POST-OPERATIVE COMPLICATIONS OF VENTRICULOPERITONEAL SHUNT IN HYDROCEPHALIC PEDIATRIS PATIENTSPresented by :Isma Angger PambayunMia Trisna DewiReza Rahardian

Journal IdentityTitle : Post-Operative Coplications of Ventriculoperitoneal Shunt in Hydrocephalic Pediatric Patients-Nursing CareAuthor : Efstratios Athanasakis, Despina ErmidouPublished date : August 2011

IntroductionHydrocephalusexcessive accumulation of cerebrospinal fluid in the ventricles of the brainCentral nervous system in infants

swelling of the head, protrusion of the forehead and brain atrophyincreased cerebrospinal fluid volume, increased intracranial pressure and dilatation of the ventricular walls

Aim

Results The complications involves postoperative shunt infectionshunt placement failureshunt obstruction-malfunctionabdominal complications-peritonitisvalve complicationsslit-ventricle syndrome and seizures.

Complications

Postoperative shunt infectionPrevention :Regular hand-washing before and after any manipulations of the cetheterAlways wear gloves during every nursing interventionApplication of an aseptic techniqueAntibiotic treatment intravenouslyVital sign measurement especially temperature every 3 hours

Regular control of the shunt (early signs of the shunt infectios is edema)Cerebrospinal fluid specimen cultureTreated immediately to avoid generalized infection

Shunt placement failurePreventionPaying 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 obstruction-malfunctionPrevention :Paying attention to indications of SO (divergence of cranial sutures, headache, neck pain, nausea, vomiting, seizures)Testing to detecting any possible external site of obstructionVital sign measurementOccurence of nystagmusPlannig another surgical operation for placing new shunt

Abdominal complications-peritonitisPrevention :Control of the catheters opening for appearance of bleeding and trauma inspectionFollow up inspection of the patency and placement of the catheterAseptic techniqueantibiotics

DiscussionOther 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. 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.

BASICS CRITICAL APPRAISAL TitleUsed 10 words Describe the main contents of study Doesnt describe place and time of the studyAbstractThere are introduction, aim, results, and conclusions> 250 words

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Hydrocephalus is the most common congenital abnormality of the central nervous system in infantsIt is characterized by excessive accumulation of cerebrospinal fluid in the ventricles of the brain

*Its symptomatoogy is characterized by swelling of the head, protrusion of the forehead and brain atrophyAll these symptoms appear due to increased cerebrospinal fluid volume, increased intracranial pressure and dilatation of the ventricular wallsAll these symptoms appear due to increased cerebrospinal fluid volume, increased intracranial pressure and dilatation of the ventricular walls

*Although the success on the ventriculoperitoneal shunts placement, the patients usually suffer from its afterwards complications. *