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Main problems . ObstructionInfectionOverdrainageDisconnectionascites. Obstruction. Partial / intermittentNausea / vomitingDrowsy / listlessPoor feedingIncreasing head circumference. Complete obstruction. HeadacheHigh pitched cryIrritableVomitingPoor feedingFull, tense fontanelle, incre

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Presentation Transcript
main problems
Main problems
  • Obstruction
  • Infection
  • Overdrainage
  • Disconnection
  • ascites
obstruction
Obstruction
  • Partial / intermittent
  • Nausea / vomiting
  • Drowsy / listless
  • Poor feeding
  • Increasing head circumference
complete obstruction
Complete obstruction
  • Headache
  • High pitched cry
  • Irritable
  • Vomiting
  • Poor feeding
  • Full, tense fontanelle, increase HC.
nurses
Nurses
  • Parents
  • Baby behaviour
  • Feeding
  • Fontanelle
  • Vomiting, increase weight
  • Reflux?
  • Sunset eyes, observations – raised ICP
what do you do
What do you do?
  • Contact neuro-surgical team at Leeds.
  • Send notes, x-rays and uss with baby.
  • Stop feeds.
  • Parents.
what is the remedy
What is the remedy?
  • MRI scan, review uss.
  • Tests to determine where shunt blockage is.
  • Removal and replacement parts.
infection
Infection
  • Pyrexia / hypothermia, labile, niggling
  • Irritability
  • Vomiting
  • Tense fontanelle
  • Poor feeding
nurses9
Nurses
  • Monitor temperature at least BD, ICP
  • Behaviour
  • Feeding
  • Fontanelle
  • Report changes early.
what do you do10
What do you do?
  • Bloods – FBC,CRP,U/E’s, blood cultures, urine mc/ s.
  • Refer early to neurosurgical team
  • Do not tap shunt.
what happens next
What happens next?
  • X rays, shunt series
  • Urgent CT
  • CSF for culture, protein and glucose
what happens after that
What happens after that?
  • Confirmed infection- shunt removed.
  • Antibiotics
  • External Ventricular Drainage systems placed.
  • New shunt after 5-7 days antibiotics.
overdrainage of vp shunt
Overdrainage of VP Shunt
  • Headache
  • Poor feeding
  • Vomiting
  • Drowsy
  • Sunken fontanelle
  • Overlapping suture lines
nurses14
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.
what do you do15
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.
swelling over the shunt
Swelling over the shunt
  • Soft fontanelle, no raised IC pressure
  • Why? Leakage around shunt connections
  • Crepe bandage, sit in chair.
nurses17
Nurses
  • Check the shunt site daily with cares
  • Baby sitting in a chair for periods by day.
ascites
Ascites
  • Overdrainage of CSF into peritoneum
  • Reduce amount of feed
  • May need IVI 24 hours
  • Pain relief.
leaking csf from wound site
Leaking CSF from wound site
  • Why? As before
  • What to do.
  • Suture to site of the hole
  • Dry dressing
  • Bandage to head.
nurses20
Nurses
  • Check wound daily
  • Check sheets where baby has laid for leakage.
  • If wet, is it clear, pus, wound red?
redness over wound site
Redness over wound site
  • Whilst not laying on shunt.
  • ? Infection, Commence oral Flucloxacillin
nurses22
Nurses
  • Observe for wound breakdown,
  • Pressure area care
  • Thin skin
red tracking along shunt
Red tracking along shunt
  • Shunt infection
  • Refer to Neuro surgical team
temperature lethargy irritability
Temperature, lethargy, irritability
  • Shunt infection until you prove otherwise.
parent emotions
Parent emotions
  • Empathy, sensitivity,
  • Refer for support, contact a family
  • ASBAH
  • Bliss
  • Websites, books.
  • ALWAYS LISTEN TO PARENTS!
references
References
  • Chinthapalli V and Watkins L (2009). Ventricular peritoneal shunt tap. http://emedicine.medscape.com/article/81058-overview
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