Ventriculoperitoneal Shunt Placement For Hydrocephalus In Children

WHAT YOU SHOULD KNOW:

  • A ventriculoperitoneal (VP) shunt is needed to treat hydrocephalus . Hydrocephalus is the build up of too much fluid in the brain. This fluid is called cerebrospinal fluid (CSF). The CSF is made in a part of the brain called the ventricles . If there is too much CSF in the ventricles they will become larger than normal. This can put extra pressure on the brain. The VP shunt will drain the extra CSF out of the ventricles. It will also decrease the pressure on the brain. The shunt surgery is done by a neurosurgeon . Ask your child's caregiver for the CareNotes™ handout about hydrocephalus for more information.

  • Most children with hydrocephalus need to have a VP shunt for the rest of their lives. It may need to be replaced or revised (fixed) if it is not working properly. If a shunt was put in a baby, it may need to be replaced when the child is older. This is done because the tubing needs to be longer in an older child. Many shunts that are put in now are longer. This means the shunt will not need to be replaced as the child grows.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

There are always risks with surgery. Your child may bleed more than usual or get an infection (in-fek-shun). Brain damage or other problems may happen if your child's hydrocephalus is not treated. Call your child's caregiver if you have questions about your child's surgery or medicines.

WHILE YOU ARE HERE:

Before Surgery:

  • Informed Consent:

    • You have the right to understand your child's health condition. You should understand what tests, treatments, or procedures may be done to treat your child's condition. Your child's caregiver should also tell you about the risks and benefits of each treatment.

    • You may be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for your child. A consent form is a legal paper that gives a caregiver permission to do certain tests, treatments, or procedures. This form should tell you exactly what will be done to your child. Your child's caregiver should explain what the risks and benefits of each treatment are before you sign the form. Before giving your consent, make sure all your questions have been answered. This way you will understand what may happen to your child.

  • Vital Signs: This may include taking your child's temperature, pulse (heartbeats), respirations (breaths), and blood pressure. Your child's temperature may be taken in the mouth, ear, armpit, or rectum (rear-end). Caregivers may also listen to your child's heart and lungs by using a stethoscope .

  • Neuro Signs: A caregiver may check your child's eyes, memory, and how easily your child wakes up. The strength of your child's arms, hands, legs, and feet may also be checked. These signs may tell caregivers how your child's brain is working.

  • Gown: A hospital gown is needed so caregivers can easily check and treat your child. Your child's gown should be put on so it opens in the back. Your child may be able to wear regular pajamas or clothes when he feels better.

  • IV: An IV is a tiny tube placed in your child's vein. It may be put in your child's hand, arm, ankle, foot, or head. Your child's IV may be hooked to a machine that will give your child liquids and medicine. Once your child gets enough liquids and medicine, a caregiver may disconnect the IV from the machine. Your child may still need to keep the IV in or a caregiver will take it out. Let a caregiver know if your child has pain, burning, redness, or swelling at the IV site.

  • Heart Monitor: This is a machine used to see how your child's heart is handling the illness. 3 or 5 sticky pads are placed on your child's chest. Each pad has a wire that is hooked to a TV-type screen or to a small portable box. This screen or box shows a picture of your child's heartbeat. Caregivers watch this picture to make sure your child's heart is doing well.

  • Pulse Oximeter: This is a machine that tells caregivers how much oxygen is in your child's blood. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe. Tell a caregiver if the sticky strip or clip comes off of your child. The machine will alarm if the machine cannot read the oxygen level or if your child needs more oxygen. Tell a caregiver if the machine is alarming. Never turn the pulse oximeter off unless a caregiver has said it is OK.

  • Blood Tests: Your child may need blood taken for tests. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV. It is tested to see how your child's body is handling the illness. Your child may need to have blood drawn more than once.

  • CT Scan: This may also be called a CAT scan. A special x-ray machine uses a computer to take pictures of your child's brain. It may be used to look at your child's brain before and after surgery.

  • MRI: This test is called magnetic resonance imaging. During the MRI 3-D (three-dimensional) pictures are taken of your child's brain. Always ask for a caregiver's permission before entering the MRI room. Never enter the MRI room with an oxygen tank or any metal objects. This can cause serious injury.

  • Head Circumference: This is the distance around your child's head. A caregiver may use a tape measure to measure the circumference of your child's head. Depending on your child's illness, a measurement may need to be taken every day. Caregivers take these measurements if your child's head is growing faster than normal. This may happen because of too much fluid on the brain.

  • Call Button: A call button will be in your child's hospital room. You or your child should use the call button if your child is having problems and a caregiver is needed. You can also use the call button if you or your child have questions for a caregiver. Be sure to keep the call button near you or your child at all times.

  • Hair Washing: Your child's hair may need to be washed with a special shampoo. This shampoo is used to help protect against infection.

  • Transport: Your child may need to be put onto a cart to be taken to surgery. If your child is small enough, you may be able to carry your child to surgery. You may want to take a special toy or blanket along to surgery for your child.

