1. Complications –V-P Shunts, access device Anne Aspin 2010

2. Main problems Obstruction Infection Overdrainage Disconnection ascites

3. Obstruction Partial / intermittent Nausea / vomiting Drowsy / listless Poor feeding Increasing head circumference

4. Complete obstruction Headache High pitched cry Irritable Vomiting Poor feeding Full, tense fontanelle, increase HC.

5. Nurses Parents Baby behaviour Feeding Fontanelle Vomiting, increase weight Reflux? Sunset eyes, observations – raised ICP

6. What do you do? Contact neuro-surgical team at Leeds. Send notes, x-rays and uss with baby. Stop feeds. Parents.

7. What is the remedy? MRI scan, review uss. Tests to determine where shunt blockage is. Removal and replacement parts.

8. Infection Pyrexia / hypothermia, labile, niggling Irritability Vomiting Tense fontanelle Poor feeding

9. Nurses Monitor temperature at least BD, ICP Behaviour Feeding Fontanelle Report changes early.

10. What do you do? Bloods – FBC,CRP,U/E’s, blood cultures, urine mc/ s. Refer early to neurosurgical team Do not tap shunt.

11. What happens next? X rays, shunt series Urgent CT CSF for culture, protein and glucose

12. What happens after that? Confirmed infection- shunt removed. Antibiotics External Ventricular Drainage systems placed. New shunt after 5-7 days antibiotics.

13. Overdrainage of VP Shunt Headache Poor feeding Vomiting Drowsy Sunken fontanelle Overlapping suture lines

14. 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.

15. 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.

16. Swelling over the shunt Soft fontanelle, no raised IC pressure Why? Leakage around shunt connections Crepe bandage, sit in chair.

17. Nurses Check the shunt site daily with cares Baby sitting in a chair for periods by day.

18. Ascites Overdrainage of CSF into peritoneum Reduce amount of feed May need IVI 24 hours Pain relief.

19. Leaking CSF from wound site Why? As before What to do. Suture to site of the hole Dry dressing Bandage to head.

20. Nurses Check wound daily Check sheets where baby has laid for leakage. If wet, is it clear, pus, wound red?

21. Redness over wound site Whilst not laying on shunt. ? Infection, Commence oral Flucloxacillin

22. Nurses Observe for wound breakdown, Pressure area care Thin skin

23. Red tracking along shunt Shunt infection Refer to Neuro surgical team

24. Temperature, lethargy, irritability Shunt infection until you prove otherwise.

25. Parent emotions Empathy, sensitivity, Refer for support, contact a family ASBAH Bliss Websites, books. ALWAYS LISTEN TO PARENTS!

27. References Chinthapalli V and Watkins L (2009). Ventricular peritoneal shunt tap. http://emedicine.medscape.com/article/81058- overview http://emedicine.medscape.com/article/81058- overview