complications –v-p shunts, access device anne aspin 2010
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Complications –V-P Complications –V-P Shunts, access deviceShunts, access device
Complications –V-P Complications –V-P Shunts, access deviceShunts, access device
Anne AspinAnne Aspin20102010
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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/E’s, 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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References• Chinthapalli V and Watkins L (2009).
Ventricular peritoneal shunt tap. http://emedicine.medscape.com/article/81058-overview