Diagnosis and management of shunt complications in the. Surgical site infection reduction by the solutions for. Infected vp shunts increase the risk of meningitis, shunt malfunction, and mental. A shunt blockage can be very serious as it can lead to an buildup of excess fluid in the brain, which can cause brain damage. Infections of cerebrospinal fluid shunts and other devices uptodate. Ventriculoperitoneal vp shunts are used for intracranial pressure management and temporary cerebrospinal fluid csf drainage. Pediatrics volume 103 september, 2005 j neurosurg pediatrics 3 103. Cns shunt infections is a topic covered in the johns hopkins abx guide to view the entire topic, please sign in or purchase a subscription official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. Appendectomy for appendicitis in patients with a prior ventriculoperitoneal shunt. Shunt infections and their treatment clinical gate. Shunt malfunction is a partial or complete blockage of the shunt that causes it to function intermittently or not at all.
A new hydrocephalus clinical research network protocol to. Infections developed in 11% of children who underwent uncomplicated initial csf shunt placements within 24 months. The aim of the present study was to evaluate the clinical features, pathogens, and outcomes of 22 patients with csf shunt infections. Infection rates following initial cerebrospinal fluid shunt placement. Csf was assayed for the soluble membrane attack complex smac by elisa in patients with suspected shunt failure or infection. Intraventricular vancomycin in the treatment of ventriculitis associated with cerebrospinal fluid shunting and drainage. We set out to identify a biomarker that would identify shunt infection. Learn more about shunt system components, valve mechanisms, most common shunt systems, overdrainage control devices, siphonresistive devices srd and. At the trials end, the shunt infection rate in the study group was 4. The rate of complications after ventriculoperitoneal shunt. The traditional workup to rule out or establish shunt infection includes a shunt tap. Risks of the insertion of ventricular shunt there are risks and complications with this procedure. Shunt infection is also a relatively common complication after shunt. This hydrocephalus treatment is often complicated by infection of the device with biofilmforming bacteria.
Followup ranged from 2 to 10 years and was available for 23 of the. Therefore, a key issue in the treatment of these complications is early and correct di. Expected clinical and laboratory findings were remarkably absent in a sizable number of patients. All of the patients were premature babies and had received a ventriculoperitoneal shunt because of hydrocephalus. Electricity a lowresistance connection between two. Ventriculoperitoneal shunt insertion for hydrocephalus in. The shunt was inserted at infancy for congenital hydrocephalus. May 28, 2008 sixtytwo percent of infections occurred within 1 month of shunt surgery. These included the use of antibioticimpregnated sutures for wound closure, use of bioglide catheters medtronic, inc.
The most common shunt complications are malfunction and infection. The majority of second shunt infections demonstrated gramstain concordance with both the initial first shunt infection 58%, 95% ci. Complications of implanted shunt systems include mechanical failure, shunt pathway obstruction, infection, foreign body allergic reaction to implants, and csf leakage along the implanted shunt pathway. To prevent infection associated with shunt placement, antibioticimpregnated shunt systems are increasingly being used. Gastrostomy tube placement increases the risk of ventriculoperitoneal shunt infection. If a csf shunt or drain is removed for indications other than infection, cultures of shunt or drain components are not recommended strong, moderate. Treatment and microbiology of repeated cerebrospinal fluid shunt. Ventriculoperitoneal shunt vps insertion is the most frequently used surgical treatment for patients with hydrocephalus, with more than 30,000 procedures performed yearly in the united states. Pdf approximately 10% of cerebrospinal fluid csf shunt operations are associated with infection and require removal or externalization of the shunt. Neurenteric cysts are rare lesions that typically present in the upper thoracic and cervical spine and are occasionally found intracranially. Ventriculoperitoneal shunt malfunction may be caused by shunt infection which may not be clinically apparent as the cause of the malfunction by standard diagnostic criteria. Shunt infection is a very common event in the treatment of hydrocephalus, particularly in the pediatric neurosurgery practice. The rate of shunt infection is highest in the first postoperative month.
