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Provox injector Provox2, ActiValve

The injector consists of a prelubricated outer tube and the inserter.

1 Outer tube

2 Inserter

3 Safety thread
The safety thread is inserted through the hole in the inserter and pushed forwards into the clamping slot, which ensures it is safely attached.
The prosthesis is now pulled forward and placed on the inserter head.
The esophageal flange (carries the valve) is now folded crossways to the front using the right hand.
The part of the flange that is facing down is now inserted in the outer tube at an angle of approx. 45° and pushed forward with a tilting movement.
The upward-pointing part of the folded flange prevents the prosthesis from being pushed further into the outer tube.
The thumb of the left hand is now used to push the protruding part of the esophageal flange forward and into the outer tube.
Once the esophageal flange has been pushed forward deeply enough into the outer tube, the prosthesis is easily pushed further into the outer tube by the inserter.
Before pushing further, check to make sure the folded esophageal flange really is all the way in the outer tube, as otherwise further pushing will damage the prosthesis.
The prosthesis is pushed forward into the outer tube on the inserter to the first marking, and is now ready for use.

Retrograde insertion of a Provox® 2 Prosthesis

The Provox® 2 prosthesis can be inserted retrograde using a guide wire. Care must be taken to ensure that the nubs on the retaining tape face outwards as the tracheal flange is unfolded with the clamps.

The insertion of the prosthesis using the insertion instrument is demonstrated in the following using the Atos Medical company's shunt model.
The tip of the outer tube is inserted completely in the esophagotracheal fistula. It may be necessary to dilate the fistula first.
Once the outer tube has been positioned correctly in the esophagotracheal fistula, the inserter is pushed forward just as far as the second marking, which releases the esophageal flange of the prosthesis.
TIP: In order to prevent the inserter being pushed too far forward by accident, place the thumb of the left hand directly in front of the 2 on the inserter shaft.
Now carefully pull the inserter and the outer tube back carefully until the unfolded esophageal flange prevents it from being pulled any further. Once this resistance is discernible, pull only the outer tube back to release the tracheal flange.
The inserter can now be pulled off. Check that the prosthesis is working properly and in the correct position, then trim the safety thread.