Neurosurgery & Neurocritical Care Product and Accessory Catalog US Catalog.

Transcription

1 Neurosurgery & Neurocritical Care Product and Accessory Catalog 2018 US Catalog

2 Neurodiagnostics Neurocritical Care Neurosurgery Solutions that span the spectrum of neuro care Natus Neuro is a global market leader that provides diagnostic, therapeutic and surgical solutions built on a strong heritage in neurodiagnostics, neurocritical care and neurosurgery. Natus Neuro delivers clinician-led products that improve outcomes and enhance care for neuro patients through leading-edge equipment, service, education and supplies. Natus Neuro s comprehensive neurodiagnostic solutions enhance the diagnosis of neurological conditions such as epilepsy, sleep disorders and neuromuscular diseases. The neurocritical care solutions include management of traumatic brain injury by continuous monitoring of intracranial pressure and cerebrospinal fluide drainage. Our neurosurgical solutions provide options that promote dural healing in the cranium as well as treatment solutions for procedures involving hydrocephalus when quality and performance are crucial to successful outcomes. Natus Neuro is proud to partner with clinicians to improve patient outcomes across the spectrum of neuro care. Visit for more information.

3 Table of Contents For information on ordering, please call or NEUROSURGERY DURAFORM Dural Graft Implant...2 CSF Valves and Shunts Novus Valves Contour-Flex Valves Natus DP Valve System Burr Hole Shunt System...9 Valve Unit...9 UltraVS Valves Pudenz Valves Multi-Purpose Valve...14 Lumbar Shunts Spetzler Lumbar-Peritoneal Shunts and Valves Horizontal-Vertical (H-V) Lumbar Valve System Edwards-Barbaro Syringo-Peritoneal Shunt Kit...19 Anti-Siphon Devices Gravity Compensating Accessory...20 Anti-Siphon Device...21 CSF Reservoirs Natus Reservoir On-Off CSF Reservoirs...24 Foltz Reservoirs...25 Braden Reservoirs...25 Rickham Reservoirs...25 Burr Hole Reservoirs...26 Integral Reservoirs...27 CSF Reservoirs...27 Shunt Catheters CSF Ventricular Catheters CSF Peritoneal Catheters...31 CSF Lumbar Catheters...32 CSF Atrial Catheters...33 Connectors & Accessories Shunt Implantation Instruments...34 Connectors Brain Mapping...37 Nicolet Cortical Stimulator...37 NEUROCRITICAL CARE Intracranial Pressure Monitoring Camino ICP Monitor...40 Camino Pressure Monitoring Catheter Kits Camino ICP Monitor Service Contracts...44 CSF Drainage Systems & Accessories EDS 3 CSF Drainage System...45 EVD Catheters...46 Lumbar Catheters...47 Cranial Access Kits, Accessories and Components EEG in the ICU US Catalog

4 Neurosurgery Neurosurgery Dural Graft Implants CSF Valves and Shunts Lumbar Shunts Anti-Siphon Devices Reservoirs Catheters Connectors & Accessories Brain Mapping

5 Neurosurgery Dural Graft Implants DURAFORM Dural Graft Implant The DURAFORM Dural Graft Implant is the solution for the difficult handling of dural substitutes. The unique design and manufacturing process provide an implant with better handling characteristics and greater tear resistance than other onlay dural graft materials. The DURAFORM provides superior leak resistance with two different textured surfaces for enhanced wet handling capabilities and excellent anatomical conformity. Features: Textured top surface makes the DURAFORM implant easy to grip and manipulate, by hand or with forceps Soft, smooth bottom side that gently molds to the complex surface structures of the brain and dura Offers excellent anatomical conformity to help prevent CSF leakage Collagen-based biocompatible material exhibits superior tensile strength and wet handling capabilities The strength of the DURAFORM Dural Graft allows for improved manipulation of the dural substitute Extended shelf life (30 months) Enhanced Confidence with DURAFORM CSF leak resistance is a key factor in the overall effectiveness and value of dural substitutes Made of a collagen-based biocompatible material obtained from a geographical BSE risk level 1 source When wet, the DURAFORM implant is stronger and handles better than other onlay graft dural substitutes Size Units / Case US 4 x 5 (10cm x 12.5cm) US 3 x 3 (7.5cm x 7.5cm) US 3 x 3 (7.5cm x 7.5cm) US 2 x 2 (5cm x 5cm) US 2 x 2 (5cm x 5cm) US 1 x 3 (2.5cm x 7.5cm) US 1 x 3 (2.5cm x 7.5cm) US 1 x 1 (2.5cm x 2.5cm) 5 Indications: The DURAFORM Dural Graft Implant is intended for use in procedures where the repair or substitution of the patient s dura mater is needed. Contraindications: The DURAFORM Dural Graft Implant is contraindicated in patients with known sensitivity to bovine-derived materials. Do not use to repair spinal neural tube defects or for anterior spinal surgery with dural resection. Use with caution in infected areas. Natus does not recommend use to cover large defects at the skull base following surgery or dural defects involving mastoid air cells. DURAFORM Sizing Chart 2 natus.com Ordering Information:

6 CSF Valves and Shunts Neurosurgery Novus Valves The pressure/flow performance of the Novus Valve is specifically designed to resemble the characteristics of normal, healthy, CSF physiology. Novus features an integral Anti-Siphon Device based on a normally-open design. This proven innovation minimizes gravity-induced overdrainage when a patient sits or stands, maintaining intraventricular pressure within the normal physiologic range. In addition, the patented Novus horizontally-mounted T-valve mechanism allows a straighter flow path; the rigid plastic valve housing and polypropylene needle guard reduce the risk of improper needle placement when accessing the reservoir; and proximal and distal occluders permit selective flushing and patency testing. All Novus Valves include integral connectors to facilitate catheter connection, and are designed with no metal parts that can interfere with CT or MRI scans. Novus is available in both standard and mini sizes. Because the normally-open configuration of our Anti-Siphon Device adds variable resistance to flow only as required by change in patient position, the flexibility to meet a variety of patient needs is obtained with two pressure ranges. Flushable reservoir dome Straighter flow-path Rigid polysulfone valve seat/body Rigid plastic needle-guard Distal and proximal occluders Integral connectors Patented, horizontally-mounted valve Patented, normally-open Physiological Flow Device Valve Performance Chart Low Pressure Medium Pressure Dot Code Closing Pressure mm H 2 0 mm H 2 0 Range Silicone valve diaphragm Side-view Cross-section view Close-up of valve mechanism Note: The above curves describe typical in-vitro valve performance characteristics for each closing pressure range. Due to characteristics of silicone materials, some variation in pressure performance may occur which historically has not compromised effective control and treatment of hydrocephalus US Catalog 3

7 Neurosurgery CSF Valves and Shunts Novus Valves Length 37mm Standard Novus Valve Each Novus Valve is packaged with a barium-impregnated silicone right-angle ventricular catheter guide. Proximal Distal Width 16.7mm NL NL Pressure Range Low Medium Proximal Profile Height 8mm Distal Standard Novus Shunt Two Piece System Includes: Standard Novus Valve with integral 120cm open-ended, barium striped peritoneal catheter 18cm standard Pudenz ventricular catheter with introducing rod (NL ) Barium-impregnated silicone right-angle ventricular catheter guide Proximal Length 37mm Distal Length 120cm Width 16.7mm NL NL Pressure Range Low Medium 1.7cm 18cm Radiopaque Markers 1.3mm ID, 2.5mm OD Length 31mm Mini Novus Valve Each Novus Mini Valve is packaged with a barium-impregnated silicone right-angle ventricular catheter guide. Proximal Distal Width 13mm NL NL Pressure Range Low Medium Proximal Profile Height 6mm Distal Mini Novus Shunt Kit Two Piece System Includes: Mini Novus Valve with integral 90cm open-ended, barium striped peritoneal catheter 18cm small Pudenz ventricular catheter with introducing rod (NL ) Barium-impregnated silicone right-angle ventricular catheter guide NL NL Pressure Range Low Medium Proximal Length 31mm Length 90cm Distal 1.7cm Radiopaque Markers 18cm Width 13mm 1.3mm ID, 2.5mm OD 4 natus.com Ordering Information:

8 Contour-Flex Valves Contour-Flex Valves The Contour-Flex family of valves uses a proven silicone membrane pressure control element, providing consistent pressure / flow characteristic and a reproducible closing pressure. The Contour-Flex valve has proximal and distal occluders to facilitate two-way flushing. This valve has a flexible profile to conform to the curvature of the cranium and is cosmetically unobtrusive. Pressure / Flow Characteristics Description Low Med High 5ml / hr flow rate 1cm H 2 O 6cm H 2 O 12cm H 2 O 50ml / hr flow rate 7cm H 2 O 136cm H 2 O 206cm H 2 O CSF Valves and Shunts Neurosurgery Regular Contour-Flex Valve 32mm CFRL CFRM CFRH Pressure Range Low Medium High 16mm 8mm Small Contour-Flex Valve Pressure Range CFSL Low CFSM Medium CFSH High 13mm 27mm 6mm 2018 US Catalog 5

