in transport or storage,

allow the unit to come within operating range before operating.

Do not program the valve on a metal surface, such as a Mayo stand.

While becoming familiar with valve programming, it is recommended that

the pressure setting of the implanted valve be changed in increments of

no more than ±40 mm H2O (392 Pa) in a 24-hour period. Patients whose

pressure setting has been changed should be carefully monitored during the

first 24 hours post programming. It is recommended that x-rays be taken to

confirm the changes made to valve pressure setting.

Before use, check the programming unit and transmitter unit

connections, settings, and function (see Preimplantation Programming

Familiarization Procedure).

Use only Integra branded programmers to program the pressure of the

CODMAN HAKIM Programmable Valve.

Unauthorized modifications to the programming unit or transmitter unit may

cause a malfunction that could result in serious patient injury or death.

Electrical shock hazard: Do not open the programming unit or transmitter

unit. Refer servicing to qualified service personnel.

Explosion hazard: Do not use the programming unit in the presence of

flammable materials; i.e., anesthetics, solvents, cleaning agents, and

endogenous gases.

Before turning on the 100/120, 220/240 VAC programming unit (catalog

no. 82-3121 or 82-3190), verify that the supply voltage selector on the rear

of the unit is set to the correct voltage for the electrical outlet.

Do not move the transmitter unit during programming.

Never immerse the programming unit or the transmitter unit in any liquid.

Do not sterilize the programming unit or the transmitter.

Use only with components compatible with the dimensions shown in the

Device Description section.

Aseptic technique is necessary in all phases of the use of this product.

Silicone has a low cut and tear resistance; therefore, exercise care when

placing ligatures so as not to tie them too tightly. The use of stainless steel

ligatures on silicone rubber is not recommended.

Do not use sharp instruments when handling the silicone valve or catheter;

use shod forceps. Cuts or abrasions from sharp instruments may rupture or

tear the silicone components.

Do not fold or bend the valve during insertion. Incorrect insertion may cause

rupture of the silicone housing.

2

To better stabilize the position of the valve underneath the scalp, proper

valve placement is required. Place the flat underside of the valve against the

bone, with the round top surface facing upward.

Verify proper placement and integrity of ligatures at all tubing junctions to

prevent obstruction of the catheter lumen and tears or abrasions of the

silicone tubing.

Do not fill, flush, or pump the valve with fluid in which cotton, gauze,

or other lint-releasing material has been soaked.

Exercise extreme care to prevent the silicone components of the system

from coming in contact with bare fingers, towels, drapes, talc, or any linty

or granular surfaces. Silicone rubber is highly electrostatic and, as a result,

attracts airborne particles and surface contaminants that could produce

tissue reaction.

After implantation, avoid unnecessary pumping of the prechamber and

pumping chamber to prevent rapid alteration of the intraventricular pressure.

Cylindrical Valves only: Before closing the scalp incision (or mastoidal

incision, if a two-step passage technique is employed), confirm that the

direction-of-flow arrow on the valve faces up.

Adverse Events

Devices for shunting CSF may have to be replaced at any time due to

medical reasons or failure of the device.

Keep patients with implanted shunt systems under close observation for

symptoms of shunt failure.

Complications of implanted shunt systems include mechanical failure, shunt

pathway obstruction, infection, foreign body (allergic) reaction to implants,

and CSF leakage along the implanted shunt pathway.

Clinical signs such as headache, irritability, vomiting, drowsiness, or

mental deterioration may be signs of a nonfunctioning shunt. Low-grade

colonization, usually with Staph. epidermidis, can cause, after an interval

from a few days to several years, recurrent fevers, anemia, splenomegaly,

and eventually, shunt nephritis or pulmonary hypertension. An infected shunt

system may show redness, tenderness, or erosion along the shunt pathway.

Accumulation of biological matter (i.e. blood, protein accumulations, tissue

fragments, etc.) in the programming mechanism can cause inability of the

device to be reprogrammed.

Clogging of the programmable valve with biological matter can cause the

valve to become unresponsive to attempts to change the pressure setting.

Do not use excessive force if attempting to remove the catheter(s).

Excessive force can cause the catheter to break, leaving part of the catheter

within the body.

Excessive CSF drainage can cause subdural hematomas, slit-like ventricles,

and in infants, sunken fontanelles.

