Neurosurgical patients with shunts (admission pathway)

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Objectives

Referral and admission pathway for a potentially blocked shunt.

Scope

Paediatric neurosurgical patients with shunts.

Audience

Staff assessing and referring children with a potentially blocked shunt for an urgent paediatric neurosurgical review.

Known neurosurgery patients with potentially blocked shunts presenting to Emergency Departments or General Practitioners should be discussed directly with the duty consultant neurosurgeon covering RHSC.

During weekdays the duty neurosurgical nurse specialist may take calls if the neurosurgeon is unavailable e.g. in theatre.

During weekdays patients may be asked to attend the ward for review or admission. Out of hours, or if there is concern regarding the patient’s general condition, patients should be asked to present to the Emergency Department / Medical Admissions Unit.

During weekdays the general medical assessment and admission of patients will be undertaken by paediatric neurology medical staff. The neurosurgery nurse specialist or neurology registrar will assess shunt function, organise a CT scan, and perform a diagnostic tap - as required and in discussion with the consultant neurosurgeon.

Out of hours and at weekends the initial patient assessment and organisation of a CT scan will be undertaken by the duty medical registrar. Assessment of shunt function and performance of a diagnostic tap (if deemed necessary on discussion with consultant) will be undertaken by either a neurology registrar (if on duty) or the on call surgical registrar. Procedures will initially be supervised directly by the consultant neurosurgeon.

The patient should be fasted pending the outcome of shunt assessment.

If it is necessary for the patient to go to theatre this should be organised by ward and resident medical staff. Organisation of theatre will be the responsibility of the staff member leading assessment of the patient’s shunt. This may be the neurosurgical nurse specialist; neurology registrar; or general surgical registrar.

Organisation of theatre involves: ensuring the patient is fasted; has had all baseline investigations completed; has all co-morbidities identified and assessed; communication with the theatre coordinator; and communication with the anaesthetic team.

The management of patients with shunts inserted by RHSC paediatric surgeons is not covered by this pathway. These patients will be managed as at present by the general surgical team. The duty consultant paediatric surgeon may refer a patient with a shunt to the duty consultant neurosurgeon, or seek assistance with their management. Discussions regarding synchronisation of services will continue over time.

Patients presenting in extremis to the ward, emergency department or general hospitals should be discussed immediately with the PICU. The PICU can take over liaison with the consultant neurosurgeon and organisation of investigations as necessary and appropriate.

Follow up of the patient reverts to the paediatric neurosurgeon of the week the following morning and to the surgeon who initially placed the shunt upon discharge.

 

Editorial Information

Last reviewed: 01 March 2014

Next review: 01 March 2016

Author(s): Anne McGettrick