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Complications –V-P Shunts, access device. Anne Aspin 2010. Main problems . Obstruction Infection Overdrainage Disconnection ascites. Obstruction. Partial / intermittent Nausea / vomiting Drowsy / listless Poor feeding Increasing head circumference. Complete obstruction. Headache
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Complications –V-P Shunts, access device Anne Aspin 2010
Main problems • Obstruction • Infection • Overdrainage • Disconnection • ascites
Obstruction • Partial / intermittent • Nausea / vomiting • Drowsy / listless • Poor feeding • Increasing head circumference
Complete obstruction • Headache • High pitched cry • Irritable • Vomiting • Poor feeding • Full, tense fontanelle, increase HC.
Nurses • Parents • Baby behaviour • Feeding • Fontanelle • Vomiting, increase weight • Reflux? • Sunset eyes, observations – raised ICP
What do you do? • Contact neuro-surgical team at Leeds. • Send notes, x-rays and uss with baby. • Stop feeds. • Parents.
What is the remedy? • MRI scan, review uss. • Tests to determine where shunt blockage is. • Removal and replacement parts.
Infection • Pyrexia / hypothermia, labile, niggling • Irritability • Vomiting • Tense fontanelle • Poor feeding
Nurses • Monitor temperature at least BD, ICP • Behaviour • Feeding • Fontanelle • Report changes early.
What do you do? • Bloods – FBC,CRP,U/E’s, blood cultures, urine mc/ s. • Refer early to neurosurgical team • Do not tap shunt.
What happens next? • X rays, shunt series • Urgent CT • CSF for culture, protein and glucose
What happens after that? • Confirmed infection- shunt removed. • Antibiotics • External Ventricular Drainage systems placed. • New shunt after 5-7 days antibiotics.
Overdrainage of VP Shunt • Headache • Poor feeding • Vomiting • Drowsy • Sunken fontanelle • Overlapping suture lines
Nurses • Lay baby flat in the cot for short periods. • Balance between sitting up and laying down depending upon fontanelle. • Advice to parents. Refer to ASBAH.
What do you do? • Not urgent referral. • Can discuss with Reg on call for advice. • Monitor ventricle size on uss regularly and Sodium levels. • Ensure Neuro appt is made prior to discharge home.
Swelling over the shunt • Soft fontanelle, no raised IC pressure • Why? Leakage around shunt connections • Crepe bandage, sit in chair.
Nurses • Check the shunt site daily with cares • Baby sitting in a chair for periods by day.
Ascites • Overdrainage of CSF into peritoneum • Reduce amount of feed • May need IVI 24 hours • Pain relief.
Leaking CSF from wound site • Why? As before • What to do. • Suture to site of the hole • Dry dressing • Bandage to head.
Nurses • Check wound daily • Check sheets where baby has laid for leakage. • If wet, is it clear, pus, wound red?
Redness over wound site • Whilst not laying on shunt. • ? Infection, Commence oral Flucloxacillin
Nurses • Observe for wound breakdown, • Pressure area care • Thin skin
Red tracking along shunt • Shunt infection • Refer to Neuro surgical team
Temperature, lethargy, irritability • Shunt infection until you prove otherwise.
Parent emotions • Empathy, sensitivity, • Refer for support, contact a family • ASBAH • Bliss • Websites, books. • ALWAYS LISTEN TO PARENTS!
References • Chinthapalli V and Watkins L (2009). Ventricular peritoneal shunt tap. http://emedicine.medscape.com/article/81058-overview