1. Nerveäna In-Service OR Nurses

2. The Big Picture About NerveänaAbout Nerveäna Product OverviewProduct Overview PreparationPreparation The SetupThe Setup

3. About Nerveäna Neurovision Medical Products Focus – Proactive nerve location technology Nerveäna – The 4 th Generation Nerve Locator 25 year track record of success

4. Delivers stimulations and analyzes the responses Delivers milliamp pulses via Stimulating Hemostat Analyzes responses of nerve via (surface) electrode - Gives the surgeon feedback in audio alarm and audio electromyograph (EMG) - EMG waveforms can be displayed on a PC The Result: An intuitive surgical nerve location tool The Way the Nerveäna Works About Nerveäna

5. Thyroidectomy - Recurrent and Superior Laryngeal Nerves Parathyroidectomy - Recurrent Laryngeal Nerve Parotidectomy - Facial Nerve (VIIth cranial) Otologic Surgery - Facial Nerve (VIIth cranial) Neck Dissection - Accessory Nerve (XI Ih cranial) The Nerveäna – For the Following Procedures and Related Nerves at Risk About Nerveäna

6. The Nerveäna system consists of the Nerveäna, disposables, and non-disposables. All disposables are contained in the Surgical Kit. There are three different Surgical Kits. About Nerveäna The Nerveäna

7. About Nerveäna The Nerveäna EMG

8. About Nerveäna Surgical Kit for Thyroidectomy and Parathyroidectomy Surgical Kit for Facial Nerve (Parotidectomy; Otologic Surgery) The Nerveäna Surgical Kits Surgical Kit for Accessory Nerve (Neck Dissection)

9. About Nerveäna Contents of the Surgical Kit for Thyroidectomy and Parathyroidectomy Laryngeal Surface Electrode in a sterile pull pack Stimulating Hemostat lead wire and subdermal needle electrode in a sterile peel pack One Hydrogel surface electrode

10. Contents of the Surgical Kit for Facial Nerve (Parotidectomy; Otologic Surgery) Stimulating Hemostat lead wire and subdermal needle electrode in a sterile peel pack Two paired Hydrogel surface electrodes One Hydrogel surface electrode

11. About Nerveäna Contents of the Surgical Kit for Neck Dissection Stimulating Hemostat lead wire and a subdermal needle electrode in a sterile peel pack Three Hydrogel surface electrodes

12. The two (BLACK) EMG and Stim cables The Stimulating Hemostat Nerveäna Non-Disposables About Nerveäna

13. Product Overview The Nerveäna, shown with all attachments

14. Preparation Have Ready in the OR A fully charged Nerveäna (and power cord, if needed) A fully charged Nerveäna (and power cord, if needed) The two (black) Stim and EMG cables The two (black) Stim and EMG cables The Stimulating Hemostat (sterile) The Stimulating Hemostat (sterile) The correct Surgical Kit for the procedure The correct Surgical Kit for the procedure

15. Preparation Prior to Setup Proceed with Setup (Steps One, Two and Three below) after intubation and placement of Stimulator (needle) and EMG (hydrogel surface) ground electrodes by the anesthesiologist (or surgeon).Proceed with Setup (Steps One, Two and Three below) after intubation and placement of Stimulator (needle) and EMG (hydrogel surface) ground electrodes by the anesthesiologist (or surgeon). The scrub nurse should have the Stimulating Hemostat and its (red) lead wire.The scrub nurse should have the Stimulating Hemostat and its (red) lead wire.

16. FYI --Placement of Electrodes The white, needle, stimulator ground electrode is placed just subdermal (cover with surgical tape). Hydrogel surface electrodes are placed after ten strokes (one direction) with the triangular pad (black side) on the skin area, followed by alcohol wipe/dry (cover with surgical tape).

17. Setup The Setup - OR Nurses Step 0ne: Nerveäna SetupStep 0ne: Nerveäna Setup Step Two: Connect Electrode LeadsStep Two: Connect Electrode Leads Step Three: Connect Stimulating Hemostat Red LeadStep Three: Connect Stimulating Hemostat Red Lead

18. Setup Step One: Nerveäna Setup (circulator) Place the Nerveäna on battery power* on flat, stable surface such as Mayo table (not on other electrical devices).Place the Nerveäna on battery power* on flat, stable surface such as Mayo table (not on other electrical devices). Connect black “EMG” and “STIM” cables to ports on back of Nerveäna (one way only).Connect black “EMG” and “STIM” cables to ports on back of Nerveäna (one way only). (*The AC battery charger can be used but may cause some “noise.”)

19. Setup Step One: Nerveäna (back) with Stim and EMG Cables Connected

20. Setup Step Two: Connect Electrode Leads (circulator) EMG cable terminal: Connect the Red and Blue electrode lead wires to Red and Blue ports. Connect the Green electrode ground lead to Green port.EMG cable terminal: Connect the Red and Blue electrode lead wires to Red and Blue ports. Connect the Green electrode ground lead to Green port. Stim cable terminal: Connect the White (needle) ground electrode lead wire to White port.Stim cable terminal: Connect the White (needle) ground electrode lead wire to White port.

21. Setup Step Two - Connect Electrode Leads

22. Setup Step Three: Connect Dissecting Stimulator Lead Wire The scrub nurse connects Blue end of Red lead wire to (Blue) Stimulating Hemostat and passes the Red end of lead wire off the sterile field to circulator for connection to Red port on Stim cable terminal.The scrub nurse connects Blue end of Red lead wire to (Blue) Stimulating Hemostat and passes the Red end of lead wire off the sterile field to circulator for connection to Red port on Stim cable terminal. (During surgery, the scrub nurse passes Stimulating Hemostat to surgeon.) (During surgery, the scrub nurse passes Stimulating Hemostat to surgeon.)

23. Setup Step Three – Connect the (Red) Dissecting Stimulator Lead Wire

24. Setup The Nerveäna Setup for Thyroidectomy and Parathyroidectomy

25. Setup The Nerveäna Setup for Facial Nerve (Parotidectomy and Otologic Surgery)

26. Setup The Nerveäna Setup for Neck Dissection (Accessory Nerve)

27. Setup Power up and verify these settings and responses: During the surgery, the surgeon may request the stimulation level to be changed (circulator adjusts the Stimulation Knob).

28. Setup In practice, the above Steps may vary depending on specific OR procedures and preferences.In practice, the above Steps may vary depending on specific OR procedures and preferences. In Practice --

29. Setup Complete Instructions Nerveäna Quick Reference (supplied) Instruction Sheet with each Surgical Kit www.neurovisionmedical.com (Instructions, Support Videos) Email, fax, or call Neurovision

30. Questions Ventura, CA USA 866-815-6999 www. neurovisionmedical.com Neurovision Medical Products