Particulate matter such as blood clots, brain fragments, or other tissue

particles can obstruct the ventricular catheter. Also, the ventricular catheter

can become obstructed by excessive reduction of ventricle size.

If not properly located in the lateral ventricle, the catheter can become

embedded in the ventricular wall or choroid plexus.

Fibrous adhesions can bind the catheter to the adjacent choroids plexus

or to the ventricular wall. Gentle rotation may free the catheter. DO NOT

REMOVE THE CATHETER FORCEFULLY. If the catheter cannot be

removed without force, it is recommended that it remain in place, rather

than risk intraventricular hemorrhage.

The ventricular catheter can be withdrawn from, or lost in, the lateral

ventricles of the brain if it becomes detached from the shunt system.

Blunt or sharp trauma to the head in the region of implant or repetitive

manipulation of the valve during implant may compromise the shunt.

Check valve position and integrity after occurrence.

Device Description

Programmable Valve Operating Pressure

30 to 200 mm H2O (294 to 1960 Pa) programmable in steps of

10 mm H2O (98 Pa)

Programmable 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

Cylindrical

Micro with RICKHAM Reservoir

Micro

CODMAN HAKIM In-line and Right Angle Valves include a programmable

valve with a low profile and flat bottom, and an in-line or right angle integral

reservoir with or without SIPHONGUARD.

CODMAN HAKIM Cylindrical Valves include a programmable valve, a

pumping chamber, and an outlet valve available with a prechamber, without

a prechamber, or with a RICKHAM reservoir.

CODMAN HAKIM Micro Valves include a programmable valve with or

without an integral RICKHAM reservoir.

3

All programmable valve configurations are designed for use with

components having the following dimensions:

Component Inner Diameter Outer Diameter

Ventricular Catheter 1.4 mm 2.7 mm

Drainage Catheter 1.0 mm 2.2 mm

SIPHONGUARD Device

CSF flows through the inlet valve and enters the SIPHONGUARD Device,

where it flows into two internal passages. Under normal conditions, the

majority of CSF flows through a central ruby ball and cone valve, and

exits directly out of the distal port of the SIPHONGUARD Device. The

remaining CSF travels through a spiral passage that surrounds the central

passage, and joins the fluid passing through the central passage, distal to

the ball and cone valve.

A sudden increase in CSF flow will close the ball and cone valve and the

entire volume of CSF will be forced through the longer spiral passage,

effectively slowing the rate at which CSF is shunted from the brain. Once

the flow rate entering the SIPHONGUARD Device decreases, the ruby ball

separates from the valve seat, opening the central passage. As long as

CSF continues to be shunted from the ventricles, flow through the spiral

passage of the SIPHONGUARD Device never stops, regardless of the

patient’s position.

Note: The SIPHONGUARD Device will not activate at low CSF flow rates.

The SIPHONGUARD Device has a rigid enclosing shell of polyethersulfone

to prevent inadvertent closure (and subsequent reduction or blockage of

CSF flow) caused by externally applied pressure.

How Supplied

The Valve includes a programmable valve, instructions for use, straight

connector(s)*, introducer**, and priming adapter***.

The Valve System includes a programmable valve, 14 cm ventricular

catheter, 120 cm peritoneal catheter, instructions for use, right angle

adapter, and priming adapter***.

The Valve System, Unitized, includes a programmable valve, 14 cm

ventricular catheter, 85 cm slit**** or 120 cm unitized peritoneal catheter,

instructions for use, straight connector(s)*, introducer**, right angle adapter,

and priming adapter***.

*Straight connectors provided with Cylindrical, Micro, and In-line with

SIPHONGUARD and Platform with Proximal Tube versions only.

**Introducers provided with Cylindrical versions only.

***Priming adapter provided with In-line, Right Angle, and Micro versions only.

****85 cm slit catheter packaged with 82-3853 only.

Components and Accessories

Valve Programmer

The valve programmer, available in 100/120 or 220/240 VAC, is

supplied with a transmitter head, transmitter cord, and carrying case.

The programmer is sold nonsterile and available separately. The

programmer is required for changing the pressure setting of the valves.

Ventricular Catheter and Right Angle Adapter (Figure 3)

The ventricular catheter is a 14 cm straight ventricular catheter molded

of radiopaque silicone elastomer with x-ray detectable dots and a

preassembled stainless steel introducing stylet.

