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DBS - Stage 2 > Stage 2 Exam > Flashcards

Stage 2 Exam Flashcards

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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
Define short circuit?
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
What is charge density?
.
26
What might you tell a patient while checking impedance for a Soletra and Kinetra?
That therapy may turn off and may feel it.
27
What are the MRI guidelines?
- 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
What happens to therapeutic output with legacy products over time?
- 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
What are groups? And why are they used?
Collection of 1-4 programs. 2 per lead. Must share rate. Can be used to reach ultimate therapy.
30
Activa brain stimulation system is contraindicated for?
- 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
What are the programming settings for MRI
- 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
CT and X-Ray guidelines?
CT - set to off | X-Ray - nothing
33
What electro cautery is recommended for DBS?
Bipolar If monopolar is used, then set to lowest current possible and keep INS out of current path.
34
What is the Soletra patient program called? What can it tell you?
Access review patient programmer. Tells you if it's On/Off Tells you If implant battery is functioning Controls loudness of beep
35
What is the Kinetra pt. programmer called? What does it tell you?
``` 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
What is a constant current safety setting?
You can only have 1 negative electrode.
37
If an RC patient can't charge, what can they do? And how do they get there?
Use antenna locator found on the recharger. This is done by holding the 2 black buttons (shop and audio).
38
What is ERI
Elective replacement Indicator
39
What is EOS?
End of service
40
Can a patient clear a POR and reinstate therapy?
Yes Press any direction on the navigation key once you see the POR message Set the time Press stim on key
41
What is the most common extension (older) vs newer?
40cm and 51cm | 40cm and 60cm
42
What types of obturators are there?
Single tip Dual tip Wedge tip
43
Describe the wrenches new vs old?
New has a torque limit or (4 clicks) | Old you finger tight plus 1/4 turn
44
What are the frequency rate ranges for Soletra and Kinetra?
Soletra 2-185 | Kinetra 2-250
45
Impudence checks?
Unipolar - 250-2000 Bipolar - 250 a 4000 When checking impedance, keep over battery or you may reset therapy to last check settings.
46
If testing unipolar intra op, and reading is over 40,000 what do you do?
Be sure INS is in the pocket Let stim for 10 min Could be a component fracture
47
What is used to test a lead?
Alligator clamps or twist lock

DBS - Stage 2 (3 decks)

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