Ventriculoperitoneal shunt drainage: Difference between revisions
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*Should only be performed by emergency physician in an emergency | *Should only be performed by emergency physician in an emergency | ||
*Alleviates [[increased ICP]] and helps make definitive diagnosis | *Alleviates [[increased ICP]] and helps make definitive diagnosis | ||
*Can also attempt medical management (mannitol and hyperventilation). | |||
==Contraindications== | ==Contraindications== | ||
Revision as of 23:32, 4 March 2016
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 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