  • General Anesthesia: This is medicine to make your child comfortable and sleep during surgery. The medicine is usually given through an IV. It may also be given as a gas through a face mask. It may also go through a tube placed in your child's mouth and throat. This tube is called an endotracheal tube or "ET tube." This medicine goes into your child's lungs. Ask your child's caregiver for the anesthesia CareNotes™ handout if you want to know more about anesthesia.

During Surgery:

  • After your child is asleep, a small area of hair on your child's head may need to be cut or shaved. Your child's head will then be cleaned with a special soap. Your child's neck, chest, and abdomen will also be cleaned with special soap. These areas are cleaned because the shunt starts in the head and runs under the skin to the abdomen. This soap may make your child's skin yellow, but it is cleaned off later. All of this soap and cleaning is used to prevent infection. Sheets will be put over your child while leaving an opening only where the surgery will be done. These sheets are used to keep the surgery area clean.

  • Two small incisions (cuts) are made. One will be in your child's head and the other in the abdomen. The top end of the shunt is usually put into one of the ventricles that has too much fluid. This end is connected to a piece of the shunt called a valve. The valve controls the amount of CSF that goes through the shunt and the pressure on the brain. Near the valve is another piece of the shunt called a reservoir or pump. This pump lies right under the skin of the head. This can be pressed by caregivers to check how the shunt is working.

  • Connected to the valve is the bottom catheter (tube). This long piece of tubing is tunneled under the skin from the head to the abdomen. This tube runs under the skin to the peritoneal cavity. This cavity is an area around the organs in the abdomen (belly). When the CSF empties into this cavity, it is quickly absorbed into the blood.

  • Sometimes teenagers or tall children will need a small third incision. This incision is made near the collarbone to get the shunt down to the abdomen. Your child's incisions will usually be closed with staples or stitches (thread). Bandages may then be put over the incisions.

After Surgery:

Your child will be taken to the recovery room until he wakes up and is comfortable. You may be able to visit your child in the recovery room after caregivers get him settled. Your child will then be taken to his room in the hospital. Your child may be sleepy and have some pain after surgery. Caregivers may want your child to take deep breaths and cough. This can help to get some of the medicine out of the lungs. Your child should not sit up or get out of bed until caregivers say it is OK.

  • Emotional Support: You may stay with your child for comfort and support. Your child may need to stay in the hospital for more than a day. Ask a caregiver if you or another family member can stay with your child. If you or another family member cannot stay, bring in something from home that your child likes. This may include a blanket, a favorite toy, or clothing. You may want to bring one of these items for your child even if you can stay.

  • Activity: Caregivers will tell you what position your child should be in after surgery. Your child may need the head of the bed slightly elevated or flat for a while.

  • Bandages: A bandage may be around the top of your child's head. Another bandage may be on your child's belly or collarbone. These bandages should stay on until caregivers take them off. If any bandages come off, tell a caregiver so they can be put back on. Some children will not have any bandages.

  • Bathing: A caregiver will tell you when your child can take a bath and wash his hair. Your child may not be able to wash his hair for a couple of days. The scalp (skin on the head) may be sore when the hair is first washed.

  • Eating: Your child may be able to eat when bowel sounds (stomach growling) are heard. A caregiver will listen to your child's stomach for bowel sounds using a stethoscope. A caregiver will then let you know what your child can eat. Ice chips are usually given first and then liquids (water, broth, apple juice, or clear soda). If your child does not have problems after drinking liquids, a caregiver may let your child eat soft foods. Some examples of soft foods are ice cream, applesauce, or pudding. If your child does OK with soft food, he may begin eating a regular diet.

  • Oxygen: Oxygen may be needed to treat after surgery. Your child may need a nasal cannula (small tubes placed in the nose) or mask. Many children don't like having these on their face. So, a caregiver may place an oxygen mask next to your child's face. A caregiver will decide which oxygen device is needed for your child. You or your child should not take the oxygen off until a caregiver has said it is OK.

  • Shunt Tap: This is done if caregivers want to check for an infection in the CSF. An area on the skin of your child's head is cleaned with a special soap. Then a small needle is put into the pump under the skin of your child's head. This can be done while your child is awake and in bed. When the CSF is collected it is sent to the lab for testing.

  • Medicines:

    • Antibiotics: This may be given to help your child fight an infection caused by a germ called bacteria. Antibiotics are usually given through an IV or your child's mouth. They are sometimes given as a shot. Some people are allergic to antibiotics. Tell a caregiver if you know your child is allergic to antibiotics.

    • Anti-Nausea Medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up). Your child may have an upset stomach after surgery or from taking pain medication. Anti-nausea medicine will usually be given through an IV or in your child's rectum (rear-end).

    • Fever Medicine: This medicine is given to help lower a fever. Bringing down the fever should help your child feel better.

    • Pain Medicine: Caregivers may give medicine to help your child's pain go away. This medicine can be given by mouth, through an IV, in the rectum (rear end), or by shot. Tell a caregiver if your child's pain does not go away or comes back after taking this medicine. Pain medicine can have some side effects. Tell a caregiver if your child has trouble breathing, is very sleepy, or has an upset tummy. Tell a caregiver if you know your child is allergic to pain medicine.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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