The right angle adapter, made of PROLENE® Material, allows 90 degree

bending of the ventricular catheter at the burr hole site.

Priming Adapter (Figure 4)

The priming adapter, provided with the In-line, Right Angle, and Micro Valves,

facilitates preimplantation irrigation to the valve and catheters.

Straight Connector

The straight connector joins the proximal and distal catheters to the valve.

Valve Introducer

A disposable polyethylene valve introducer is supplied to aid in passing the

valve and drainage catheter from the burr hole site to a mastoidal incision,

when a two-step passage technique is used. Because of the malleability

of this introducer, it can be preformed to a desired curvature prior to

valve placement.

Sterility

The CODMAN HAKIM Programmable Valve Systems are intended for SINGLE

USE ONLY; DO NOT RESTERILIZE. Use aseptic technique in all phases of

handling. Integra will not be responsible for any product that is resterilized,

nor accept for credit or exchange any product that has been opened but not

used.

Integra single-use devices have not been designed to undergo or withstand

any form of alteration, such as disassembly, cleaning or re-sterilization, after

a single patient use. These devices are intended to come into contact with

the central nervous system and the ability does not currently exist to destroy

possible contaminates such as Creutzfeldt-Jakob Disease. Reuse can

also compromise device performance and any usage beyond the design

intent of this single-use device can result in unpredictable use hazards or

loss of functionality. (THIS STATEMENT APPLIES TO NON-IMPLANTABLE

COMPONENTS ONLY.)

As long as the individual package is not opened or damaged, the product

is sterile.

4

The following components have been tested and were determined to

be nonpyrogenic:

Valve, In-line with SIPHONGUARD Device

Valve, In-line with SIPHONGUARD Device and Platform with Proximal Tube

Valve, In-line

Valve, Right Angle with SIPHONGUARD Device

Valve, Right Angle

Valve, Cylindrical with Prechamber

Valve, Cylindrical with RICKHAM Reservoir

Valve, Cylindrical

Valve, Micro with RICKHAM Reservoir

Valve, Micro

Peritoneal Catheter

Ventricular Catheter

Priming Adapter

Right Angle Adapter

Straight Connector

Preimplantation Performance Testing

Each CODMAN HAKIM Programmable Valve is individually tested on

a component level to ensure conformance to the advertised performance

characteristics. Each valve is dynamically tested at six different settings

for proper dynamic opening pressure over the entire performance range.

Performing a manometer test is not recommended, as it is susceptible

to environmental factors. Manometer testing yields a result that is not

physiologic in nature and for which manufacturers do not specify performance

ranges. If the surgeon insists upon performing manometer testing for

confirmation of CODMAN HAKIM Valve closing pressures, it is possible,

but is not recommended. When performed correctly, manometer testing

generates valve closing pressures similar to the CODMAN HAKIM Valve

opening pressure setting. However, closing pressure results will typically

vary noticeably from the opening pressure setting.

For those surgeons who wish to perform functional testing, please see

Preimplantation Performance Testing in the Appendix.

Programming the Programmable Valve

Programmer Information

WARNING: The CODMAN HAKIM Programmable Valves are supplied

without a specific programmed pressure and must be programmed

prior to implantation.

Programming must be performed prior to implantation through the

nonsterile outer package. Perform programming postoperatively as needed.

The programmer consists of two parts, the programming unit and the

transmitter unit. The programming unit control panel (Figure 5) features

a power switch, programming instructions, and a representation of the

programmable portion of the valve system as it appears when x-rayed. This

representation also incorporates the 18 pressure selection buttons. Eighteen

LEDs, corresponding to the position of the valve pressure indicator when

viewed on x-ray, confirm the pressure setting chosen.

After depressing the desired pressure selector button, an LED lights in the

programming unit. The lighted LED corresponds exactly with the position of

the pressure indicator on the valve. When programming begins, the transmitter

unit emits a sequentially coded electromagnetic signal. The stepper motor

of the valve detects the signal and rotates the cam assembly, which, in turn

adjusts the tension of the spring to the selected pressure setting.

Transmitter Information

Note: This Transmitter Information is for the CODMAN HAKIM Programmers

ONLY. When using another Integra programmer, please refer to the

instructions for use packaged with your programmer.

