Neurosurgical patients with shunts (admission pathway)

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Objectives

Referral and admission pathway for a child with 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 on call paediatric neurosurgical registrar. If they are unavailable the on call paediatric neurosurgical consultant can be contacted by via the RHC switchboard.

If a child with a ventriculo-peritoneal (or other CSF shunt) self presents when unwell to the Emergency Department, a clinical assessment should be completed to determine whether the child’s symptoms and signs are suggestive of a shunt malfunction.

Possible symptoms of shunt malfunction include headache, vomiting, blurred vision,  drowsiness and loss of consciousness (which may be episodic). Signs of shunt malfunction include decreased GCS, papilloedema, loss of upward gaze and bulging fontanelle (in infants). Fever can be a sign of shunt infection.

If shunt malfunction is suspected, the child should be fasted and the following investigations performed:

  • Full blood count, urea and electrolytes and CRP
  • CT brain

The results should be discussed with the on call neurosurgical team. If a shunt malfunction is diagnosed the neurosurgical theatre team will arrange for the patient to go to theatre.

For patient where the investigations do not show an obvious shunt malfunction, the paediatric neurosurgical team will consider tapping the shunt to measure the intracranial pressure and obtain a sample of CSF, admitting the patient for observation or discharge home with advice to return if symptoms worsen.

Parents of children with VP shunts, can contact the paediatric neurosurgical team or ward directly for advice; if it is thought that the child should be reviewed urgently, the parents will be advised to bring the patient to RHC emergency department. The paediatric neurosurgical team will inform the RHC Emergency Department Co-ordinator that the child will be presenting to their department and upon their arrival a member of the team will review the child as soon as possible and initiate a management plan.

Editorial Information

Last reviewed: 01 October 2020

Next review: 31 October 2023

Author(s): Emer Campbell

Version: 2