9 Neurosurgery Contour-Flex Valves CSF Valves and Shunts Regular Contour-Flex Two Piece Shunt System Includes: Regular Contour-Flex valve with integral polypropylene connector 32mm 8mm 1.1mm ID, 2.3mm OD Integral 91cm, barium striped peritoneal catheter, open ended with slits 15cm ventricular catheter with introducing rod and right angle guide Pressure Range Low Medium High 1.4mm ID, 2.7mm OD 4 rows of 10 holes Small Contour-Flex Two Piece Shunt System Includes: Small Contour-Flex valve with integral polypropylene connector 27mm 6mm 1.1mm ID, 2.3mm OD Integral 91cm, barium striped peritoneal catheter, open ended with slits 15cm ventricular catheter with introducing rod and right angle guide Pressure Range Low Medium High 1.4mm ID, 2.7mm OD 4 rows of 10 holes 6 natus.com Ordering Information:

10 Differential Pressure Valves CSF Valves and Shunts Natus DP Valve System Over 30 years of clinical experience have made the Natus DP valve a standard among differential pressure (DP) valves. The original Ball-In-Cone and Spring mechanism is the basis of all our Natus DP Valve Systems. The Natus DP Valve for hydrocephalus management has proven: Accurate pressure control Long term reliability Superior protein handling capacity, and resistance to obstruction. Several color-coded pressure ranges are offered in standard and pediatric versions. A variety of system configurations are available, depending on physician preference. Each valve system includes all the necessary components required for implantation. A serial number is engraved on the body of the valve. Neurosurgery Differential Pressure (mm H 2 0) Differential Pressure Color (operating) Group ID Band Pressure, mm H 2 0 Very High Green High Brown Medium Yellow Low White Very Low Blue Flow (ml / hr) US Catalog 7

11 Neurosurgery Differential Pressure Valves Natus Standard DP Valve System Standard valve unit with integral reservoir Formerly known as Hakim Integral open-ended striped peritoneal catheter with slits (F7, 110cm) Plastic subcutaneous tube passer Introducing rod Stainless steel right angle connector Stainless steel straight connector Includes: Finned ventricular catheter (F8, 15cm) Color Pressure Range * Blue Very low* White Low Yellow Medium Brown High Green Very high Includes: Straight ventricular catheter with radiopaque length dots (F8, 15cm) Color Pressure Range White Low Yellow Medium Brown High CSF Valves and Shunts *Recommended for post-operative drainage of hygromas and other extraventricular conditions. Natus Pediatric DP Valve System Pediatric valve unit with integral reservoir Formerly known as Hakim Integral open-ended striped peritoneal catheter with slits (F7, 110cm) Plastic subcutaneous tube passer Introducing rod Stainless steel right angle connector Stainless steel straight connector Includes: Finned ventricular catheter (F8, 15cm) Color Pressure Range * Blue Very low* White Low Yellow Medium Brown High Green Very high Includes: Straight ventricular catheter with radiopaque length dots (F8, 15cm) Color Pressure Range White Low Yellow Medium Brown High *Recommended for post-operative drainage of hygromas and other extraventricular conditions. 8 natus.com Ordering Information:

12 Differential Pressure Valves Burr Hole Shunt System Valve unit with integral burr hole cap Integral open-ended, striped peritoneal catheter with slits (F7, 110cm) Straight ventricular catheter with radiopaque length dots (F8, 15cm) Introducing rod Stainless steel straight connector Standard Burr Hole System Includes 6.4mm stainless steel burr hole reservoir (2.5mm depth) Color Pressure Range White Low Yellow Medium Brown High Pediatric Burr Hole System Includes 6.4mm stainless steel burr hole reservoir (0.8mm depth) Color Pressure Range White Low Yellow Medium Brown High CSF Valves and Shunts Neurosurgery Valve Unit Valve unit Integral open-ended, striped catheter with slits (F7, 110cm) Two straight stainless steel connectors Standard Valve Units Color Pressure Range * Blue Very low* White Low Yellow Medium Brown High Green Very high Pediatric Valve Units Color Pressure Range White Low Yellow Medium Brown High *Recommended for post-operative drainage of hygromas and other extraventricular conditions US Catalog 9

13 Neurosurgery UltraVS Valves CSF Valves and Shunts UltraVS Valve System The simple cylindrical shape of UltraVS lowers the profile of the valve system in order to reduce the risk of skin erosion. At only 13mm long and 3.8mm wide, the UltraVS Neonate is the smallest valve manufactured, and the Natus valve most appropriate for neonatal patients. UltraVS incorporates a miter valve mechanism, a design that naturally opens more slowly in response to hydrostatic pressure than a diaphragm type valve. The direct flow path of the UltraVS easily resists occlusion even in cases of excessively high protein CSF. All UltraVS Valve units incorporate integral connectors to facilitate catheter connection. The option of an integral injectable Rickham-style reservoir allows CSF sampling. UltraVS Valves are available in two sizes, and each size is available in three pressure ranges. The availability of several different system configurations gives UltraVS the ultimate in system flexibility. High Pressure Valve Neonate Medium Pressure Valve Low Pressure Valve Standard Integral connectors Sheath Miter valve 10 natus.com Ordering Information:

14 CSF Valves and Shunts Neurosurgery UltraVS Valves Standard UltraVS Valve Pressure Range NL Low NL Medium NL High Connector 1mm ID, 1.9mm OD 47.5mm 29mm Diameter 5.8mm Connector 1mm ID, 1.9mm OD Standard UltraVS Shunt Kit with Small Rickham-style Reservoir 11.5mm 22mm 29mm 120cm NL NL NL Pressure Range Low Medium High Diameter 5.8mm 4.6mm 2mm 7.7mm Neonate UltraVS Valve Kit Pressure Range NL Low NL Medium NL High 31mm 13mm Diameter 3.8mm Neonate UltraVS Shunt Kit with Small Rickham-style Reservoir Includes: Neonate UltraVS Valve Integral 90cm, open-ended, barium striped peritoneal catheter with side slits Integral Rickham-style reservoir 18cm small Pudenz ventricular catheter with stylet (NL ) 11.5mm 11mm 13mm 90cm Diameter 3.8mm 4.6mm 2mm NL NL NL Pressure Range Low Medium High 7.7mm 2018 US Catalog 11

15 Neurosurgery Pudenz Valves CSF Valves and Shunts Pudenz Valve System Reliability of performance and the widest variety of sizes and pressure ranges available have made Pudenz Valves the burr-hole valve of choice for over three decades. The addition of integral connectors to facilitate catheter attachment and the availability of an integral Anti-Siphon Device provide increased flexibility in meeting a variety of patient requirements. All Pudenz Flushing Valves feature an injectable reservoir for CSF sampling, distal flushing, and distal patency testing. A one-way diaphragm-type valve and radiopaque pressure range indicators are incorporated in all Pudenz Valves Reservoir Chamber Anti-Siphon Device Anti-Siphon Device Anti-Siphon Device Diaphragm Diaphragm seat Distal outlet 25 or less Injecting fluids into the distal catheter Checking patency of the shunt by transcutaneous finger pressure Proximal inlet Valve Performance Chart Low Medium High Pressure Pressure Pressure Dot Code Closing Pressure mm H 2 O mm H 2 O mm H 2 O Range Flow / 5ml / hr. 5mm H 2 O 50mm H 2 O 110mm H 2 50ml / hr. 75mm H 2 O 140mm H 2 O 220mm H 2 O Note: Valves shown in the flow / pressure range chart are the low point of the established 5ml / hr range and the high point of the 50ml / hr range. High Pressure Note: Shaded areas on the graph describe typical in-vitro valve performance as tested at the time of manufacture. Due to characteristics of silicone materials, some variation in pressure performance may occur which historically has not compromised effective control and treatment of hydrocephalus. Medium Pressure Low Pressure 12 natus.com Ordering Information:

16 CSF Valves and Shunts Neurosurgery Pudenz Valves Pudenz Valve, 12mm Diameter With Anti-Siphon Device Pressure Range NL Low NL Medium NL High Without Anti-Siphon Device Pressure Range NL Low NL Medium NL High 5mm 3.8mm 5mm 3.8mm Anti-Siphon Device 12mm Outlet Integral Connector Size 1.1mm ID, 1.9mm OD 3.9mm Inlet Integral Connector Size 1.1mm ID, 1.9mm OD Outlet Integral Connector Size 1.1mm ID, 1.9mm OD 12mm Inlet Integral Connector Size 1.1mm ID, 1.9mm OD Pudenz Valve, 16mm Diameter With Anti-Siphon Device Pressure Range NL Low NL Medium NL High Without Anti-Siphon Device Pressure Range NL Low NL Medium NL High 5mm 3.8mm 5mm 3.8mm Anti-Siphon Device 16mm Outlet Integral Connector Size 1.1mm ID, 1.9mm OD 3.9mm Inlet Integral Connector Size 1.1mm ID, 1.9mm OD Outlet Integral Connector Size 1.1mm ID, 1.9mm OD 16mm Inlet Integral Connector Size 1.1mm ID, 1.9mm OD 2018 US Catalog 13

