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Ventriculoperitoneal Shunt—Child

Definition

A ventriculoperitoneal shunt operation is a surgery where a doctor inserts a drainage tube (catheter) into the brain. The tube runs into the abdominal cavity. This tube is used to move extra fluid in the brain to the abdomen where it can be absorbed. The entire tube is under the skin and not visible.

Reasons for Procedure

This type of shunt is used to treat hydrocephalus, an condition that results in excess in the brain. Extra fluid can cause increased pressure. This pressure can damage sensitive brain tissues. The shunt drains the extra fluid and reduces pressure on the brain.
Hydrocephalus
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Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your child's doctor will review potential problems, like:
  • Shunt failure
  • Brain swelling
  • Blood clot or bleeding in the brain
  • Infection in the shunt or brain
  • Damage to brain tissue
  • Reaction to the anesthesia

What to Expect

Prior to Procedure

At your child’s doctor appointment before the surgery, the doctor may:
  • Do a neurological exam—This is to find out how your child’s nerves work. It involves evaluating mental status, as well as motor and sensory abilities.
  • Order MRI or CT scans of the brain—Images of your child’s body will help the doctor plan the surgery.
  • Answer any question that you have—Can my child take her regular medicines before the surgery? What kind of recovery can we expect? How soon will symptoms start to improve? What are signs that the shunt is not working?
  • Instruct your child to not eat or drink before the surgery—Your child’s doctor will give you instructions about fasting based on your child’s age. Fasting may range from 6-12 hours before surgery.

Anesthesia

General anesthesia will be used. It will block any pain and keep your child asleep during the surgery. It is given through an IV (needle) in the hand or arm.

Description of the Procedure

A breathing tube will be placed to help your child breathe during surgery. The scalp and abdomen are cleaned with antiseptic. The doctor will make small incisions in the scalp and abdomen. A small hole is made in the skull. A catheter is passed through the hole into your child’s brain. Then the catheter is tunneled under the skin down to the abdomen. This end of the catheter is put into the abdominal cavity. The incisions are closed and a dressing is applied to each area.

Immediately After Procedure

After the surgery, your child will be taken to the recovery room for observation. If all is well, the breathing tube will likely be removed there. Your child will be moved to a hospital room to recover.

How Long Will It Take?

1-1½ hours

How Much Will It Hurt?

Anesthesia prevents pain during surgery. Your child will be given medication to relieve pain or soreness during recovery.

Average Hospital Stay

Your child may be in the hospital for 3-7 days. Your child’s doctor may choose to keep him longer if complications arise.

Post-procedure Care

At the Hospital
  • Your child may need to lay flat for up to 24 hours after surgery.
  • Your child’s heart rate, blood pressure, breathing rate, and brain status will be monitored closely.
  • Your child will receive nutrition through an IV until she is ready to eat and drink.
  • The shunt will be checked to make sure it is working.
  • Antibiotics may be given. Pain medicine will be given as needed.
Preventing Infection
During your child's stay, the hospital staff will also take steps to reduce the chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your child's incisions covered
There are also steps you can take to reduce your child's chance of infection, such as:
  • Washing both you and your child's hands often, and reminding visitors and healthcare providers to do the same
  • Reminding your child's healthcare providers to wear gloves or masks
  • Not allowing others to touch your child's incision
At Home
When your child is at home, do the following for a smooth recovery:
  • Follow the doctor’s instructions on bathing. You will probably not be allowed to soak your child’s head in water or wash her hair until healing is complete.
  • Check the incision sites to make sure they are not infected.
  • Do not let your child pick at the incisions.

Call Your Child’s Doctor

After your child leaves the hospital, contact the doctor if any of the following occurs:
  • Symptoms that went away return
  • Stiff neck
  • Headache
  • Irritability
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, a lot of bleeding, or any discharge from the incision site
  • Vomiting (which may be a sign of the shunt not working)
  • Pain that is not controlled with the medicines your child has been given
  • Vision problems
  • Being very sleepy
  • Confusion
  • Developmental delays
  • Not eating or drinking enough
Call for emergency medical services right away for:
  • Fast breathing or trouble breathing
  • Blue or gray skin color
  • Not waking up or not interacting
  • Not wanting to be held
  • Seizures
If you think you have an emergency, call for medical help right away.

RESOURCES

Hydrocephalus Association http://www.hydroassoc.org

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

CANADIAN RESOURCES

Canadian Paediatric Society http://www.cps.ca

Spina Bifida and Hydrocephalus Canada http://www.sbhac.ca

References

About normal pressure hydrocephalus. National Hydrocephalus Association website. Available at: http://www.hydroassoc.org/docs/AboutNormalPressureHydrocephalus-A%5FBook%5Ffor%5FAdults%5Fand%5FTheir%5FFamilies.pdf. Accessed September 17, 2009.

Neff DM. Discharge instructions for hydrocephalus. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about. Updated March 24, 2009. Accessed date September 17, 2009.

NINDS Hydrocephalus information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/hydrocephalus/hydrocephalus.htm. Accessed September 17, 2009.

Professional Guide to Diseases. 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.

Ventriculoperitoneal shunt. Jefferson Hospital for Neuroscience website. Available at: http://www.jeffersonhospital.org/rx%5Ffiles/neurosurgery/venshunt9943.pdf. Accessed September 17, 2009.

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