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DBS - Stage 2 > Stage 2 Exam > Flashcards

Stage 2 Exam Flashcards

This flashcard deck was created using Flashcardlet's card creator

0
Q

Define an open electrical circuit and when can it happen? How can you check it?

A

When there is no electricity going through.
When there is a break in the connector ) patient might have fallen down)
Impedance reads >40,000 and current <12

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1
Q

What is a lead connection check? When is it done? When is it used?

A
  • It allows you check for open circuits only (activa system)
  • Use the 2 black buttons on the front of the programmer
  • it only tells you the the # of OK electrodes
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2
Q

Define an electrical leak, and when it can happen?

A
  • everything can appear normal
  • it can happen with liquid
  • patient usually tells you something feels wrong
  • tingling can take place at the affected area
  • impedance check may comeback low
  • voltage may need to be increased to get the required therapy
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3
Q

Describe the impedance on kinetra and soletra systems? Describe any adjustments needed to measure?

A
  • > 2000 & Kinetra >4000
  • for soletra you increase voltage to 1.5 V & for kinetra you increase to 4.0V
  • when checking impedance using a kinetra, patient should be warned that the therapy will be turned off
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4
Q

Define the impedance measurement capabilities of RC/PC/SC?

A
  • > 40,000

- increases in voltage duing testing (0.7, 1.5, 3.0)

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5
Q

What is a doubler, trippler, and when are they encountered?

A
  • found in the Soletra
  • Doubler <3.7V (draining the battery in twice as fast)
  • Trippler <7.4V (draining the battery three times as fast)
  • The Kinetra doesn’t have doubles or tripplers
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6
Q

What is Interleaving? When might it be used?

A
  • Finer control over a stimulation field
  • To configure multiple sets to a single lead
  • For side effects
  • for multiple symptoms
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7
Q

What happens to therapeutic output with Legacy devices over time?

A
  • The stimulator doesn’t have the same charge as It reaches its end of life and so higher Voltage is required to get the same effect.
  • Fast drop off
  • Umpredictable delivery
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8
Q

What are groups? What are the guidelines? And When may they be used?

A
  • A group is a collection of 1-4 programs (1-2 for SC)
  • Uses the same rate
  • Can be used to reach optimal settings sooner in advance mode or after therapy changes
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9
Q

Constant current safety setting?

A

You can only have one negative electrode.

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10
Q

How long does RC have before going into over discharge? How many over discharge do you have?

A
  • Over 50 days

- 3x

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11
Q

RC

A
  • No change

- Consistent therapy

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12
Q

What depth do the stimulators need to be placed at?

A
  • 4cm

- RC 1cm

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13
Q

If an RC patient can’t find the INS when charging, what can they do?

A

Use the antenna locator (press stop & Audio) two black buttons

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14
Q

When RC patient let their INS fully discharge and they can no longer charge, what should they do?

A
  • Patients have a maximum of 3 resets

- they need to go to Physicians recharge mode

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15
Q

What do ERI and EOS stand for?

A
  • Elective replace indicator

- End of service

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16
Q

At what temperature does the RC antenna turn off?

A
  • automatically shuts off when temp. Is >101.4 (38.3c)

- recharging then resumes when temp. Drops back <101 (38.1c)

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17
Q

Whith an Access Review programmer, what can the patient do?

A
  • turn the stimulator on/off and see if the battery is low.

- turn off the volume

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18
Q

What are the differences between the 3387 and the 3389?

A
  • 3387 have 1.5mm sized contacts with 1.5mm spacing

- 3389 have 1.5mm sized contacts with 0.5mm spacing

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19
Q

What are the PD indications?

A
  • Bilateral stimulation
  • GPi and STN
  • Adjunctive therapy
  • Levadopa-responsive
  • not adequately controlled with medication
20
Q

What are ET indications?

A
  • Unilateral thalamic stimulation
  • Not adequately controlled by medication
  • significant functional disability
  • Upper extremity
21
Q

Indications for Dystonia?

A
  • Unilateral or Bilateral stimulation
  • GPi & STN
  • Chronic, intractable (drug refractory) primary Dystonia
  • Generalized and Segmental Dystonia
  • HDE
22
Q

OCD “Reclaim” approved indications?