17 Neurosurgery CSF Valves and Shunts Multi-Purpose Valve Multi-Purpose Valves All Multi-Purpose Valves feature the exclusive On-Off Device. This integral on-off control can be utilized to monitor for shunt dependency, can assist in controlling ventricle decompression, and allows easy proximal flushing and patency testing. An integral proximal occluder allows easy opening of on-off mechanism and facilitates distal flushing, while the inline reservoir assists with both proximal and distal flushing and provides access for CSF sampling and fluid/medication injection. This easy-to-use flat bottom miter valve device is available in three pressure ranges, with or without an integral Anti-Siphon Device, to meet a wide range of patient needs. Dot Code Pressure Rating Closing Pressure Range (mm of H 2 O) Low Medium Occluder Proximal outlet On-off control High Reservoir Miter valve Anti-siphon device Distal outlet Procedure for closing the system Multi-Purpose Valve With Anti-Siphon Device Pressure Range NL Low NL Medium NL High Procedure for opening the system Proximal flushing Without Anti-Siphon Device Pressure Range NL Low NL Medium NL High Distal flushing Anti-Siphon Device 6.2mm 7mm 6.2mm 7mm 33.3mm Anti-Siphon Device 33.3mm 18.5mm 18.5mm Inlet Tube Size 1.2mm ID, 2.2mm OD Outlet Tube Size 1.2mm ID, 2.2mm OD Inlet Tube Size 1.2mm ID, 2.2mm OD Outlet Tube Size 1.2mm ID, 2.2mm OD 14 natus.com Ordering Information:

18 Lumbar Shunts Neurosurgery Lumbar Shunts Spetzler Lumbar-Peritoneal Shunt Kit Spetzler is the most prominent name in lumbar-peritoneal shunting products, available exclusively from Natus. The original lumbar-peritoneal shunt, designed for the treatment of communicating hydrocephalus in adults, can be inserted without a laminectomy. Pressure control is achieved through a combination of the double slit valve at the peritoneal end and the small inner diameter catheter. Each Spetzler Lumbar-Peritoneal Shunt is packaged as a complete kit. Optional in-line valves and reservoirs are also available. Spetzler Lumbar-Peritoneal Catheter Pressure Ranges Catheter alone, as packaged mm H 2 O Includes: One (1) lumbar-peritoneal catheter One (1) metal connector One (1) 14 gauge Tuohy needle Three (3) suture collars Catheter Length Tuohy Needle Length NL cm 3.5 (990003) NL97105S01 105cm 6 (NL82059S03) Catheter, reservoirs, and inline valves also sold separately. 18mm 0.7mm ID, 1.5mm OD Four Length Marker Dots Spaced at 5cm Intervals 1.2cm Metal Connector (NL75121S06) 10cm 5cm Suture Collar 14-Gauge Tuohy Needle 5.2mm Suture Holes 2018 US Catalog 15

19 Neurosurgery Lumbar Shunts Lumbar Shunts Spetzler Lumbar-Peritoneal CSF Reservoir Includes: Two metal connectors (NL75121S06) NL NL Size Small Large 2.2cm Small Reservoir 0.6cm Inlet and Outlet Tube Size.7mm ID, 1.5mm OD 2.9cm Large Reservoir 1.2cm Spetzler Lumbar-Peritoneal In-Line Valves Includes: Integral metal connectors NL NL NL Pressure Range Low Medium High Inlet and Outlet Tube Size.7mm ID, 1.5mm OD 2.1cm 3.2cm In-line Valve 5mm Valve Performance Chart Low Medium High Pressure Pressure Pressure Dot Code Differential Pressure mm H 2 O mm H 2 O mm H 2 O 9ml / hr Flow / 5ml / hr. 15mm H 2 O 50mm H 2 O 85mm H 2 50ml / hr. 115mm H 2 O 200mm H 2 O 310mm H 2 O Note: Valves shown in the flow / pressure range chart are the low point of the established 5ml / hr range and the high point of the 50ml / hr range. High Pressure Valve Note: Addition of a large or small reservoir to the one-piece shunt system will add a minimum pressure of 50mm of H 2 O at a flow rate of 23ml / hr. Trimming the shunt length by 20cm will result in an overall decrease in system pressure of approximately 15mm H 2 O at a flow rate of 23ml / hr. Medium Pressure Valve Low Pressure Valve 16 natus.com Ordering Information:

20 Lumbar Shunts Neurosurgery Lumbar Shunts Horizontal-Vertical (H-V) Lumbar Valve System Each Horizontal-Vertical (H-V) lumbar valve system adjusts for changes in posture to maintain pressure at appropriate levels in the standing and recumbent positions. When the valve unit is horizontal, the spring-actuated, ball-incone inlet valve alone controls the lower pressure limit. When the valve unit is vertical, the gravity-actuated, ball-in-cone outlet valve combines with the inlet valve to control the higher pressure. Each valve unit is color-coded according to its combination of horizontal and vertical closing pressures for easy identification. Cross Section of Valve Unit ) Suture holes 2) Inlet valve (controls pressure in the horizontal position) 3) Outlet valve (controls pressure in the vertical position) 4) Color-coded band Selection of Pressure Ranges The horizontal pressure range should generally be selected according to the extent of the patient s ventricular enlargement. If ventricular enlargement is extreme, valves with lower horizontal pressure ranges are usually selected. If the degree of ventricular enlargement is minor, higher horizontal pressures are generally applied. The vertical valve pressure should be selected on the basis of the patient s height from the base of the spine to the head (see table on previous page) US Catalog 17

21 Neurosurgery Lumbar Shunts Lumbar Shunts Horizontal-Vertical (H-V) Lumbar Valve System Includes: 2 side-by-side, ball-in-cone valves in a silicone elastomer housing Closed tip lumbar catheter (F5, 46cm) Suturable tubing clamp (F5) Stainless steel straight connector Stainless steel stepdown connector (F8 / F5) Open-ended, striped peritoneal catheter (F7, 71cm) Reservoir Guidewire in dispenser 14G Tuohy needle (90mm) Luer Connector For patients with minor ventricular enlargement Closing Pressure (mm H 2 O) Horizontal Vertical Color code Suggested Application A Blue Small children A Yellow Tall children, adults A Green Tall adults For patients with extreme ventricular enlargement Closing Pressure (mm H 2 O) Horizontal Vertical Color code Suggested Application A Red Small children A White Tall children, adults A Brown Tall adults Note on use in MRI: A sample set of H-V Lumbar valves was pressure tested at different flow rates (60, 50, 30, 20, 10 and 5ml / hr) before being subjected to two MRI sequences*. The products were tested again after MRI exposure. Additional H-V Lumbar valves were subjected to an MRI magnetic field of 1.5 Tesla. The results of the tests indicated that exposure to MRI does not affect the pressure settings of the valves. No significant forces or temperature changes were noticed during MRI exposure. *T1 sequence, 2 05, 800ms repetition time, 12ms echo, 1.5 Tesla field T2 sequence, 2 34, 3500ms repetition time, 120ms echo, 1.5 Tesla field 18 natus.com Ordering Information:

22 Lumbar Shunts Neurosurgery Lumbar Shunts Edwards-Barbaro Syringo-Peritoneal Shunt Kit Edwards-Barbaro is a T-tube catheter designed to provide continuous drainage of fluid from within a spinal cord cyst (syrinx) to the peritoneum. The small T-tube diameter (approximately F5) minimizes the size of the myelotomy, and the T shape allows drainage from above and below the myelotomy site which minimizes the risk of kinking and migration. Multiple perforations reduce the chance of catheter occlusion at the spinal cord. Includes: 25cm x 3.5cm F5 T-tube 90cm peritoneal reflux control catheter Step down connector Foltz CSF Reservoir (NL ) NL80076S01 19mm Foltz CSF Reservoir 7mm Outlet Tube Size 1.2mm ID, 2.2mm OD Stepdown Connector Outlet Tube Size.6mm ID, 2.1mm OD 0.6mm ID, 1.2mm OD Inlet Tube Size 1.2mm ID, 2.2mm OD 1.2cm T-tube 0.76mm ID, 1.5mm OD Peritoneal Reflux Control Catheter 25cm 90cm 10cm 5cm 2.5cm 3.5cm Radiopaque tip 1.1mm ID, 2.3mm OD Length markers at 10, 20 and 30cm from tip Suture Tab 0.5mm ID, 0.8mm OD 2018 US Catalog 19