The transmitter unit (Figure 6) incorporates an illuminated center hole and

directional arrows to aid in proper positioning over the valve. It connects

to the programming unit via a pronged plug and is activated by the

START button.

Preimplantation Programming Familiarization Procedure

To become familiar with valve programming, perform the following

preimplantation programming procedure while the valve remains in

the blister package.

1. Insert the pronged plug from the transmitter unit into the receptacle at

the back of the programming unit.

2. Plug the power cord from the programming unit into an appropriate

power source.

Note: The instructions contained in steps 3 through 6 are for the

CODMAN HAKIM Programmers ONLY. When using another Integra

programmer, please refer to the instructions for use packaged with

your programmer.

3. Press the programming unit’s power button to the ON position. Both

the ON button and Instruction 1 on the panel will illuminate. Press the

desired pressure selection button; Instruction 2 illuminates.

4. Place the transmitter unit’s four prongs in the four depressions in the

blister around the inlet valve. Point the arrow on the transmitter unit in

the same direction as the arrow on the blister (the direction of flow).

Look through the illuminated center hole of the transmitter unit.

CAUTION: Do not move the transmitter unit during programming.

5

5. Push the transmitter unit’s START button. Instruction 3 on the control

panel illuminates. During programming, the pressure selector buttons

light sequentially until the selected pressure setting is attained.

6. When programming is completed (approximately five seconds),

Instruction 4 on the panel illuminates momentarily and a

buzzer sounds.

Postimplantation Programming Procedure

1. Insert the pronged plug from the transmitter unit into the receptacle

at the back of the programming unit.

2. Plug the power cord from the programming unit into an appropriate

power source.

3. Prior to programming, it is advisable to take an x-ray of the patient’s

head to verify the valve’s pressure setting and position.

Note: The instructions contained in steps 4 through 11 are for the

CODMAN HAKIM Programmers ONLY. When using another Integra

programmer, please refer to the instructions for use packaged with

your programmer.

4. Press the programming unit’s power button ON. The ON button

and Instruction 1 on the panel illuminate. Press the desired pressure

selection button; Instruction 2 on the programmer panel and the

center hole of the transmitter unit will illuminate.

5. Note: It is not necessary to shave the scalp for this procedure.

Palpate the scalp to locate the implanted valve, specifically, the inlet

valve, located distal of the reservoir. A fluoroscopic screen may assist

in this process. Place the tip of the left forefinger precisely over the

inlet valve, keeping the index finger parallel to the valve system and

pointing in the direction of flow (Figure 7).

6. Place the transmitter unit’s four prongs around the inlet valve so that

the prongs are sitting on the scalp. The arrows on the transmitter unit

should be parallel to the forefinger and pointing in the direction of

flow (Figure 8).

7. Center the transmitter unit so that the illuminated opening is directly

above the nail of the index finger (Figure 9).

8. Remove finger from the valve and push the transmitter unit’s START

button (Figure 10). Instruction 3 on the control panel illuminates,

indicating that the valve is programming.

CAUTION: Do not move the transmitter unit during programming.

9. During programming, the pressure selector buttons light sequentially

until the selected pressure setting is attained.

10. When programming is completed (approximately five seconds),

Instruction 4 on the panel illuminates momentarily and

a buzzer sounds.

11. Verify the valve pressure setting with an x-ray.

X-Raying the Valve

Note: The instructions contained in X-Raying the Valve are for the

CODMAN HAKIM Programmers ONLY. When using another Integra

programmer, please refer to the instructions for use packaged with

your programmer.

It is advisable to x-ray the complete system immediately after implantation

to have a permanent record of component placement and to verify valve

pressure. It is also advisable to x-ray the valve whenever valve pressure

is reprogrammed.

Use an x-ray with intensifying TV screen, or an x-ray plate to confirm proper

valve pressure. When documenting the valve pressure with x-rays, take care

when positioning so that:

• the nonimplanted side of the head rests on the plate (the implanted side

is uppermost from the plate), and,

• the inlet valve is parallel to the x-ray plate.

Viewing the x-ray, the white marker on the valve indicates the right-hand

side of the valve. The pressure indicator on the white ring indicates the

chosen pressure setting (Figure 11).

There is a direct correlation between the position of the programming unit

control panel pressure selector buttons and the position of the pressure

indicator on the valve as seen when x-rayed. Note that when the valve is

programmed to 70, 120, or 170, the pressure indicator aligns with the “X”

in the center of the valve (Figure 12).

