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Ventricular Peritoneal Shunts, Emergency Medicine

Richard S. Krause Reviewed 06/2017
 


Basics

Description

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

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

  • Obstruction: Shunt malfunction impairs drainage of ...

Diagnosis

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 ...

Treatment

Pre-Hospital

  • 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...

Follow-Up

Disposition

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...

Codes

ICD9

  • 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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