Complications VP Shunts, access device

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Complications V-P Shunts, access device

• Anne Aspin
• 2005

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Main problems

• Obstruction
• Infection
• Overdrainage
• Disconnection
• ascites

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Obstruction

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

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Complete obstruction

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

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Nurses

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

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What do you do?

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

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What is the remedy?

• MRI scan, review uss.
• Tests to determine where shunt blockage is.
• Removal and replacement parts.

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Infection

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

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Nurses

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

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What do you do?

• Bloods FBC,CRP,U/Es, blood cultures, urine mc/
  s.
• Refer early to neurosurgical team
• Do not tap shunt.

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What happens next?

• X rays, shunt series
• Urgent CT
• CSF for culture, protein and glucose

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What happens after that?

• Confirmed infection- shunt removed.
• Antibiotics
• External Ventricular Drainage systems placed.
• New shunt after 5-7 days antibiotics.

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Overdrainage of VP Shunt

• Headache
• Poor feeding
• Vomiting
• Drowsy
• Sunken fontanelle
• Overlapping suture lines

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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.

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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.

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Swelling over the shunt

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

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Nurses

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

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Ascites

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

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Leaking CSF from wound site

• Why? As before
• What to do.
• Suture to site of the hole
• Dry dressing
• Bandage to head.

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Nurses

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

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Redness over wound site

• Whilst not laying on shunt.
• ? Infection, Commence oral Flucloxacillin

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Nurses

• Observe for wound breakdown,
• Pressure area care
• Thin skin

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Red tracking along shunt

• Shunt infection
• Refer to Neuro surgical team

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Temperature, lethargy, irritability

• Shunt infection until you prove otherwise.

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Parent emotions

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

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THANK YOU