Programming Procedure in Case of an Inverted Valve

Note: The instructions contained in Programming Procedure in Case of

an Inverted Valve are for the CODMAN HAKIM Programmers ONLY. When

using another Integra programmer, please refer to the instructions for use

packaged with your programmer.

An inverted valve can be diagnosed on x-ray; the white marker will appear on

the left side of the valve, instead of the right side. Programming the inverted

valve requires a “double programming” to obtain the desired pressure setting.

6

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).

7

Troubleshooting

If valve function is adversely affected by accumulations of biological matter,

it may be possible to dislodge the material and restore proper function

through one of the following methods:

• Flushing and/or pumping the valve (only for those valves

without SIPHONGUARD)

• Multiple programming attempts

If these remedial steps fail to rectify the problem, replace the valve.

Bibliography

Adams RD, Fisher M, Hakim S, Ojemann RG, Sweet WH: Symptomatic

occult hydrocephalus with “normal” cerebrospinal fluid pressure.

New Eng J Med 273: 117–126, 1965.

Bayston R: Serological surveillance of children with CSF shunting devices.

Supplement 35: 104–110, 1975, to Develop Med Child Neurol 17.

Bayston R, Swinden J: Aetiology & prevention of Shunt Nephritis.

Zeitschrift für Kinderchirurgie 28: 377–384, 1979.

Black P McL, Hakim R, Bailey NO: The Use of the Codman-Medos

Programmable Hakim Valve in the Management of Patients with

Hydrocephalus: Illustrative Cases. Neurosurgery 34: 6, 1994.

Black P McL: Idiopathic normal-pressure hydrocephalus. Results of shunting

in 62 patients. J Neurosurg 53: 371–377, 1980.

Black P McL, Tzouras A, Ojemann RG: CSF shunts for dementia, gait

disturbance, and incontinence, Clinical Neurosurgery.

Cohen SJ, Callaghan RP: A syndrome due to bacterial colonisation of Spitz-

Holter valves. A review of 5 cases, Brit Med J 2: 677–680, 1961.

Drake JM, Kestle JRW, Milner R, et al: Randomized Trial of

Cerebrospinal Fluid Shunt Valve Design in Pediatric Hydrocephalus.

Neurosurgery 43: 2, 1998.

Fager CA: Complicated and unusual neurosurgical problems, Surg Clin

N Am 48: 637–642, 1968.

Guthrie TC, Dunbar HS, Karpell B: Ventricular size and chronic increased

intracranial venous pressure in the dog. J Neurosurg 33: 407–414, 1970.

Hakim C: The physics and physiopathology of the hydrauIic complex

of the central nervous system (The Mechanics of Hydrocephalus and

Normal Pressure Hydrocephalus). Ph.D. Thesis, Massachusetts Institute

of Technology, 1985.

Hakim S, Zuluaga A, Cabrera O: Derivación ventriculoatrial para el

tratamiento de la hidrocefália por medio de la válvula de Hakim.

Tesis de grado, Facultad de Medicina, Universidad Javeriana,

Bogotá, Colombia, 1964.

Hakim S, Adams RD: The special clinical problem of symptomatic

hydrocephalus with normal cerebrospinal fluid pressure. Observations on

cerebrospinal fluid hydrodynamics. J Neurol Sci 2: 307–327, 1965.

Hakim S, Adams RD, Fisher CM: Occult hydrocephalus.

New Eng J Med 274: 466, 1966.

Hakim S: Observations on the physiopathology of the CSF pulse and

the prevention of ventricular catheter obstruction in valve shunts.

Hydrocephalus and Spina Bifida. Supplement 20: 42–48, 1970, to

Develop Med Child Neurol.

Hakim S: Biomechanics of hydrocephalus, in Harbert JC (ed):

Cisternography and Hydrocephalus, Charles C. Thomas, Springfield, IL,

25–55, 1972.

Hakim S, Duran de la Roche F, Burton JD: A critical analysis of valve

shunts used in treatment of hydrocephalus. Develop Med Child Neurol

15: 230–255, 1973.

