Ventriculoperitoneal shunt
Introduction
• In medicine, a shunt is a hole or a small passage which moves fluid
from one part of the body to another.
Introduction
The ventricles of the brain are a communicating network of cavities
located within the brain parenchyma. The choroid plexus in the
ventricles produce CSF, which fills the ventricle and the subarachnoid
space in a constant cycle of production and reabsorption.
The CSF is then absorbed into the cerebral venous circulation through
the arachnoid granulations. Any block or obstruction in this pathway
will produce obstructive hydrocephalus and if permanent will require a
shunt.
Introduction
• Ventriculoperitoneal shunt (VPS) placement is one of the most
commonly performed neurosurgical procedures and is necessary to
treat most forms of hydrocephalus.
• VPS shunt is a cerebral shunt that drains excess cerebrospinal fluid
(CSF) when there is an obstruction in the normal outflow or there is a
decreased absorption of the fluid.
Introduction
• A shunt is a narrow, flexible tube used to move fluid from the brain to
another part of the body. One end of the shunt is placed into one of
four cavities, or ventricles, in the brain where cerebrospinal fluid
(CSF) circulates.
• A small valve attached to tubing is placed under the scalp. The tubing
is then threaded under the skin, down the neck, and into the abdominal
cavity
Introduction
Shunt systems are composed of a proximal ventricular catheter that is
located in the ventricular system of the brain, or lumber subdural
space, a one-way valve system, and a distal catheter located in
different body cavities, commonly the peritoneum or right atrium.
Introduction
Introduction
indication
1. Congenital hydrocephalus associated with mental retardation.
2. Tumors leading to CSF blockage of the ventricles.
3. Communicating hydrocephalus secondary to meningitis or
subarachnoid hemorrhage
4. Arachnoid cysts are a defect caused when CSF forms a collection
that is trapped in the arachnoid membranes.
contraindication
Absolute contraindications include:
• Infection over the entry site
• Infection of the CSF
• Allergy to any of the catheter components (silicone)
contraindication
Related contraindications include:
• Altered coagulation function
• High CSF protein
• CSF with blood
preparation
Brain magnetic resonance imaging (MRI) or computed tomography
(CT) scan is reviewed for the planning of the shunt and the proper
placement of the proximal catheter.
All patients need appropriate preoperative workup and informed
consent for surgery and general anaesthesia.
preparation
The patient is placed supine. For a parieto-occipital approach, the head
is tilted to the contralateral side of the shunt placement.
Preoperative antibiotics are given and the patient is dressed in sterile
conditions.
complication
Shunt catheter obstruction is the most common cause shunt
malfunction, accounts approximately 50% of all shunt malfunction.
Shunt infection
Intracerebral or intraventricular hemorrhage, Subdural hematomas
(can result from erosion of the catheter into cerebral vasculature or
sudden ICP reduction after VPS placement).
Bowel perforation
Shunt disconnection
nursing responsibilities
• The responsibilities include preparing client for surgery, caring for
immediate postoperative, proper functioning and monitoring shunt
function, preventing complications, caring for the surgical sites and
educating family for ongoing care.
• The ongoing care of patient with VP shunt is crucial for long-term
clinical outcomes; therefore, emphasis is placed on the education of
family members.
nursing responsibilities
• Positioning: After the shunt is inserted, the nurse shouldn’t lie the
patient on the side of the body where the shunt is located.
• The patient should lie supine to avoid rapid decompression and
decrease complications.
nursing responsibilities
• Assess both proximal (head) and distal (abdominal) shunt catheter
site incisions for bleeding, drainage, and signs of wound infection.
• Signs and symptoms of infection include erythema or edema at the
incision site or along the catheter pathway, fever, lethargy or
irritability, abdominal pain, anorexia, headache, nuchal rigidity, low-
grade fever, and elevated white blood cell count.
nursing responsibilities
• After a CSF specimen for culture has been obtained, start treatment
with a broad-spectrum antibiotic such as vancomycin as prescribed.
• To optimize CSF drainage, elevate the head of bed, typically to 30
degrees, although the shunt will drain as programmed independent of
head of bed elevation.
• Perform frequent neurologic and other organ system assessments to
detect changes that may result from intracerebral hemorrhage,
increased ICP, meningitis, or peritonitis.
nursing responsibilities
• Throughout the postoperative period, it is essential to monitor for the
symptoms of increased ICP to rule out shunt failure.
• Careful suctioning, analgesic administration to control pain prior to
procedures, comfort measures can prevent increased ICP.
• In addition, observe for seizures and assess surgical sites for signs of
infection. Assess the abdomen for any signs of ileus.
nursing responsibilities
• Peritonitis may develop as a peritoneal response to the foreign
object. Assess for abdominal pain or tenderness, erythema, and
warmth and tenderness over the shunt tubing.
• CSF malabsorption from the peritoneal cavity can lead to abdominal
distension and discomfort.
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