Ventriculoperitoneal shunt drainage: Difference between revisions
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==Procedure== | ==Procedure== | ||
*Prep | *Prep | ||
**Have | **Have patient seated upright | ||
**Prepare tap site in sterile manner using iodine (hair does not need to be shaved) | **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 | ||
Revision as of 21:50, 1 July 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 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 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