Hakim S: Algunas observaciones sobre la presión del L.C.R. Sindrome

hydrocefálico en el adulto con presión normal del L.C.R. (Presentación de

un nuevo sindrome.) Tesis de grado. Facultad de Medicina, Universidad

Javeriana, Bogotá, Colombia, 1964. Available in English as: Some

observations on CSF pressure. Hydrocephalic syndrome in adults with

“normal” CSF pressure. (Recognition of a new syndrome.)

Hakim S, Venegas JG, Burton JD: The physics of the cranial cavity,

hydrocephalus, and normal pressure hydrocephalus: mechanical

interpretation and mathematical model. Surg Neurol 5: 187–210, 1976.

Hakim S, Hakim C: A biomechanical model of hydrocephalus and its

relationship to treatment. Hydrocephalus, edited by K Shapiro, A Marmarou,

and H Portnoy. 143–160. Raven Press, New York, 1984.

Hammock MK, Milhorat TH, Earle K, DiChiro C: Vein of Galen ligation of the

primate. J Neurosurg 34: 77–83, 1971.

Leheta F: Erfahrungen mit dem Cordis-Hakim-Ventil. Zbi Neurochir

33: 69–74, 1972.

Mori K: Management of Idiopathic Normal Pressure Hydrocephalus: A Multi

Institutional Study Conducted in Japan. J Neurosurg 2: 95, 2001.

Nulsen FE, Spitz EB: Treatment of hydrocephalus by direct shunt from

ventricle to jugular vein. Surg Forum 2: 399–403, 1952.

O’Brien M, Parent A, Davis B: Management of ventricular shunt infections.

Child’s Brain 5: 304–309, 1979.

Ojemann RG: Initial experience with the Hakim valve for ventriculovenous

shunt. J Neurosurg 28: 283–287, 1968.

8

Ojemann RG: Normal pressure hydrocephalus. Clin Neurosurg 18:

337–370, 1971.

Ojemann RG, Black P McL: Evaluation of the patient with dementia and

treatment of normal pressure hydrocephalus. In: Wilkins RH, Regachary SS

(eds). Neurosurgery. McGraw Hill, 1984.

Penn RD, Bacus JW: The brain as a sponge: a computed tomographic look

at Hakim’s Hypothesis. Neurosurgery 14: 670–675, 1984.

Raimondi AJ, Yashon D, Matsumoto S, Reyes C: Increased intracranial

pressure without lateralizing signs, the “midline syndrome.”

Neurochirurgia 10: 197–209, 1967.

Rayport M, Reiss J: “Hydrodynamic Properties of certain shunt

assemblies for the treatment of hydrocephalus, Part I: Report of a case

of communicating hydrocephalus with increased cerebrospinal fluid

production treated by duplication of shunting device.” Part II: Pressure-flow

characteristics of the Spitz-Holter, Pudenz-Meyer, and Cordis-Hakim shunt

systems. J Neurosurg 30: 455–467, 1969.

Reinprecht A, Dietrich W, Bertalanffy A, Czech T: The Medos Hakim

Programmable Valve in the Treatment of Pediatric Hydrocephalus.

Childs Nerv Syst 13: 588–594, 1997.

Zemack G, Romner B: Seven-year clinical experience with the

CODMAN HAKIM programmable valve: a retrospective study of 583 patients.

Neurosurg Focus 7: 4, 1999.

APPENDIX

Preimplantation Performance Testing

Although Integra does not recommend functional testing, some

surgeons may choose to do so. Before testing, it is extremely important

that a CODMAN HAKIM Valve with or without SIPHONGUARD Device be

flushed of all air bubbles. Air bubbles within the CODMAN HAKIM Valve or

SIPHONGUARD Device produce inaccurate manometer test results. The

presence of air bubbles can reduce the cross-sectional area of the flow path,

increase system resistance, and impede the flow of fluid through the system

during testing.

SIPHONGUARD Device Functional Testing

Equipment Required (use all sterile equipment, perform testing under

sterile conditions)

One manometer, wide-bore (e.g. 3.5 mm), graduated in mm (available in

lengths from 38 to 60 cm)

One 4-way stopcock

One syringe, 5 mL

One syringe filter, 5 µm

Tubing adapters

Silicone tubing

One male luer connector with 1/16 in. barb

Saline solution

Flushing Procedure

Note: At a rate of 0.5 mL/minute, unitized versions require 2–3 minutes

to complete flushing. This is the time required for fluid to fill the valve and

exit the distal catheter. Allot additional time to ensure the system is free of

air bubbles.

