Daily Bolus of LR: VP Shunts

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February 8, 2011 by dailybolusoflr

The Ventriculo-Peritoneal (VP) shunt is small tubing that is placed inside the brain’s ventricle and tunneled underneath the skin to the peritoneum.  The purpose of the VP shunt is to reduce the amount of cerebral spinal fluid in the brain by draining it into the peritoneal space.

 

VP shunt malfunctions or infections are the most common complications of VP shunt placement. 

 

Shunt blockage is the most common. 

·         When palpating the ventricular chamber, difficulty compressing can indicate a distal obstruction while refill in >3 seconds can indicate a proximal obstruction.

·         However, up to 40% of obstructions can feel normal to palpation yet still be obstructed, making this an inaccurate physical exam finding.

 

Shunt infections may not present classically with fever and meningismus.

 

Both infection and blockage frequently present with nonspecific symptoms such as:

·         headache

·         nausea/vomiting

·         abdominal pain

·         irritability

·         lethargy

·         coma

·         NOTE: a classic finding in infants is a downward deviation of gaze

 

The appropriate initial work up includes:

·         CT head to evaluate for CSF obstruction or ventriculitis

·         shunt series to evaluate kinks or breaks in the VP shunt tubing

·         shunt tap to evaluate for infection

 

 

Ann-Christine Duhaime.  Evaluation and Management of Shunt Infections in Children with Hydrocephalus.  Clin Pediatr. 2006: 45; 705

 

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