Ventriculoperitoneal shunt drainage

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

See Also

External Links

References