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Ventricular Peritoneal Shunts, Emergency Medicine

Richard S. Krause Reviewed 06/2017



  • Ventricular peritoneal (VP) shunts are usually placed for hydrocephalus:

    • Conduit between CSF and peritoneal cavity (or right atrium)

  • Obstruction: Shunt malfunction impairs drainage of ...


Signs and Symptoms

  • Shunt obstruction:

    • Headache, nausea

    • Malaise, general weakness, irritability

    • Decreased level of consciousness (LOC)

    • Increased head size or bulging fontanelle

    • Seizures: New-onset ...



  • Patients with shunt malfunction are at risk for apnea and respiratory arrest

  • Oxygen should be applied with close monitoring of respiratory status

  • When increased ICP is suspected, t...



Admission Criteria

Patients with shunt complications usually require neurosurgical consultation and admission. An ICU or other monitored setting is often needed. 

Discharge Criteria


Pearls and Pitfalls

  • Avoid “tunnel vision” in a patient with a shunt and consider other causes for the presentation

  • Severe constipation may cause increased intra-abdominal pressure and decrease drainage...

Additional Reading

  • Barnes  NP, Jones  SJ, Hayward  RD, et al. Ventriculoperitoneal shunt block: What are the best predictive clinical indicators? Arch Dis Child.  2002;87:198–201.

  • Madsen  MA. Emer...



  • V45.2 Presence of cerebrospinal fluid drainage device

  • 996.63 Infection and inflammatory reaction due to nervous system device, implant, and graft

  • 996.75 Other complications due to nervous syst...

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