23 Neurosurgery Gravity Compensation Anti-Siphon Devices Gravity Compensating Accessory The Gravity Compensating Accessory (GCA) is designed to be mounted in line with the DP valve or any other differential pressure valve system in order to counteract the siphoning effect of hydrostatic pressure when the patient is in the upright position. The GCA can be used in all cases where an anti-siphon device is deemed necessary. Its operating characteristics are not dependent on its location along the shunt distal tubing and they are not sensitive to external pressure. Cross Section Of The Gravity Compensating Accessory Suture holes 2. Gravity actuated, ball-in-cone mechanism 3. Silicone elastomer housing 4. Integral plastic connectors 5. Color band Additional Resistance to flow at 5ml / h (mm H 2 O) at 50ml / h Color Range Suggested Application White Low Children Yellow Medium Adults Brown High Tall Adults Note on use in MRI: The GCA is an integral component of the H-V Lumbar Valve System. A sample set of H-V Lumbar valves was pressure tested at different flow rates (60, 50, 30, 20, 10 & 5 ml / h) before being subjected to two MRI sequences*. The products were tested again after MRI exposure. Additional H-V Lumbar valves were subjected to an MRI magnetic field of 1.5 Tesla. The results of the tests indicated that exposure to MRI does not affect the pressure settings of the valves. No significant forces or temperature changes were noticed during MRI exposure. *T1 sequence, 2 05, 800 ms repetition time, 12 ms echo, 1.5 Tesla field. T2 sequence, 2 34, 3500 ms repetition time, 120 ms echo, 1.5 Tesla field. 20 natus.com Ordering Information:

24 Anti-Siphon Devices Hydrostatic Pressure Management Neurosurgery Anti-Siphon Device The original physiologically designed siphon control mechanism, the Anti-Siphon Device, is normally open and reacts only as needed to changes in hydrostatic pressure. When a patient sits or stands, the device resists the hydraulic siphoning common to differential pressure CSF-control valves, preventing over-drainage and keeping the patient s intra-ventricular pressure within the physiological normal range. The Anti-Siphon Device may be connected in series with any flushing reservoir or proximal control valve using the connectors packaged with the device. Skin Diaphragm (Top) Directional Arrow (bottom) Periosteum The Anti-Siphon Device is an integral component of many Natus valve systems. NL Description One (1) Flat bottom ASD, Two (2) Pudenz Straight Connectors (NL ) Pudenz Straight Connector 1.5cm ASD minimizes siphon effect by closing as the hydrostatic pressure changes relative to patient position (standing, sitting or supine). 1.1mm ID, 1.9mm OD Anti-Siphon Device 9mm Top surface Directional Arrow Outlet tube size 1.2mm ID, 2.2mm OD 3.9mm Bottom surface with directional arrow Inlet tube size 1.2mm ID, 2.2mm OD 2018 US Catalog 21

25 Neurosurgery Reservoirs Natus Reservoir Designed as a closed ventricular access system, the Natus Reservoir (formerly Ommaya) facilitates CSF withdrawal as well as delivery of radioisotopes and chemotherapeutic agents. Several models are offered, providing the flexibility to accommodate many different treatment protocols. The reservoir may also be converted to or added in-line to an existing shunt system. Each Standard Natus CSF Reservoir is packaged with a small Pudenz ventricular catheter (NL , not shown). Reservoirs Standard Reservoir Includes: Small Pudenz ventricular catheter (NL , not shown) Size Style Flushing Volume NL cm Burr-hole 0.68ml NL cm Flat-bottom 1.26ml 2.2cm 6mm 5.8mm 3.4cm 2.5cm 7.2mm 1.5cm Inlet Integral Connector Size 1.1mm ID, 1.9mm OD Inlet Integral Connector Size 1.1mm ID, 1.9mm OD Side-Inlet Reservoir Includes: Small Pudenz ventricular catheter (NL , not shown) Right-angle catheter guide (NL83024S01, not shown) Size Style Flushing Volume NL cm Flat-bottom 0.31ml NL cm Flat-bottom 1.14ml 5mm 7.2mm 2.2cm 1.5cm 3.4cm Inlet Integral Connector Size 1.1mm ID, 1.9mm OD Inlet Integral Connector Size 1.1mm ID, 1.9mm OD 2.5cm 22 natus.com Ordering Information:

26 Reservoirs Neurosurgery Reservoirs Convertible Reservoir 2.2cm Includes: Small Pudenz ventricular catheter (NL , not shown) Right-angle catheter guide (NL83024S01, not shown) Plugged Distal Outlet Size Style Flushing Volume NL cm Burr-hole 0.68ml 4.7mm 5.8mm 1.5cm Outlet Tube Size 1.2mm ID, 2.2mm OD Plugged Outlet Inlet Integral Connector Size 1.1mm ID, 1.9mm OD NL cm Flat-bottom 1.31ml 3.4cm Plugged Outlet 7.2mm 2.5cm Inlet Integral Connector Size 1.1mm ID, 1.9mm OD Outlet Tube Size 1.2mm ID, 2.2mm OD Mini Reservoir Includes: Polypropylene straight connector Polypropylene right-angle connector Ventricular Catheter not Included 4.6mm 1.6cm Standard Inlet Tube Size 1.5mm ID, 2.7mm OD Style Flushing Volume NL83026S01 Standard 0.14ml NL83026S02 Side-inlet 0.23ml NL83026S03 Convertible 0.23ml 3.7mm 1.6cm Side-Inlet Inlet Tube Size 1.2mm ID, 2.2mm OD NL83026S04 Flat-bottom 0.25ml 4.6mm 1.6cm Convertible Plugged Outlet Outlet Tube Size 1.2mm ID, 2.2mm OD Inlet Tube Size 1.5mm ID, 2.7mm OD 3.7mm 4.6cm Flat-Bottom Outlet Tube Size 1.2mm ID, 2.2mm OD 1.6cm Inlet Tube Size 1.2mm ID, 2.2mm OD 2018 US Catalog 23

27 Neurosurgery Other Reservoirs On-Off CSF Reservoirs On-Off CSF Reservoirs feature the exclusive On-Off Device, a proximal occluder, and reinforced flat bottom. The reservoir is offered with or without an Anti-Siphon Device. Reservoirs NL NL Style Without Anti-Siphon Device With Anti-Siphon Device On-Off CSF Reservoir without Anti-Siphon Device On-Off CSF Reservoir with Anti-Siphon Device Anti-Siphon Device 6.2mm 7mm 6.2mm 7mm 33.3mm 42.5mm Anti-Siphon Device 18.5mm 18.5mm Inlet Tube Size 1.2mm ID, 2.2mm OD Outlet Tube Size 1.2mm ID, 2.2mm OD Inlet Tube Size 1.2mm ID, 2.2mm OD Outlet Tube Size 1.2mm ID, 2.2mm OD 24 natus.com Ordering Information:

28 Reservoirs Neurosurgery Other Reservoirs Foltz CSF Reservoir The Foltz CSF Reservoir is a singledome reservoir with a reinforced flat bottom. 19mm 7mm Outlet Tube Size 1.2mm ID, 2.2mm OD NL Inlet Tube Size 1.2mm ID, 2.2mm OD Braden CSF Reservoir The Braden CSF Reservoir is a flat bottom device, incorporating twin reservoir domes. 40mm Outlet Tube Size 1.2mm ID, 2.2mm OD NL mm 6mm Inlet Tube Size 1.2mm ID, 2.2mm OD Rickham-Style CSF Reservoir Size NL Small NL Large 2mm Small 4.6mm 2.8cm 7.7mm Large 4.8mm 2.6cm 1.5mm 9.5mm 2018 US Catalog 25

29 Neurosurgery Burr Hole Reservoirs Burr Hole Reservoirs and Caps with X-ray Detectable Side Arms Burr hole reservoir Radiopaque silicone elastomer cap Diameter: 6.4mm, radiopaque polypropylene Description Regular depth 2.5mm Shallow depth 0.8mm Reservoirs Diameter: 6.4mm, stainless steel Description Regular depth 2.5mm Shallow depth 0.8mm Diameter: 10mm, stainless steel Description Regular depth 2.5mm Shallow depth 0.8mm Burr Hole Reservoirs and Caps without Side Arms Burr hole reservoir Radiopaque silicone elastomer cap Diameter: 6.4mm, radiopaque polypropylene Description Regular depth 2.5mm Shallow depth 0.8mm Diameter: 6.4mm, stainless steel Description Regular depth 2.5mm Shallow depth 0.8mm Diameter: 10mm, stainless steel Description Regular depth 2.5mm Shallow depth 0.8mm 26 natus.com Ordering Information:

30 Reservoirs Neurosurgery Reservoirs Integral Ventricular Reservoirs (IVR) Translucent silicone elastomer dome Radiopaque silicone elastomer base with 4 suture indicators Polysulfone needle guard Ventricular catheter introducer and introducing rod Integral right angle catheter of varying lengths Radiopaque polypropylene straight connector and tubing plug Flushing volume: 0.3ml Length cm cm cm CSF Reservoirs Translucent silicone elastomer dome designed to resist up to 250 punctures* Radiopaque polypropylene needle guard Flushing volume: 0.6ml Radiopaque polypropylene integral connector 4 suture indicators Description CSF Reservoir *With a 25G needle CSF Reservoir Kit with: Straight, full barium ventricular catheter (F8, 15cm) Right angle guide Introducing rod CSF Reservoir Kit with: Right angle ventricular catheter (F8, 7cm) Introducing rod Length 7cm CSF Reservoir Kit with: Right angle ventricular catheter (F8, 9cm) Introducing rod Length 9cm US Catalog 27

