Integra™ CSF Accessories
Integra offers a wide variety of accessories, available in radiopaque polypropylene and stainless steel, to facilitate your shunting requirements.


Tubing connectors

• Straight
• Threaded and double threaded
• Right-angle
• Three-way (Y and T shape)
• Step-down connectors
• Right angle catheter guides

Indications
Integra Connectors and the Hemmer Connection Sleeve are utilized principally in the treatment of hydrocephalic patients, as components in systems designed to shunt cerebrospinal fluid from the lateral cerebral ventricles of the brain into either the right atrium of the heart or the peritoneum.


Contraindications
Integra connectors and the Hemmer Connection Sleeve are designed for use as components in systems which provide access to the ventricles of the brain, particularly hydrocephalic shunt systems. Hydrocephalic shunting systems should not be used in the presence of known or suspected infections along the course of the shunt (meningitis, ventriculitis, skin infections, bacteremia or peritonitis).It is advisable to avoid shunting procedures
if infection is present anywhere in the body.


Warnings
Hydrocephalic patients with cerebrospinal fluid shunting systems must be kept under close observations for signs and symptoms of increasing intracranial pressure due to shunt failure. These signs and symptoms may vary from patient to patient. Increasing intracranial pressure is characterized by head ache, vomiting, irritability, listlessness, drowsiness and other signs of deterioration of consciousness, and nuchal rigidit. In the infant, increased scalp tension at anterior fontanelle and congestion of scalp veins will be noted.

If connections are not secure, components of the shunt system may separate, causing severe complications.
Lint, fingerprints, talc and other surface contaminants can cause foreign body reactions. Utmost caution should be taken to avoid contaminants.


Complications
Complications which may result from the use of this product include the risks associated with the medication and methods utilized in the surgical procedure, as well as the patient's response, reaction or degree of intolerance to any foreign object implanted in the body.

The principal complications associated with cerebrospinal fluid shunting into the right atrium or peritoneum are shunt obstruction, functional failure of the shunt system, infection or intracranial hypotension.

Shunt obstruction may occur in either the proximal ventricular catheter or in the distal, atrial or peritoneal catheters. Ventricular catheters may be obstructed by particulate matter such as blood clots, fibrin or brain fragments. If not properly located in the lateral ventricle, the catheter may become embedded in the ventricular wall or choroid plexus. Less commonly, the catheter may be obstructed by excessive reduction of ventricular size to slit-like proportions.

Cardiac and peritoneal catheters may also be obstructed by particulate matter. The intra-atrial segment of the cardiac catheter may be obstructed by investment in a thrombus. Emboli from the latter may seed the pulmonary circulation sufficiently to result in pulmonary artery hypertension and corpulmonale. Peritoneal catheters may be obstructed by the omentum or coiled loops of bowel.

Functional failure of the shunt system due to separation of its component parts can result in serious complications. Ventricular catheters may migrate into the lateral ventricles. Should the cardiac catheter become detached, it may lodge in the right atrium or ventricle or, rarely, in the pulmonary artery. Peritoneal catheters may migrate completely into the peritoneal cavity. Volvulus and perforation of intra-abdominal viscera may occur or the catheter may be extruded.

Infection is a common and serious complication of a shunting system and is most frequently caused by skin contaminants. Septicemia, which occurs most frequently in debilitated infants, can result from infections anywhere in the body and may develop with few or no symptoms. It may occur as a result of a wound infection. The presence of a foreign body (i.e. the shunting system), may trigger ventriculitis or a dormant meningitis. Intracranial infection may then be disseminated throughout the body via the distal catheter. Lesions developing from the breakdown of skin or tissue over the shunting system may also serve as foci of serious infections. In the event of an infection, removal of the shunt system is indicated in addition to the appropriate therapy. Excessive lowering of intracranial pressure may result in complications, particularly in the infant. These include subdural hematomas, markedly sunken fontanelles, overriding of cranial bones and the conversion of a communicating to a non-communicating hydrocephalus due to obstruction of the aqueduct of Sylvius.

Failure of the shunting system may be evidenced by any or all of the following: continuing symptoms of increased intracranial pressure, the subcutaneous exudation of CSF along the pathway of the shunt and leakage of fluid through the surgical wound. These failures require immediate replacement of the shunting system or of the affected component.


Other Accessories

• Suture collars
• Luer connectors
• 14G Tuohy needle
  • 9cm with snap on wings
  • 15.2cm

Catheter passers

• Malleable stainless steel tunnelers (box of 5)
  • Lengths: 45cm and 65cm
• Reusable stainless steel peritoneal introducers
  • Lengths: 31, 46, 61, and 70 cm
• Replacement translucent polypropylene peritoneal introducer sheaths
  • Lengths: 31, 46, 61, and 70 cm
• Disposable peritoneal catheter passers (box of 6)
  • 36 cm and 60 cm
• Plastic disposable subcutaneous tube passer for Integra DP™ Pediatric Valves
• Stylet for 18cm ventricular catheter
• Ventricular catheter introducer for one-piece shunt

Indications
The passers are intended for use during hydrocephalus shunting procedures designed to establish a subcutaneous tunnel between the flushing device and the incision for the peritoneal catheter.