1. Assemble manometer, stopcock, syringe, and tubing (Figure A-1).

Manometer

To Valve

Figure A-1

2. Detach syringe from assembly and fill the syringe with sterile saline

solution using the 5 µm filter in-line. Detach the filter after filling

the syringe.

3. Set the valve opening pressure to 30 mm H2O (294 Pa) while the valve

remains in its sterile package.

4. Remove valve from the sterile package, and connect the valve to the

manometer/syringe assembly.

Note: Do not attach the distal catheter at this time.

9

5. Adjust the stopcock to connect the syringe to the valve assembly

(Figure A-2).

Valve

Figure A-2

6. Position the valve vertically to direct the flow of saline upward through

the assembly. This orientation aids in flushing air from the system.

7. Using the syringe, gently flush saline through the system while

gently depressing the prechamber to purge air bubbles from the

valve assembly.

8. Attach the distal catheter and continue to flush the system using the

syringe until saline solution exits the end of the distal catheter.

Note: An excessive flow rate (>0.75 mL/min) activates the

SIPHONGUARD Device and creates the impression that the

valve is distally occluded. In reality, flow is being diverted to the

high resistance secondary pathway.

9. The device is now ready for SIPHONGUARD Device Functional Test or

Manometer Testing.

Note: All valves are susceptible to damage due to excessive flow rate

during testing. Take extreme care when flushing a valve as damage

can occur when excessive flow rates are used. It is recommended

to use a flow rate of no greater than 0.5 mL/min.

SIPHONGUARD Device Functional Test

Note: This procedure applies only to valves with an integrated

SIPHONGUARD Device.

Note: Perform this procedure immediately after completing the flushing

procedure. This procedure is designed to provide visual confirmation of

proper functioning of the SIPHONGUARD Device.

1. Use a full syringe of saline solution attached to the 4-way stopcock to

fill the manometer to the top.

2. Turn the stopcock to connect the manometer to the CODMAN HAKIM

Valve and SIPHONGUARD Device (Figure A-3).

Figure A-3

Note: Attach the distal catheter at this time, flushed free of air bubbles.

10

3. Bring the end of the distal catheter level with the fluid level in the

manometer (Figure A-4).

Note: The CODMAN HAKIM Valves with SIPHONGUARD Device

must lie on a sterile surface and remain undisturbed for the duration

of the test.

Figure A-4

4. Hold the catheter distal tip adjacent to the manometer and slowly lower

the end of the distal catheter until the fluid level in the manometer

begins to drop.

5. Continue to lower the catheter tip at a rate that exceeds the drop

rate of the fluid level in the manometer. As you do so, you will note

a corresponding increase in the rate of descent of the fluid level in

the manometer.

6. A point will be reached where the rate of descent of the fluid level

in the manometer dramatically decreases, but does NOT stop. This

is the point at which the SIPHONGUARD Device primary pathway

closes and flow diverts to the higher resistance secondary pathway.

This confirms proper functioning of the SIPHONGUARD Device.

7. Repeat Steps 3 through 6 as necessary to reconfirm SIPHONGUARD

Device function.

8. Remove distal catheter for manometer testing of valve.

Manometer Testing

Note: Performing a manometer test is not recommended as this test

is susceptible to environmental factors and yields a result that is not

physiologic in nature and for which manufacturers do not specify

performance ranges.

Note: Perform this test only on devices that have been prepared according

to Steps 1 through 8 in Flushing Procedure.

Equipment Required (use all sterile equipment, perform testing under

sterile conditions)

One manometer, wide-bore (e.g. 3.5 mm), graduated in mm (available in

lengths from 38 to 60 cm)

One 4-way stopcock

One syringe, 5 mL

One syringe filter, 5 µm

Tubing adapters

Silicone tubing

One male luer connector with 1/16 in. barb

Saline solution

Flushing Procedure

Prepare the valve following Steps 1 through 8 in SIPHONGUARD Device

Functional Testing, Flushing Procedure.

Equipment Setup

1. Disconnect the valve from the tubing leading to the stopcock.

Perform this step with the valve submerged in a water bath so as not

to reintroduce air into the valve.

2. Place the end of the tubing leading from the stopcock into the water

bath. Position the tubing so that the end does not come into contact

with the sides of the bath.

11

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