Ventriculoperitoneal shunt drainage

Indications

• Should only be performed by emergency physician in an emergency
• Alleviates increased ICP and helps make definitive diagnosis
• Can also attempt medical management (mannitol and hyperventilation).

Equipment Needed

• LP kit
• 25 gauge butterfly needle or 23 gauge needle
• Topical Lidocaine (if time)

Procedure

• Prep
  • Have patient seated upright
  • Prepare tap site in sterile manner using iodine (hair does not need to be shaved)
• 23ga needle or butterfly attached to a manometer is inserted into the reservoir
  • If no fluid returns or flow ceases, a proximal obstruction is likely
• Measure opening pressure (nl = 12 +/- 2)
  • Measure while reservoir outflow is occluded
  • Opening pressure >20 indicates distal obstruction; low pressure indicates proximal
• Fluid removal (for increased ICP)
  • Remove slowly to avoid choroid plexus bleeding
  • Remove until pressure is 10-20

Complications

• If no fluid can be drained, be concerned for proximal obstruction and is a surgical emergency due to risk for herniation

See Also

• Ventriculoperitoneal shunt problems

References

Authors

Ross Donaldson, Justin Arndt, Trevor C. Wilson, Neil Young