Ventriculoperitoneal shunt drainage: Difference between revisions
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==Indications== | ==Indications== | ||
[[File:Diagram showing a brain shunt CRUK 052.png|thumb|A diagram of a typical brain shunt with component parts.]] | |||
*Should only be performed by emergency physician in an emergency | *Should only be performed by emergency physician in an emergency | ||
*Alleviates | *Alleviates [[increased ICP]] and helps make definitive diagnosis | ||
*Can also attempt medical management (mannitol and hyperventilation). | |||
==Contraindications== | ==Contraindications== | ||
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==Equipment Needed== | ==Equipment Needed== | ||
*LP kit | *LP kit | ||
*25 gauge butterfly needle | *25 gauge butterfly needle or 23 gauge needle | ||
*Topical Lidocaine (if time) | *Topical [[Lidocaine]] (if time) | ||
==Procedure== | ==Procedure== | ||
*Prepare tap site in sterile manner | [[File:Ventriculoperitoneal shunt - surgical wound healing - head - day 15 - stitches removed - 2018.jpg|thumb|Port site on head.]] | ||
*Prep | |||
**Have patient seated upright | |||
**Prepare tap site in sterile manner using iodine (hair does not need to be shaved) | |||
*23ga needle or butterfly attached to a manometer is inserted into the reservoir | *23ga needle or butterfly attached to a manometer is inserted into the reservoir | ||
**If no fluid returns or flow ceases, a proximal obstruction is likely | **If no fluid returns or flow ceases, a proximal obstruction is likely | ||
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**Measure while reservoir outflow is occluded | **Measure while reservoir outflow is occluded | ||
**Opening pressure >20 indicates distal obstruction; low pressure indicates proximal | **Opening pressure >20 indicates distal obstruction; low pressure indicates proximal | ||
*Fluid removal (for | *Fluid removal (for increased ICP) | ||
**Remove slowly to avoid choroid plexus bleeding | **Remove slowly to avoid choroid plexus bleeding | ||
**Remove until pressure is 10-20 | **Remove until pressure is 10-20 | ||
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[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Neurology]] | |||
Latest revision as of 05:19, 8 May 2021
Indications
- Should only be performed by emergency physician in an emergency
- Alleviates increased ICP and helps make definitive diagnosis
- Can also attempt medical management (mannitol and hyperventilation).
Contraindications
Equipment Needed
- LP kit
- 25 gauge butterfly needle or 23 gauge needle
- Topical Lidocaine (if time)
Procedure
- Prep
- Have patient seated upright
- Prepare tap site in sterile manner using iodine (hair does not need to be shaved)
- 23ga needle or butterfly attached to a manometer is inserted into the reservoir
- If no fluid returns or flow ceases, a proximal obstruction is likely
- Measure opening pressure (nl = 12 +/- 2)
- Measure while reservoir outflow is occluded
- Opening pressure >20 indicates distal obstruction; low pressure indicates proximal
- Fluid removal (for increased ICP)
- Remove slowly to avoid choroid plexus bleeding
- Remove until pressure is 10-20
Complications
- If no fluid can be drained, be concerned for proximal obstruction and is a surgical emergency due to risk for herniation