31 Neurosurgery CSF Ventricular Catheters CSF Catheters CSF Catheters are available in a variety of configurations: Fully impregnated with barium for complete radiopacity or with an embedded barium radiopaque stripe Straight or right-angled Pressure-rated as well as non-pressure-rated. Shunt Catheters Ventricular Catheters Radiopaque tantalum markings between 4cm and 10cm intervals with larger markings at 5cm and 10cm aid in catheter placement. Standard 1.7cm Radiopaque Markers 1.3mm ID, 2.5mm OD Pudenz Standard 18cm Length Size Style NL cm 1.3mm ID, 2.5mm OD Barium Stripe NL cm 1.3mm ID, 2.2mm OD Barium Stripe Small 1.7cm Radiopaque Markers 1.3mm ID, 2.2mm OD 18cm Pudenz Right-Angle Length Size Style NL cm 1.3mm ID, 2.5mm OD Barium Stripe 5cm 7cm 9cm Radiopaque Markers NL cm 1.3mm ID, 2.5mm OD Barium Stripe NL cm 1.3mm ID, 2.5mm OD Barium Stripe 1.7cm 1.3mm ID, 2.5mm OD 6cm 28 natus.com Ordering Information:

32 CSF Ventricular Catheters Shunt Catheters Neurosurgery Ventricular Catheter with Large Holes Similar to Pudenz Standard, but 20cm in length and with larger holes, 4 on each side. Tantalum markings at 5cm, 6cm, 7cm, 10cm and 15cm. 20cm Radiopaque Markers 1.3mm ID, 2.5mm OD Length Style NL96001S01 20cm Barium Stripe 1.3mm ID, 2.5mm OD Large Ventricular Catheter 1.7cm Radiopaque Markers Length Style NL99023S01 23cm Full Barium 23cm Ventricular Catheter with Right-Angle Guide F8 ventricular catheter Introducing rod Right angle guide Length Style VC1 25cm Full Barium 1.4mm ID, 2.7mm OD 4 rows of 10 holes Right Angle Ventricular Catheters F8 ventricular catheter Straight polypropylene connector Introducing rod Length Style 9MZ203 3cm Full Barium 9MZ204 4cm Full Barium 9MZ205 5cm Full Barium 9MZ206 6cm Full Barium 9MZ207 7cm Full Barium 9MZ208 8cm Full Barium 9MZ209 9cm Full Barium 9MZ210 10cm Full Barium 9MZ211 11cm Full Barium 2018 US Catalog 29

33 Neurosurgery CSF Ventricular Catheters Shunt Catheters 15cm Ventricular Catheters Description Style 9MD102A 9MD102B Radiopaque length dots every 2cm up to 10cm from tip Straight polypropylene connector Right angle guide Introducing rod Accuracy catheter Radiopaque numbers and dots every 1cm up to 11cm from tip Straight polypropylene connector Right angle guide Introducing rod Stainless steel, right angle connector Introducing rod Full Barium Barium Strip Full Barium Full Barium 1.4mm ID, 2.7mm OD 1.4mm ID, 2.7mm OD 1.4mm ID, 2.7mm OD 1.4mm ID, 2.7mm OD 15cm Finned Ventricular Catheters Description Style A A Straight polypropylene connector Right angle guide Introducing rod Stainless steel right angle connector Introducing rod Full Barium Full Barium 1.4mm ID, 2.7mm OD 1.4mm ID, 2.7mm OD 8mm Diameter 10mm Thick Flanges spaced 2.5mm apart 1.3mm ID, 2.2mm OD Portnoy Flanged Length Style NL cm Full Barium, Flanged 10cm 5cm 18cm Radiopaque Markers 30 natus.com Ordering Information:

34 CSF Peritoneal Catheters Shunt Catheters Neurosurgery Reflux Control Length Style NL cm Barium Stripe NL cm Open-Ended with or without Slits Length Style NL cm Barium Strip, with Slits NL98003S01 90cm Barium Strip, with Slits PC1 90cm Barium Strip, with Slits cm Barium Strip, with Slits 9MZ101 91cm Full Barium, with Slits 9MZ110N 110cm Barium Strip, without Slits Radiopaque Tip NL98003S01 1.3mm ID, 2.5mm OD Length Markers at 10, 20 and 30cm from tip 90cm 1.3mm ID, 2.5mm OD Length Markers at 10, 20 and 30cm from tip NL cm mm ID, 2.5mm OD Length Markers at 10, 20 and 30cm from tip 1.1mm ID, 2.3mm OD PC1 9MZ mm ID, 2.5mm OD Length markers 2 slit openings located at 180º 4 slit openings located at 90º 1.1mm ID, 2.1mm OD Pudenz Pressure Rated Catheters Length Style Pressure Range NL cm Barium Stripe Low NL cm Barium Stripe Medium NL cm Barium Stripe High Dot Code Pressure Rating Differential Pressure Range (mm of H 2 O) Low Medium High cm Typical 90cm 1.3mm ID, 2.5mm OD Length Markers at 10, 20 and 30cm from tip Open-ended Barium-striped Peritoneal Catheter without Slits (F7, 110cm) 9MZ110N Reservoir N / A 2018 US Catalog 31

35 Neurosurgery Lumbar Catheter Shunt Catheters Y-lumbar Catheter Radiopaque silicone elastomer catheter (720mm, F5) 2 open-ended, proximal branches (75mm, F5) with 3 series of 10 holes Open distal outlet Suturable tubing clamp for F5 catheters Radiopaque polypropylene F8/F5 stepdown connector mm 75 mm.8 mm ID, 1.6 mm OD 75 mm 32 natus.com Ordering Information:

36 Shunt Catheters Neurosurgery Atrial Catheters Atrial (Cardiac) Catheters All atrial catheters feature conical tips to ease insertion. Standard and infant models are available in three pressure ranges for distal control, eliminating the need for a proximal valve. The infant model offers a reduceddiameter distal end to aid penetration of small vessels without trauma. Dot Code Pressure Rating Differential Pressure Range (mm of H2O) Low Medium High Pudenz Standard Length Style Pressure Range NL cm Barium Stripe Low NL cm Barium Stripe Medium NL cm Barium Stripe High 1.4 cm 1.3 mm ID, 2.2 mm OD 60 cm 1 cm Typical Pudenz Infant Length Style Pressure Range NL cm Barium Stripe Low 10 cm 46 cm NL cm Barium Stripe Medium NL cm Barium Stripe High.7 mm ID, 1.3 mm OD 1.3 mm ID, 2.2 mm OD Atrial Catheters Length Style cm Barium Stripe 9MZ100 46cm Full Barium 1.1 mm ID, 2.3 mm OD 1.1 mm ID, 2.1 mm OD MZ US Catalog 33

37 Neurosurgery Connectors & Accessories Shunt Implantation Instruments Catheter Passers and Introducers NL NL Description Disposable Peritoneal Catheter Passer, 60cm (box of 6) Disposable Peritoneal Catheter Passer, 36cm (box of 6), not shown Malleable Shunt Tunneler, 45cm, ID: 3.5mm (box of 5) Malleable Shunt Tunneler, 65cm, ID: 3.5mm (box of 5) NL , Reusable Peritoneal Introducers Stainless steel Non sterile (multiple use) Length cm cm cm 9MD270 70cm Replacement Peritoneal Introducer Sheaths Translucent polypropylene 5 sterile units per box (single use) Length cm cm cm 9MD170 70cm Plastic Subcutaneous Tube Passer For F8 or 2.7mm OD, 15cm length tube Polypropylene Sterile 9MD2101 9MD2101 Description Tube Passer for Pediatric DP Valves Tuohy Needle Packaged Sterile 6 (15.2cm) NL82059S03 Description Tuohy Needle, 14G, 15.2cm NL82059S03 34 natus.com Ordering Information:

38 Connectors & Accessories CSF Accessories Connectors Neurosurgery Shunt Accessories Natus offers a variety of disposable accessories, including catheter connectors, guides, passers and introducers. All connectors and guides are packaged sterile. Pudenz Straight Connector 1.5cm 1.1mm ID, 1.9mm OD Pudenz Right-Angle Connector 1.1cm 1.1mm ID, 1.9mm OD 1.1cm Catheter Connectors and Guides NL NL NL NL NL NL75121S06 NL97001S01 Description Pudenz Straight Connector (Nylon) Pudenz Right-Angle Connector (Nylon) Pudenz Three-Way ( Y ) Connector, (Silicone elastomer and Nylon) Threaded Straight Connector (Nylon) Double-Threaded Straight Connector (Nylon) Metal Connector for Lumbar-Peritoneal Shunt Luer Connector (Polycarbonate) 9mm Pudenz Three-way Connector 15mm 1.2mm ID, 2.4mm OD All connectors 1.1mm ID, 1.9mm OD Double-Threaded Straight Connector 60 Threaded Straight Connector 1.6cm 1.1mm ID, 1.9mm OD Metal Connector 1.2cm 1.7cm 0.6mm ID, 1.2mm OD Luer Connector 1.1mm ID, 1.9mm OD Catheter Guides NL83024S Description Right-Angle Ventricular Catheter Guide (Silicone with barium sulfate) Right Angle Guide (5 per box) (Silicone with barium sulfate) Ventricular Catheter Guide Right Angle Guide Suturable Tubing Clamps Description Suturable Tubing Clamp for F7 catheters (5 per box) (Silicone with barium sulfate) Suturable Tubing Clamp for F5 catheters (5 per box) (Silicone with barium sulfate) Suturable Tubing Clamp for F8 catheters (5 per box) (Silicone with barium sulfate) US Catalog 35

