Ventriculoperitoneal shunt drainage

Indications

• Should only be performed by emergency physician in an emergency
• Alleviates incr ICP and helps make definitive diagnosis

Equipment Needed

• LP kit
• 25 gauge butterfly needle
• Topical Lidocaine (if time)

Procedure

• Prepare tap site in sterile manner
• 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

See Also

• Ventriculoperitoneal shunt problems