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Title : Post-Operative Coplications of Ventriculoperitoneal Shunt in Hydrocephalic Pediatric Patients-Nursing Care Author : Efstratios Athanasakis, Despina Ermidou Published date : August 2011
Introduction
Hydrocephalu s Central nervous system in infants
increased cerebrospinal fluid volume, increased intracranial pressure and dilatation of the ventricular walls
Aim
To describe the ventriculoperitoneal shunt complications in pediatrics patients and to point out the role of nursing stuff in the prevention of them
Results
The complications involves postoperative shunt infection shunt placement failure shunt obstruction-malfunction abdominal complications-peritonitis valve complications slit-ventricle syndrome and seizures.
Complications
Shunt placement failure
Shunt obstructionmalfunction
Abdominal complicationsperitonitis
Prevention :
Regular
hand-washing before and after any manipulations of the cetheter Always wear gloves during every nursing intervention Application of an aseptic technique Antibiotic treatment intravenously Vital sign measurement especially temperature every 3 hours
Regular
control of the shunt (early signs of the shunt infectios is edema) Cerebrospinal fluid specimen culture Treated immediately to avoid generalized infection
Prevention
Paying
attention to the appearance of any of the above symptoms (increased contour of the head (megalocephaly), sleepiness or lethargy, irritability, vomiting, headache, swelling of the head, loss of balance and downward deviation of the eye, prominent scalp veins, loss of previous abilities, seizures, headache and loss of balance) May be asymptomatic, with a simple change in the patients behavior
Shunt obstructionmalfunction
Prevention :
Paying
attention to indications of SO (divergence of cranial sutures, headache, neck pain, nausea, vomiting, seizures) Testing to detecting any possible external site of obstruction Vital sign measurement Occurence of nystagmus Plannig another surgical operation for placing new shunt
Abdominal complicationsperitonitis
Prevention :
Control
of the catheters opening for appearance of bleeding and trauma inspection Follow up inspection of the patency and placement of the catheter Aseptic technique antibiotics
Discussion
It is applied to patients with obstructive hydrocephalus, such as stenosis or tumor in the cerebral aqueduct. Endoscopy is useful treatment for imaging the ventricular ground, though the use of special catheters, to allow cerebrospinal fluid drainage without a shunt. Complications : bleeding, cerebrospinal fluid leakage, subdural hematoma, bradycardia, and sudden death from the rapid increase of intracranial pressure
Conclusion
Current treatment for hydrocephalus is endoscopic third ventriculostomy or ventriculoperitoneal shunt. The widely applicable method is the ventriculoperitoneal shunt. Despite this, the shunt infection is the most common post-operative complication. A proper nursing assessment leads to the timely identification of complications and their prompt treatment.
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Abstract
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