39 Neurosurgery Connectors & Accessories CSF Accessories Connectors Radiopaque Polypropylene Connectors 1.0mm ID, 2.0mm OD 5 sterile units per box Description Straight Right angle Y T Stepdown (F8 to F5), 0.8mm ID, mm OD Stainless Steel Connectors OD: 1.8mm; ID: 1.2mm 5 sterile units per box Description Straight Right angle Y T Stepdown (F8 to F5), 0.8mm ID, mm OD natus.com Ordering Information:

40 Brain Mapping Neurosurgery Cortical Stimulation Nicolet Cortical Stimulator for Neurosurgery The Nicolet Cortical Stimulator is a compact, digital and portable unit that aids in identification and mapping of the areas of the brain that control speech, sensory, vision and motor skills. The resulting map aides physicians and surgeons in planning surgical approach and procedure. In addition to providing direct, constant current stimulation to the brain, the Nicolet Cortical Stimulator offers full control over pulse frequency and duration, train duration and current levels. Features and Benefits: Displays selected and actual current delivered Ictal Disrupt feature for management of after discharges Small, compact size Easy to use controls Disposable probe Optional integrated software Description Nicolet Cortical Stimulator Includes; Cortical Stimulator Control Unit, Operator s 982A0558 Manual, Stand Alone system- does not require LTM system or amps. Does not include Probe) Cortical Stimulator Disposable Bi-Polar Probe 2018 US Catalog 37

41 Neurocritical Care Neurocritical Care Intracranial Pressure Monitoring External Ventricular Drainage Cranial Access Kits 2018 US Catalog 39

42 Neurocritical Care Intracranial Pressure Monitoring Camino ICP Monitor The CAMINO ICP Monitor is an advanced, touch-screen monitoring system that captures real-time data at the time of catheter insertion and trend data over a five-day period. The Natus Camino ICP Monitor is a compact, portable device that provides tools for continuously determining and monitoring intracranial pressure (ICP) and intracranial temperature (ICT) directly in the brain. The Camino supports a family of bolted and tunneled catheters providing versatility in draining and monitoring the patient. All Natus catheters measure their respective values at the tip of the catheter, providing continual ICP measurements. This design eliminates the need for a fluid filled system to communicate pressure to an external transducer. Camino supports the following advanced ICP monitoring catheters: Natus Camino Fiber Optic ICP catheters (1104 series) Parenchymal, Ventricular and Subdural options available Camino Flex Ventricular Catheter (VTUN) providing immediate therapy by draining cerebrospinal fluid Key functions of the monitor: Touchscreen, menu guided design Compact size with ergonomic carrying handle Light-weight, portable design with 1.5 hour battery Wide screen display can be read from 10 feet away at a 30 degree angle Scalable trend data can be viewed at 3 hours, 12 hours, 24 hours, 48 hours or 120 hours Export trend data to USB flash drive or USB to RS232 For instructions on using the Camino catheters, see the directions for use supplied with each respective catheter. FLEXEXT : CAM02 System includes: Camino ICP Monitor CAMCABL Camino fiber optic catheters cable FLEXEXT Camino Flex catheter cable PMIOMPM1 Main cable for connecting Camino to patient bedside monitor EXPORTCAB USB-to-RS232 adapter cable MONPWR AC power adaptor BAT1001 Battery CAMCABL EXPORTCAB PMIOMPM1 BAT1001 MONPWR with adaptors 40 natus.com Ordering Information:

43 Neurocritical Care Intracranial Pressure Monitoring Camino Pressure Monitoring Catheter Kits Camino Catheter Family Summary Technique Location Parenchyma Ventricle Sub Dura Bolted B, BT, L HM, HMT Tunneled VTUN G Camino 1104B Catheter Kit Intracranial Pressure Monitoring Placement: Parenchyma or subarachnoid space Catheter depth markings: 1 to 10cm markings to gauge the insertion depth Strain relief sheath: Protective sheath Red depth indicator: To check the depth position Technology: Fiber optic pressure transducer Kit Components 1 transducer tipped catheter 4Fr / 1.35 mm Camino bolt Twist drill bit with safety stop Stylet Hex wrench Zero adjustment tool : 1104B Packaged Individually Sterile With compression cap, turning wings and spacer to adjust seating depth of the bolt 8Fr / 2.7mm To clear the passage To adjust the safety stop To adjust the transducer to zero Compression cap Transducer connector Bolt Pressure transducer Spacer Safety stop Drill bit Transducer air vent 1cm markings up to 10cm Zero adjustment tool Hex wrench Stylet Red depth indicator Strain relief sheath Camino 1104BT Catheter Kit Intracranial Pressure and Temperature Monitoring Placement: Parenchyma Catheter depth markings: 1 to 10cm markings to gauge the insertion depth Red depth indicator: To check the depth position Technology: Fiber optic pressure transducer Kit Components 1 transducer tipped catheter with thermistor Camino Bolt Twist drill bit (with safety stop) Stylet Hex wrench Zero adjustment tool : 1104BT Packaged Individually Sterile 4Fr / 1.35mm (Thermistor is placed approx. 1cm from the tip of the catheter) With compression cap, turning wings and spacer to adjust seating depth of the bolt 8Fr / 2.7mm To clear the passage To adjust the safety stop To adjust the transducer to zero Compression cap Transducer connector Bolt Thermistor connector Pressure transducer Spacer 1cm markings up to 10cm Safety stop Drill bit Transducer air vent Zero adjustment tool Hex wrench Stylet Red depth indicator Strain relief sheath 2018 US Catalog 41

44 Neurocritical Care Intracranial Pressure Monitoring Camino Pressure Monitoring Catheter Kits Camino 1104L Catheter Kit Intracranial Pressure Monitoring with Licox Bolt Fitting Model 1104L is used to measure intracranial pressure through a Licox Introducer Kit. Placement: Parenchyma Technology: Fiber optic pressure transducer Kit Components 1 transducer tipped catheter with Licox bolt fitting Zero adjustment tool 4Fr / 1.35mm To adjust the transducer to zero Note: To be used in conjunction with compatible Licox kits : 1104L Packaged Individually Sterile Transducer connector Pressure transducer Zero adjustment tool Licox bolt adapter fitting Transducer air vent Black ring Anti-compression sleeve Compressor cap White plastic sleeve Camino 1104G Catheter Kit Post Craniotomy Subdural Pressure Monitoring Placement: Subdural space post craniotomy Technology: Fiber optic pressure transducer Kit Components 1 transducer tipped catheter 4Fr / 1.35mm Trocar with guide tube 3.17mm Zero adjustment tool To adjust the transducer to zero : 1104G Packaged Individually Sterile Transducer connector Trocar w/guide tube Pressure transducer Depth markers Transducer air vent Zero adjustment tool 42 natus.com Ordering Information:

45 Neurocritical Care Intracranial Pressure Monitoring Camino Pressure Monitoring Catheter Kits Camino 1104HM Catheter Kit Micro Ventricular Drainage and Pressure Monitoring with Bolt Placement: Ventricles Technology: Fiber optic pressure transducer Kit Components 1 transducer tipped catheter 4Fr / 1.35mm Ventricular Catheter with bolt Outer Diameter Inner Diameter Length Twist drill bit (with safety stop) Hex wrench Luer Cap Zero adjustment tool : 1104HM Packaged Individually Sterile 11Fr / 3.7mm 7Fr / 2.2mm 6-8cm (adjustable) 16Fr / 5.3mm To adjust the safety stop Prevents CSF leak To adjust the transducer to zero Transducer connector Pressure transducer Ventricular catheter Transducer air vent Ventricular access device Female luer lock Bolt Zero adjustment tool Compression cap Drainage system connector Safety stop Stylet Luer cap Drill bit Hex wrench Camino 1104HMT Catheter Kit Micro Ventricular Drainage, Pressure and Temperature Monitoring with Bolt Placement: Ventricles Technology: Fiber optic pressure transducer Kit Components 1 transducer tipped catheter with thermistor Ventricular Catheter with bolt Outer Diameter Inner Diameter Length Twist drill bit (with safety stop) Hex wrench Luer Cap Zero adjustment tool : 1104HMT Packaged Individually Sterile 4Fr / 1.35mm 11Fr / 3.7mm 7Fr / 2.2mm 6-8cm (adjustable) 16Fr / 5.3mm To adjust the safety stop Prevents CSF leak To adjust the transducer to zero Transducer connector Temperature connector Pressure transducer Transducer air vent Ventricular access device Female luer lock Zero adjustment tool Drainage system connector Safety stop Luer cap Drill bit Ventricular catheter Bolt Compression cap Stylet Hex wrench 2018 US Catalog 43

