POST OPERATIVE COMPLICATIONS OF VENTRICULOPERITONEAL SHUNT IN HYDROCEPHALIC PEDIATRIS PATIENTS NURSING CARE

Presented by Ayu Rizqi Nurul Iriani Adviser Dr. Chatarina Rini Pratiwi, Sp.A

Pray for Nanda

Picture was taken Dec 14th, 2013 in ICU RSUD Sunan Kalijaga Demak

Journal Identity

Title : Post-Operative Coplications of Ventriculoperitoneal Shunt in Hydrocephalic Pediatric Patients-Nursing Care Author and correspondency has been writen Efstratios Athanasakis, Despina Ermidou Publisher and publication time : International Journal of Caring Sciences May-August 2011 Vol 4 Issue 2

Sirculation of LCS
Plexus choroideus Lateral ventricles Foramen interventricular Monroe 3rd ventricle Aquoductus sylvii 4th ventricle 1 foramen Magendie (medial) and 2 foramen Luscha (lateral) Cavum subarachnoid vili arachnoidalis

Introduction
Hydrocephalu s Central nervous system in infants

excessive accumulation of cerebrospinal fluid in the ventricles of the brain

swelling of the head, protrusion of the forehead and brain atrophy

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

Postoperative shunt infection Shunt placement failure

Shunt obstruction-malfunction
Abdominal complications-peritonitis

Postoperative shunt infection

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

Shunt placement failure

Prevention

Paying attention to the appearance of any 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

Preventi on

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

Other treatment of hydrocephalus is endoscopic third ventriculostomy

Endoscopic third ventriculostomy

It is applied to patients with obstructive hydrocephalus, such as stenosis or tumor in the cerebral aqueduct.

Complications : bleeding, cerebrospinal fluid leakage, subdural hematoma, bradycardia, and sudden death from the rapid increase of intracranial pressure

Endoscopy is useful treatment for imaging the ventricular ground, though the use of special catheters, to allow cerebrospinal fluid drainage without a shunt.

Conclusion
Current treatment for hydrocephalus
endoscopic third ventriculostomy or ventriculoperitoneal shunt

The widely applicable method is the ventriculoperitoneal shunt.

The shunt infection is the most common postoperative complication.

A proper nursing assessment leads to the timely identification of complications and their prompt treatment.

BASICS CRITICAL APPRAISAL

Title Consist of 12 words Describe the main contents of study Doesnt describe place and time of the study Abstract There are introduction, aim, methods, results, conclusions and also key words > 250 words There is no PICO

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