Ventriculoperitoneal shunt drainage: Difference between revisions
| Line 11: | Line 11: | ||
==Procedure== | ==Procedure== | ||
*Prepare tap site in sterile manner | *Have pt 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 | ||
Revision as of 00:42, 1 December 2015
Indications
- Should only be performed by emergency physician in an emergency
- Alleviates incr ICP and helps make definitive diagnosis
Contraindications
Equipment Needed
- LP kit
- 25 gauge butterfly needle
- Topical Lidocaine (if time)
Procedure
- Have pt 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 incr 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