46 Neurocritical Care Intracranial Pressure Monitoring Camino Pressure Monitoring Catheter Kits Camino Flex (VTUN) Catheter Kit Intracranial Pressure Monitoring with Trocar Placement: Ventricles One time auto-zeroing prior to insertion MRI Conditional at 1.5T and 3T Separate lumen design allows for simultaneous CSF drainage and ICP monitoring Sensor location allows for continuous ICP measurement regardless of fluid flow Sensor location allows for continuous ICP monitoring independent of patient position Catheter depth markings: 1cm to 10cm markings to gauge the insertion depth Technology: Strain gauge micro electro-mechanical system (MEMS) piezoresistive silicon chip Kit Components Catheter size Trocar with tunneling sheath Twist drill bit with safety stop Stylet Suture loops Hex Wrench 9/10Fr (3.3mm outer diameter) 3.17mm 7mm 0.7mm 2 units For adjustment of the drill stop Protection tube Depth markings Suture loops (2) Trocar Drill bit with stop Pressure transducer Stylet Plastic tunneling sheath Hex wrench MRI Conditional at 1.5T and 3T Drainage port with luer lock : VTUN Packaged Individually Sterile Catheter Transducer connector Camino ICP Monitor Service Contracts Natus offers a variety of service contract options to better protect your investment of the Camino ICP Monitor System. The service contract options differ in the following ways: Length of contract 1 or 3 years Time of purchase At the time of purchase or after the point of sale Payment duration - Up front or over 3 years Service Coverage includes: Camino ICP Monitor repair by a depot repair technican at our service center Camino ICP Monitor service loaner for a maximum of thirty days if customer requires repair service Annual preventive maintenance and calibration of the Camino ICP Monitor at our service center during agreement term Above services Include:»» Visual inspection»» Functional Test --Internal electrical test --Battery charging circuit test --Display functional test --Pressure functional test --Sensor board test -- Power board test»» Calibration»» Battery replacement»» Electrical safety testing»» Final system functional testing 44 natus.com Ordering Information:

47 Neurocritical Care CSF Drainage Systems & Accessories CSF External Drainage System Natus EDS 3 CSF External Drainage System designed with and for clinicians The EDS 3 CSF External Drainage System was developed with input from more than 200 nurses and physicians. With its ease-of-use, integrated pole clamp, oleophobic filter and accurate leveling from a unique laser leveling device the EDS 3 System is unequaled. Entirely disposable, complete system Simple setup Laser accuracy to ensure accurate leveling Large red cap and clearly marked yellow tag to identify CSF access site MRI safe when laser level is removed Not made with natural rubber latex Description EDS 3 with clear ventricular catheter included EDS 3 without ventricular catheter EDS 3 with Lumbar Catheter Kit II (see p/n page 47 for description) High-visibility pressure scales in mmhg (-3 to 20) and cm (-5 to 27) Drip Chamber marked for 1-100ml capacity, funnel bottom and sampling site (outlet) EDS 3 Accessories Description Replacement CSF collection bags (5 units) Laser leveling device* *Class 2 laser product Pressure-resistant striped CSF tubing line Leveling Device incorporates reusable bubble level with Class 2 laser lamp Easy-to-use side clamps 2018 US Catalog 45

48 Neurocritical Care EVD Catheters External Drainage Ventricular Set : CSF Drainage Systems & Accessories External Drainage Ventricular set, sterile, designed to drain CSF from ventricles of the brain. Sterile - Contains two sets of: One 35cm radiopaque silicone ventricular catheters (1.5mm ID, 3.1mm OD) 36cm straight stylet Curved trocar Female luer lock connector Luer lock cap Standard Clear Ventricular Catheter : mm ID 35cm length Barium stripe Depth markings 3cm to 15cm Large Clear Ventricular Catheter : mm ID 35cm length Barium stripe Depth markings 3cm to 15cm Disposable ICP Luer Lock Connector : Designed to connect a silicone ventricular catheter (ID from 1.3mm to 1.5mm) to a CSF drainage or monitoring device. Disposable Sterile Female luer lock connector with male luer lock cap 46 natus.com Ordering Information:

49 Neurocritical Care CSF Drainage Systems & Accessories Lumbar Catheters Lumbar External Drainage kit : Open ended catheter used for temporary access to the lumbar subarachnoid region as a means of draining CSF to reduce intracranial volume and pressure Sterile Contains: 46cm silicone lumbar catheter (0.76mm ID, 1.65mm OD) 14G Tuohy needle with Huber point Female luer lock connector and cap for connection to monitoring or CSF collection equipment Ten Tantalum location markings on catheter Lumbar Drainage Catheter kit II* : The Lumbar Drainage Catheter Kit II consists of a lumbar catheter 80cm in length with a closed tip and side holes to allow for drainage without clogging. A Teflon-coated precoiled steel guide wire with an adjustable stop is also included. This kit includes a 14-gauge Tuohy needle with a clear plastic flash back chamber, centimeter markings, and wings for leverage and ease of use. A female luer lock connector and suture dips made of soft silicone allow for easy connection and attachment to patient. Sterile Contains: 80cm closed tip radiopaque catheter Drainage hole pattern with enlarged hole diameter Teflon-coated 100cm guide wire with adjustable stop 14G Tuohy needle with 1cm depth markings Low profile female luer lock and luer lock cap Silicone suture clips *also available with EDS 3 system (see page 45) 2018 US Catalog 47

50 Neurocritical Care Cranial Access Kits, Accessories and Components The Natus Cranial Access Kit allows for access to the subarachnoid space or the lateral ventricles of the brain. The kit is intended to be used with an external drainage and monitoring system in selected patients to reduce intracranial pressure to provide temporary drainage of CSF, and to monitor ICP. With various options and accessories to choose from these kits are convenient pre-packaged sterile sets containing all necessary components for entry into the cranium. Quantity Description INSHITH INSHITHRZN INSHITHND INS5HND INS7250 INS7260 INS7270 INS7280 INS7040 Prep Materials Disposable Razors Povidone Iodine Swabs " x 36" Fenestrated drape with barrier " x 51" Fenestrated drape with barrier " x 15" Fenestrated drape with barrier 1 18" x 26" White Absorbent Towels " x 4" Gauze Sponges " x 2" Gauze Sponges Marker and Flexible Ruler Cutting / Drilling Materials #11 Scalpel with Handle #15 Scalpel with Handle Self-retaining Retractor Hand Drill * 3.97mm Drill Bit Assembly mm Drill BIt Assembly mm Drill Bit Assembly Hex Wrench Adson Forceps, Serrated Adson Forceps, 1 x Mosquito Forceps, Curved Needle Holder Forceps Nylon Suture Scissors Needles 18G x 1-1/2" Needle G x 5/8" Needle G x 1" Needle G x 3-1/2" Spinal Needle G x 5-1/2" Ventricular Needle 1 1 Solutions and Syringes Lidocaine with Epinephrine 1 1 Lidocaine Povidone Iodine Ointment Povidone Iodine Solution ml.9% Sodium Chloride Solution 1 1 6ml DuraPrepª Solution oz. Medicine Cups Culture Tubes with Screw Cap 1 1 5cc Syringe cc Safety Syringes * Includes Twist-Lock Drill Guard, which allows accurate, secure adjustment of cranial drill depth. 48 natus.com Ordering Information:

51 Neurocritical Care Cranial Access Kits HITH KIT : INSHITH Description Quantity Povidone Iodine Swabs 1 12cc Safety Syringes 2 18G x 1-1/2 Needle 2 25G x 5/8 Needle 1 18G x 3-1/2 Spinal Needle 1 Lidocaine with Epinephrine 1 Marker and Flexible Ruler 1 31 x 51 Fenestrated drape with barrier 1 18 x 26 White Absorbent Towels 3 4 x 4 Gauze Sponges 10 Povidone Iodine Solution 1 Hand Drill 1 #11 Scalpel with Handle 1 #15 Scalpel with Handle 1 Adson Forceps, Serrated 1 Adson Forceps, 1 x 2 1 Mosquito Forceps, Curved 1 Needle Holder Forceps 1 2 oz. Medicine Cups 2 Self-retaining Retractor 1 Scissors mm Drill BIt Assembly 1 Hex Wrench 1 Culture Tubes with Screw Cap 2 6ml DuraPrep Solution 1 10ml.9% Sodium Chloride Solution Nylon Suture 2 INSHITH with ventricular needle and razor, and 31 x 51 drape : INSHITHRZN Description Quantity Disposable Razors 1 Povidone Iodine Swabs 1 12cc Safety Syringes 2 18G x 1-1/2 Needle 2 25G x 5/8 Needle 1 18G x 3-1/2 Spinal Needle 1 12G x 5-1/2 Ventricular Needle 1 Lidocaine with Epinephrine 1 Marker and Flexible Ruler 1 31 x 51 Fenestrated drape with barrier 1 18 x 26 White Absorbent Towels 3 4 x 4 Gauze Sponges 10 Povidone Iodine Solution 1 Hand Drill 1 #11 Scalpel with Handle 1 #15 Scalpel with Handle 1 Adson Forceps, Serrated 1 Adson Forceps, 1 x 2 1 Mosquito Forceps, Curved 1 Needle Holder Forceps 1 2 oz. Medicine Cups 2 Self-retaining Retractor 1 Scissors mm Drill BIt Assembly 1 Hex Wrench 1 Culture Tubes with Screw Cap 2 6ml DuraPrep Solution 1 10ml.9% Sodium Chloride Solution Nylon Suture US Catalog 49

