1 / 27

Complications –V-P Shunts, access device

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

riva
Download Presentation

Complications –V-P Shunts, access device

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Complications –V-P Shunts, access device Anne Aspin 2010

  2. Main problems • Obstruction • Infection • Overdrainage • Disconnection • ascites

  3. Obstruction • Partial / intermittent • Nausea / vomiting • Drowsy / listless • Poor feeding • Increasing head circumference

  4. Complete obstruction • Headache • High pitched cry • Irritable • Vomiting • Poor feeding • Full, tense fontanelle, increase HC.

  5. Nurses • Parents • Baby behaviour • Feeding • Fontanelle • Vomiting, increase weight • Reflux? • Sunset eyes, observations – raised ICP

  6. What do you do? • Contact neuro-surgical team at Leeds. • Send notes, x-rays and uss with baby. • Stop feeds. • Parents.

  7. What is the remedy? • MRI scan, review uss. • Tests to determine where shunt blockage is. • Removal and replacement parts.

  8. Infection • Pyrexia / hypothermia, labile, niggling • Irritability • Vomiting • Tense fontanelle • Poor feeding

  9. Nurses • Monitor temperature at least BD, ICP • Behaviour • Feeding • Fontanelle • Report changes early.

  10. What do you do? • Bloods – FBC,CRP,U/E’s, blood cultures, urine mc/ s. • Refer early to neurosurgical team • Do not tap shunt.

  11. What happens next? • X rays, shunt series • Urgent CT • CSF for culture, protein and glucose

  12. What happens after that? • Confirmed infection- shunt removed. • Antibiotics • External Ventricular Drainage systems placed. • New shunt after 5-7 days antibiotics.

  13. Overdrainage of VP Shunt • Headache • Poor feeding • Vomiting • Drowsy • Sunken fontanelle • Overlapping suture lines

  14. 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.

  15. 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.

  16. Swelling over the shunt • Soft fontanelle, no raised IC pressure • Why? Leakage around shunt connections • Crepe bandage, sit in chair.

  17. Nurses • Check the shunt site daily with cares • Baby sitting in a chair for periods by day.

  18. Ascites • Overdrainage of CSF into peritoneum • Reduce amount of feed • May need IVI 24 hours • Pain relief.

  19. Leaking CSF from wound site • Why? As before • What to do. • Suture to site of the hole • Dry dressing • Bandage to head.

  20. Nurses • Check wound daily • Check sheets where baby has laid for leakage. • If wet, is it clear, pus, wound red?

  21. Redness over wound site • Whilst not laying on shunt. • ? Infection, Commence oral Flucloxacillin

  22. Nurses • Observe for wound breakdown, • Pressure area care • Thin skin

  23. Red tracking along shunt • Shunt infection • Refer to Neuro surgical team

  24. Temperature, lethargy, irritability • Shunt infection until you prove otherwise.

  25. Parent emotions • Empathy, sensitivity, • Refer for support, contact a family • ASBAH • Bliss • Websites, books. • ALWAYS LISTEN TO PARENTS!

  26. THANK YOU

  27. References • Chinthapalli V and Watkins L (2009). Ventricular peritoneal shunt tap. http://emedicine.medscape.com/article/81058-overview

More Related