Borgberg et al, risk of infection after cerebrospinal fluid shunt. The patient did not report recent travels to foreign countries. The most common organisms responsible for shunt infection include coagulasenegative staphylococcus and staphylococcus aureus. The formation of a brain abscess as a result of a cerebrospinal fluid shunt complication is extremely rare in the literature with only 7 cases reported in the last 20 years. The aim of the present study was to evaluate the clinical features, pathogens, and outcomes of 22 patients with csf shunt infections collected over. Incidence and risk factors of ventriculoperitoneal shunt infections. Surgery using a notouch technique meant that the surgical team. Get a printable copy pdf file of the complete article 810k, or click on a page image below to browse page by page. The authors therefore began using a new protocol that included aics in an effort to reduce the infection rate. Cerebrospinal fluid csf shunts are used in the setting of hydrocephalus to divert csf to another part of the body for absorption. Interpreters statement i was able to ask questions and raise concerns with the doctor about my condition, the proposed procedure and its risks, and my treatment options. Neurenteric cyst secondary to lumboperitoneal shunt. However, fungal infection is still considered to be rare. Ventricular shunts are the most common neurosurgical procedure performed in the united states.
Incidence and risk factors of ventriculoperitoneal shunt. The shunt, being a foreign object in the body, increases the risk for infection. This suggests that the real incidence of infected shunts might be higher than previously suspected. Shunt infection remains a frequent and potentially fatal complication of csf diversion. Clinical signs such as headache, irritability, vomiting, drowsiness, or mental deterioration may be signs of a nonfunctioning shunt. Postoperative shunt infection is the most common and feared complication of ventriculoperitoneal shunt placement for treatment of hydrocephalus.
Section of pediatric neurosurgery catholic university medical school, rome introduction the history of the treatment of. Treatment of ventriculoperitoneal shunt infection and. Incidence of vp shunt infection of the 333 inserted shunts, 35 shunts 10. A functioning vps provides a permanent pathway for ventricular csf outflow and allows for normalisation of csf pressure in hydrocephalus. Fungal infection of ventriculoperitoneal shunts in.
Reinfection after treatment of first cerebrospinal fluid shunt infection. A protocol for diagnosis and management of cerebrospinal shunt. Approximately half of all shunt infections are due. Shunt infection is a common complication in patients who do not undergo subsequent abdominal surgery, occurring at an overall average rate of 710% in north america 3, 4. First, your child will need an operation to remove the infected shunt and put in a temporary drainage device. Antibioticimpregnated catheters aics were not part of the protocol but were used off protocol by some surgeons. If left unchecked, the cerebrospinal fluid can build up leading to an increase in intracranial pressure icp which can lead to intracranial hematoma, cerebral edema, crushed brain tissue or herniation. Emergency surgery will be needed to replace the malfunctioning shunt.
Nov 15, 2014 ventricular shunts are the most common neurosurgical procedure performed in the united states. Infection perioperative management of ventriculoperitoneal. Positive csf cultures, the final proof of infection, have a minimum waiting time of 24 hours, and a final. Nursing care of infants with a ventriculoperitoneal shunt. We report a patient that developed a brain abscess adjacent to a functioning ventricular catheter in the presence of shunt infection by another pathogen. Management of abdominal pseudocyst in shuntdependent. Testing the variables for their ability to predict a shunt infection revealed that only placement of a gastrostomy tube was a significant predictor of shunt infection on both univariate and multivariate analyses. Treatment of shunt infections currently includes shunt removal and systemic or intraventricular antibiotic therapy. The optimal treatment is gross total excision as subtotalpartial excisions are associated with high recurrence rates.
Csf shunt placement has been the mainstay of treatment for hydrocephalus for more. Learn more about shunt system components, valve mechanisms, most common shunt systems, overdrainage control devices, siphonresistive devices srd and the different symptoms of malfunction andor infection. The majority of initial csf shunt infections were treated with total shunt removal and evd placement 175 patients. Section of pediatric neurosurgery catholic university medical school, rome introduction the history of the treatment of hydrocephalus by using cerebrospinal fluid csf. A ventriculoperitoneal shunt vp had been placed at the age of 14 due to congenital aqueductal stenosis and hydrocephalus.
