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Complications –V-P Shunts, access device PowerPoint PPT Presentation


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Complications –V-P Shunts, access device. Anne Aspin 2010. Main problems . Obstruction Infection Overdrainage Disconnection ascites. Obstruction. Partial / intermittent Nausea / vomiting Drowsy / listless Poor feeding Increasing head circumference. Complete obstruction. Headache

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Complications –V-P Shunts, access device

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Complications v p shunts access device l.jpg

Complications –V-P Shunts, access device

Anne Aspin

2010


Main problems l.jpg

Main problems

  • Obstruction

  • Infection

  • Overdrainage

  • Disconnection

  • ascites


Obstruction l.jpg

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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THANK YOU


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References

  • Chinthapalli V and Watkins L (2009). Ventricular peritoneal shunt tap. http://emedicine.medscape.com/article/81058-overview


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