Complications –V-P Complications –V-P Shunts, access deviceShunts, access device

Complications –V-P Complications –V-P Shunts, access deviceShunts, access device

Anne AspinAnne Aspin20102010

Main problems • Obstruction• Infection• Overdrainage• Disconnection• ascites

Obstruction• Partial / intermittent• Nausea / vomiting• Drowsy / listless• Poor feeding• Increasing head circumference

Complete obstruction• Headache• High pitched cry• Irritable• Vomiting• Poor feeding• Full, tense fontanelle, increase HC.

Nurses• Parents• Baby behaviour• Feeding• Fontanelle• Vomiting, increase weight• Reflux?• Sunset eyes, observations – raised ICP

What do you do? • Contact neuro-surgical team at

Leeds.• Send notes, x-rays and uss with

baby.• Stop feeds.• Parents.

What is the remedy?• MRI scan, review uss.• Tests to determine where shunt

blockage is.• Removal and replacement parts.

Infection• Pyrexia / hypothermia, labile,

niggling• Irritability• Vomiting• Tense fontanelle• Poor feeding

Nurses• Monitor temperature at least BD,

ICP• Behaviour• Feeding• Fontanelle• Report changes early.

What do you do?

• Bloods – FBC,CRP,U/E’s, blood cultures, urine mc/ s.

• Refer early to neurosurgical team

• Do not tap shunt.

What happens next?• X rays, shunt series

• Urgent CT

• CSF for culture, protein and glucose

What happens after that?

• Confirmed infection- shunt removed.• Antibiotics• External Ventricular Drainage systems

placed.

• New shunt after 5-7 days antibiotics.

Overdrainage of VP Shunt

• Headache• Poor feeding• Vomiting • Drowsy• Sunken fontanelle• Overlapping suture lines

Nurses• Lay baby flat in the cot for short

periods.

• Balance between sitting up and laying down depending upon fontanelle.

• Advice to parents. Refer to ASBAH.

What do you do?• Not urgent referral.• Can discuss with Reg on call for

advice.• Monitor ventricle size on uss

regularly and Sodium levels.• Ensure Neuro appt is made prior

to discharge home.

Swelling over the shunt• Soft fontanelle, no raised IC

pressure• Why? Leakage around shunt

connections• Crepe bandage, sit in chair.

Nurses• Check the shunt site daily with

cares• Baby sitting in a chair for periods

by day.

Ascites• Overdrainage of CSF into peritoneum

• Reduce amount of feed

• May need IVI 24 hours• Pain relief.

Leaking CSF from wound site

• Why? As before• What to do.• Suture to site of the hole• Dry dressing• Bandage to head.

Nurses• Check wound daily• Check sheets where baby has laid

for leakage.• If wet, is it clear, pus, wound red?

Redness over wound site

• Whilst not laying on shunt.• ? Infection, Commence oral

Flucloxacillin

Nurses• Observe for wound breakdown,• Pressure area care• Thin skin

Red tracking along shunt

• Shunt infection• Refer to Neuro surgical team

Temperature, lethargy, irritability

• Shunt infection until you prove otherwise.

Parent emotions• Empathy, sensitivity, • Refer for support, contact a family• ASBAH• Bliss• Websites, books.• ALWAYS LISTEN TO PARENTS!

References• Chinthapalli V and Watkins L (2009).

Ventricular peritoneal shunt tap. http://emedicine.medscape.com/article/81058-overview