52 Neurocritical Care Cranial Access Kits INS5HND without ventricular needle and razor, and 31 x 51 drape : INSHITHND Description Quantity 12cc Safety Syringes 2 18G x 1-1/2 Needle 2 25G x 5/8 Needle 1 18G x 3-1/2 Spinal Needle 1 Marker and Flexible Ruler 1 31 x 51 Fenestrated drape with barrier 1 18 x 26 White Absorbent Towels 3 4 x 4 Gauze Sponges 10 Hand Drill 1 #11 Scalpel with Handle 1 #15 Scalpel with Handle 1 Adson Forceps, Serrated 1 Adson Forceps, 1 x 2 1 Needle Holder Forceps 1 2 oz. Medicine Cups 2 Self-retaining Retractor 1 Scissors mm Drill BIt Assembly 1 Hex Wrench Nylon Suture 2 Cranial Kit - No Drugs : INS5HND Description Quantity Disposable Razors 1 12cc Safety Syringes 2 5cc Syringe 1 18G x 1-1/2 Needle 2 25G x 5/8 Needle 1 18G x 3-1/2 Spinal Needle 1 12G x 5-1/2 Ventricular Needle 1 Marker and Flexible Ruler 1 15 x 15 Fenestrated drape with barrier 1 18 x 26 White Absorbent Towels 3 4 x 4 Gauze Sponges 10 Hand Drill 1 #11 Scalpel with Handle 1 #15 Scalpel with Handle 1 Adson Forceps, Serrated 1 Adson Forceps, 1 x 2 1 Needle Holder Forceps 1 2 oz. Medicine Cups 2 Self-retaining Retractor 1 Scissors mm Drill BIt Assembly 1 Hex Wrench Nylon Suture 2 50 natus.com Ordering Information:

53 Neurocritical Care Cranial Access Kits Cranial Kit with three drill bits : INS7250 Description Quantity Disposable Razors 2 Povidone Iodine Swabs 2 5cc Syringe 1 18G x 1-1/2 Needle 1 23G x 1 Needle 1 Lidocaine 1 Marker and Flexible Ruler 1 24 x 36 Fenestrated drape with barrier 1 18 x 26 White Absorbent Towels 2 4 x 4 Gauze Sponges 20 2 x 2 Gauze Sponges 5 Povidone Iodine Ointment 1 Povidone Iodine Solution 1 Hand Drill 1 #11 Scalpel with Handle 1 #15 Scalpel with Handle 1 Adson Forceps, 1 x 2 1 Mosquito Forceps, Curved 1 Needle Holder Forceps 1 Self-retaining Retractor 1 Scissors mm Drill Bit Assembly mm Drill BIt Assembly mm Drill Bit Assembly 1 Hex Wrench 1 Culture Tubes with Screw Cap Nylon Suture 1 Cranial Kit with two drill bits : INS7260 Description Quantity Disposable Razors 2 Povidone Iodine Swabs 2 5cc Syringe 1 18G x 1-1/2 Needle 1 23G x 1 Needle 1 Lidocaine 1 Marker and Flexible Ruler 1 24 x 36 Fenestrated drape with barrier 1 18 x 26 White Absorbent Towels 2 4 x 4 Gauze Sponges 20 2 x 2 Gauze Sponges 5 Povidone Iodine Ointment 1 Povidone Iodine Solution 1 Hand Drill 1 #11 Scalpel with Handle 1 #15 Scalpel with Handle 1 Adson Forceps, 1 x 2 1 Mosquito Forceps, Curved 1 Needle Holder Forceps 1 Self-retaining Retractor 1 Scissors mm Drill Bit Assembly mm Drill Bit Assembly 1 Hex Wrench 1 Culture Tubes with Screw Cap Nylon Suture US Catalog 51

54 Neurocritical Care Cranial Access Kits Cranial Kit with variable drill bits : INS7270 Description Quantity Disposable Razors 2 Povidone Iodine Swabs 2 5 cc Syringe 1 18 G x 1-1/2 Needle 1 23 G x 1 Needle 1 Lidocaine 1 Marker and Flexible Ruler 1 24 x 36 Fenestrated drape with barrier 1 18 x 26 White Absorbent Towels 2 4 x 4 Gauze Sponges 20 2 x 2 Gauze Sponges 5 Povidone Iodine Ointment 1 Povidone Iodine Solution 1 Hand Drill 1 #11 Scalpel with Handle 1 #15 Scalpel with Handle 1 Adson Forceps, 1 x 2 1 Mosquito Forceps, Curved 1 Needle Holder Forceps 1 Self-retaining Retractor 1 Scissors mm Drill Bit Assembly 1 Hex Wrench 1 Culture Tubes with Screw Cap Nylon Suture 1 Cranial Kit with 5.31mm drill bit : INS7280 Description Quantity Disposable Razors 2 Povidone Iodine Swabs 2 5 cc Syringe 1 18 G x 1-1/2 Needle 1 23 G x 1 Needle 1 Lidocaine 1 Marker and Flexible Ruler 1 24 x 36 Fenestrated drape with barrier 1 18 x 26 White Absorbent Towels 2 4 x 4 Gauze Sponges 20 2 x 2 Gauze Sponges 5 Povidone Iodine Ointment 1 Povidone Iodine Solution 1 Hand Drill 1 #11 Scalpel with Handle 1 #15 Scalpel with Handle 1 Adson Forceps, 1 x 2 1 Mosquito Forceps, Curved 1 Needle Holder Forceps 1 Self-retaining Retractor 1 Scissors mm Drill BIt Assembly 1 Hex Wrench 1 Culture Tubes with Screw Cap Nylon Suture 1 52 natus.com Ordering Information:

55 Neurocritical Care Cranial Access Kits Cranial Drill Kit with 6.35mm drill bit : INS7040 Description Quantity Disposable Razors 2 Povidone Iodine Swabs 2 18 G x 1-1/2 Needle 1 23 G x 1 Needle 1 Lidocaine 1 Marker and Flexible Ruler 1 24 x 36 Fenestrated drape with barrier 1 18 x 26 White Absorbent Towels 2 4 x 4 Gauze Sponges 20 2 x 2 Gauze Sponges 5 Povidone Iodine Ointment 1 Povidone Iodine Solution 1 Hand Drill 1* #11 Scalpel with Handle 1 #15 Scalpel with Handle 1 Adson Forceps, 1 x 2 1 Mosquito Forceps, Curved 1 Needle Holder Forceps 1 Self-retaining Retractor 1 Scissors mm Drill Bit Assembly 1 Culture Tubes with Screw Cap Nylon Suture 1 *Includes Twist-Lock Drill Guard, which allows accurate, secure adjustment of cranial drill depth 2018 US Catalog 53

56 Natus NeuroWorks ICU Systems Continuous brain monitoring wherever and whenever you need it changing the standard of care in the ICU Brain monitoring using Natus renowned NeuroWorks software and amplifiers provides critical and immediate patient information to ICU staff and to remote monitoring centers for neurologist consultation. NeuroWorks Touch-screen ICU Interface and Trending Constant video EEG monitoring with a small footprint True TCP/IP amplifiers and cameras with DHCP support that plug anywhere on your network Powerful qeeg trending Intuitive touch-screen interface designed specifically for intensive workflow Event detection and trending with user configurable notifications

57 Software EEG Monitoring Software that puts patient care first Intuitive clinical experience designed for intensive care workflow Streamlined workflow with customizable data searching and automated settings synchronization Time-saving administrative functions with enterprise level SQL database Robust and secure IT features for peace of mind Enhanced and simplified security with Active Directory Integration Bi-directional HL7 integration with HIS/EMR Citrix and VMWare Ready partner the most powerful infrastructure to facilitate collaboration READY

58 Natus Neuro Service A global service organization here for you Customer Service Excellence in customer service and support is a core value held throughout the entire company. We work cooperatively to develop long-term relationships with our customers to provide products, tools and services for clinical excellence. Technical Service Our Technical Support organization is focused, agile and committed to serving healthcare professionals worldwide. Providing our customers more time to care for their patients is our goal. Customer loyalty is our reward. Field Service Our dedicated field service team assists with onsite installation and repair of your Natus Neuro equipment. Our expansive support team includes over 100 Technical Support and Field Service Representatives. Natus Neuro Essential Support Elements Accessible and effective technical support Definitive technical documentation and knowledgeable installation teams Excellent replacement unit or spare part availability Extended warranty and service coverage programs Comprehensive, flexible and regular customer training courses At Natus Neuro, we know that the performance of our service organization is as important to meeting clinical needs as the quality of our products and we are here to serve you, our valued customers.