In both scenarios, an additional parameter with a sensij. Blood cultures are recommended in patients with susnosis weak, low. Pdf ventriculoperitoneal shunt infection and appendicitis. Erythema and tenderness over the subcutaneous shunt tubing are suggestive of csf shunt infection strong, moderate. Here you can read posts from all over the web from people who wrote about shunt infection and stomach pain, and check the relations between shunt infection and stomach pain. A lower incidence of shunt infection was observed when antibioticimpregnated shunts ais were used to treat hydrocephalus and a rapid cure was reported in cases of ventriculitis when antibiotics. Appendectomy for appendicitis in patients with a prior. Infections of ventriculoperitoneal shunt and a simple effective. Infection of the central nervous system cns is a major cause of morbidity and mortality in patients with csf shunts. Cerebrospinal fluid csf shunt infections remain a significant cause of morbidity and mortality in children with hydrocephalus.
A standardized protocol to reduce cerebrospinal fluid. Antimicrobial sutures reduce infections in brain shunt. Such infections are serious intracranial infection that can lead to serious complication and death. For the past 10 years, a patient with pseudotumor cerebri required repeated lumboperitoneal lp shunt. Shunt infection rates vary with the age of the infant at the time of the surgery20,22 as well as hospital and surgeon factors. Your child will need to stay in hospital while we treat the shunt infection. When a blockage occurs, csf accumulates and can result in symptoms of untreated hydrocephalus. Antimicrobial sutures reduce infections in brain shunt surgery, study finds date. Typical and mysterious causes for shunt malfunction and how to troubleshoot them duration. The hydrocephalus association is pleased to announce the launch of our shunt system page on our website. The suspicion of a shunt infection arises from a history that includes recent shunt surgery and various, mostly unspecific, clinical signs and symptoms. However, when primary shunt infection is the cause of. Risk factors for first cerebrospinal fluid shunt infection. Placement of a gastrostomy tube more than doubled the odds 95% ci 1.
Cerebral shunts are commonly used to treat hydrocephalus, the swelling of the brain due to excess buildup of cerebrospinal fluid csf. Infections of the cerebrospinal shunts and other neurosurgical structures are not uncommon in the clinical practice. Pdf hydrocephalus is a common entity in neurosurgical practice affecting both adult and pediatric populations. An infected shunt is treated with surgery and antibiotics. Infection is still the most common complication of shunt procedures in children. In most cases, the vp shunt is unaffected and left in place after careful perioperative inspection, while the appendix is removed 1,6.
Sixtytwo percent of infections occurred within 1 month of shunt surgery. The cerebral shunt can be used to alleviate or prevent. A yearold girl with a vp shunt presented with progressive abdominal distention, pain and vomiting. In order to study the relationship between infection and shunt malfunction, we followed a protocol over five years 54 v. The act or process of turning aside or moving to an alternate course.
A retrospective study of central nervous system shunt. The following steps are used to treat a shunt infection. Abdominal pseudocyst apc is an uncommon manifestation of a ventriculoperitoneal vp shunt that is attributed to an inflammatory response, usually the result of infection. Complications of shunt systems hydrocephalus association. Original article infections of ventriculoperitoneal shunt and a simple effective treatment junhui chen, yuhai wang, likun yang, chunlei zhang, weiliang chen, jianqing he, lei chen, jun zhu, peipei li department of neurosurgery, 101st hospital of pla, wuxi 214044, jiangsu, china. We found that fungi accounted for 17% of shunt infections 8 of 48 in a retrospective study. Common complications following successful vps include shunt infection, ventriculitis, proximal catheter occlusion or migration, shunt fracture, over drainage and distal catheter occlusion. Shunt infection rates differ among reported studies. Clinicians should consider this complication in any shunted patient. Cerebrospinal fluid shunt infection the journal of pediatrics. It is the most frequent cause of shunt complications. Reported rates of infection have large institutional variability.
A manual for nurses and midwives in the who european region has been written with the aim of developing the knowledge, skills and attitudes of nurses and midwives regarding infections and infectious diseases and their prevention and control. The hydrocephalus clinical research network quality improvement initiative clinical article. Csf was obtained at the time of initial surgical intervention. A simple method to reduce infection of ventriculoperitoneal shunts. Among the shunt complications, shunt infection is one of the most frequent occur rence and serious complication of vp shunt. Infection, requiring antibiotics and further treatment. Brain abscess formation as a csf shunt complication. Original article infections of ventriculoperitoneal shunt.
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