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VP shunt OR
- 1.
- 2. The Patient • BabyGirl • 8 days old (born 5/15) o Born at 38 weeks • No Known Allergies • Admitted to NICU after birth • Diagnosis: Hydrocephalus • History: VP shunt placement 5/17
- 3. The Patient • BG’sdiagnosis was confirmed by: o Ultrasound o Symptoms: • Enlarged head circumference • Irritability • Vomiting • Parents waiting in NICU
- 4. Hydrocephalus • Excess accumulationof CSF in the ventricles • Results in an abnormal widening and expansion of the ventricular system • This widening creates potentially harmful pressure on the tissues of the brain • Normally, CSF flows through the ventricles, and exits into cisterns (reservoirs) at the base of the brain • CSF is then reabsorbed into the bloodstream
- 5. Ventriculoperitoneal Shunt • A catheteris placed into the ventricle • It is then advanced, subcutaneously, behind the ear, down the neck, and through to the abdomen • The excess CSF is released and absorbed by the peritoneal cavity • There is typically a valve which prevents the fluid from moving in the wrong direction and only lets fluid drain when the pressure is too high
- 7. Pediatric Considerations • Roomtemperature: 79.5° F o Gaymar heating pad o Heat lamp • Patient’s weight on the whiteboard: 5lbs 9ounces (2.5kg) o Medications o Bovie pad (smallest size) o Implants (VP catheters) • Always remain by the patient’s side o Especially during intubation!
- 8. Anesthesia and Medication •General Anesthesia o Weight confirmed by 3 team members o Dose calculated by Anesthesia attending and resident o Propofol for induction and maintenance o Desflurane inhalation maintenance • Intubated • Ancef o Intravenous o 30 minutes prior to incision o Antibiotic prophylaxis • Bupivacaine with Epinephrine o Diluted with 0.9% NaCl o 10ml/10ml
- 9. Equipment and Instrumentation Equipment: •Gaymar heating pad • Heat lamp • Suction • Bovie o Monopolar: 18 cut/18 coag • Grounded left abdomen o Bipolar: 25 • Fluid warmer o 0.9% NaCl irrigation Instrumentation: • Basic Craniotomy tray • Curette tray Implants: • Ventricular catheter • Peritoneal catheter • Delta valve
- 10. Positioning • OR bed oLeg board unlatched and kept down o Turned 90° • Anesthesia at lateral side, surgeon at head, resident on opposing lateral side • Modified Supine o Shoulder roll o Head turned to opposing side with donut o Arms at sides o Secured with foam and tape
- 11. Prepping • Clippers toremove hair surrounding burr hole site o From right ear to crown • Betadine scrub and paint o Head o Abdomen
- 12. Concluding the Procedure •Procedure length: 1 hour 10 minutes • All counts correct • Closing sutures: 3-0 Vicryl PS2 o Purse string suture in peritoneum to secure catheter • Steri Strips • Specimen: o Previous VP shunt reservoir removed Pathology o CSF Microbiology • Patient was not extubated o Discharged to NICU o Still under sedation when transferred o Report given to NICU nurse (incision sites noted)
- 13. Post-Operative Considerations • Infection,infection, infection! • Bowel perforation • Bladder perforation • CSF leaks • Over drainage of CSF from ventricles • Assess and monitor developmental milestones
- 14. References Alexander, E. L.,Rothrock, J. C., & McEwen, D. R. (2015). Alexander's care of the patient in surgery (15th ed.). St. Louis, MO: Mosby/Elsevier. Hammon, W. (n.d.). Evaluation and use of the ventriculoperitoneal shunt in hydrocephalus. Journal of Neurosurgery, 34(6), 792-795. Keucher, T., & Mealey, J., (2009) Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantile hydrocephalus. Journal of Neurosurgery 50(2), 179-186.