A
  • Bilateral stimulation of the anterior limb of the internal capsule
  • Adjunct to medications
  • Treatment-resistant obsessive-compulsive disorder
  • no approval for Activa RC
  • its the only white mater target
23
Q

Constant current vs. constant voltage?

A

Constant current adjust it’s voltage based on impedance.

Constant voltage keeps current the same throughout.

24
Q

Define short circuit?

A

It’s when you have low impedance <250.
This leads to high battery drain.
Usually a crushed wire (during surgery)
Ask the patient if they get a shock when turned up.

25
Q

What is charge density?

A

.

26
Q

What might you tell a patient while checking impedance for a Soletra and Kinetra?

A

That therapy may turn off and may feel it.

27
Q

What are the MRI guidelines?

A
  • MRI examinations of DBS patients should only be done if absolutely necessary.
  • 1.5 Tesla horizontal bore
  • 0.1watts (1/10) per kg SAR (specific absorption rate)
  • transmit/receive head coil only
  • no possibility of system integrity issue for either system:
    Open circuit (taken with case electrode monopolar) >2000
    Short circuit
28
Q

What happens to therapeutic output with legacy products over time?

A
  • Fast drop off.
  • Unpredictable delivery
  • therapy treatment changes

Over time, output changes near battery end of life, often we will increase voltage to compensate.

29
Q

What are groups? And why are they used?

A

Collection of 1-4 programs. 2 per lead.
Must share rate.
Can be used to reach ultimate therapy.

30
Q

Activa brain stimulation system is contraindicated for?

A
  • patients exposed to Diathermy
  • patients who will be exposed to MRI using full body transmit radio frequency (RF) coil, a receive only head coil, or head transmit coil that extends over the chest.
  • patient for whom test stimulation is unsuccessful.
  • patients who are unable to properly operate the brain stimulator.
31
Q

What are the programming settings for MRI

A
  • Activa pc, rc, sc (turn off)
  • Kinetra (turn off, reed switch disabled, disable day cycling)
  • Soletra (turn off, set to bipolar, amp to 0)
32
Q

CT and X-Ray guidelines?

A

CT - set to off

X-Ray - nothing

33
Q

What electro cautery is recommended for DBS?

A

Bipolar

If monopolar is used, then set to lowest current possible and keep INS out of current path.

34
Q

What is the Soletra patient program called? What can it tell you?

A

Access review patient programmer.
Tells you if it’s On/Off
Tells you If implant battery is functioning
Controls loudness of beep

35
Q

What is the Kinetra pt. programmer called? What does it tell you?

A 
Access Therapy Controller
On/off
Control amplitude 
Rate and pulse width can also be changed
Adjust beeper volume
Adjust left and right channel (increase or decrease)
36
Q

What is a constant current safety setting?

A

You can only have 1 negative electrode.

37
Q

If an RC patient can’t charge, what can they do? And how do they get there?

A

Use antenna locator found on the recharger. This is done by holding the 2 black buttons (shop and audio).

38
Q

What is ERI

A

Elective replacement Indicator

39
Q

What is EOS?

A

End of service

40
Q

Can a patient clear a POR and reinstate therapy?

A

Yes
Press any direction on the navigation key once you see the POR message
Set the time
Press stim on key

41
Q

What is the most common extension (older) vs newer?

A

40cm and 51cm

40cm and 60cm

42
Q

What types of obturators are there?

A

Single tip
Dual tip
Wedge tip

43
Q

Describe the wrenches new vs old?

A

New has a torque limit or (4 clicks)

Old you finger tight plus 1/4 turn

44
Q

What are the frequency rate ranges for Soletra and Kinetra?

A

Soletra 2-185

Kinetra 2-250

45
Q

Impudence checks?

A

Unipolar - 250-2000
Bipolar - 250 a 4000

When checking impedance, keep over battery or you may reset therapy to last check settings.

46
Q

If testing unipolar intra op, and reading is over 40,000 what do you do?

A

Be sure INS is in the pocket
Let stim for 10 min
Could be a component fracture

47
Q

What is used to test a lead?

A

Alligator clamps or twist lock

DBS - Stage 2 (3 decks)

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