Ventriculoperitoneal Shunt (VP) Placement

What is Ventriculoperitoneal Shunt (VP) Placement

Ventriculoperitoneal shunt (VP) is a medical device that drains fluid from the brain into a sac in the abdomen (peritoneum). This fluid normally surrounds and protects the brain and spinal cord (cerebrospinal fluid, CSF).

The drainage pathways in the brain absorb CSF as needed. If the brain’s drainage pathways are not working properly, too much CSF builds up in the brain. This can lead to swelling and pressure in the brain (hydrocephalus).

The Ventriculoperitoneal shunt is made of two thin tubes (catheters) and a valve. A catheter is placed in the brain, and a valve is placed behind the ear. CSF drains from the catheter into the valve, and then another catheter drains the fluid into the abdomen.

Your health care provider will determine how much fluid needs to be drained and will adjust settings on your Ventriculoperitoneal shunt.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have, including history of blood clots or blood problems.
• Any surgeries you have had, especially abdominal surgery.
• Any medical conditions you have, as well as your past medical history, especially diabetes or seizure disorders.
• Whether you are pregnant or may be pregnant.
• Any recent fevers, illnesses, or infections.

What are the risks of Ventriculoperitoneal Shunt?

Generally, Ventriculoperitoneal Shunt is a safe procedure. However, problems can occur and include:

• Bleeding.
• Blood clots.
• Infection.
• Brain damage.
• Allergic reactions to medicines.
• Damage to tissues, nerves, or organs in the abdomen.
• The shunt leaking, becoming blocked, or not working (malfunctioning).
• Needing to replace or reposition the shunt.

What happens before the Ventriculoperitoneal Shunt procedure?

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Ask your health care provider what steps will be taken to help prevent infection. These may include:
  • Removing hair from your scalp, neck, chest, and abdomen.
  • Washing skin with a germ-killing soap.
  • Antibiotic medicine.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the Vp shunt procedure?

• An IV will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic). You may also be given a medicine to help you relax (sedative).
• A breathing tube will be placed into your throat.
• An incision will be made in your scalp, usually behind your ear. Another incision will be made in your abdomen.
• A flap of scalp will be lifted to expose a small area of your skull.
• A small hole will be drilled into your skull.
• A catheter will be placed into a fluid-filled cavity (ventricle) in your brain.
• Another catheter will be inserted under your skin, behind your ear. This catheter will be moved under your skin (subcutaneously) down your head, neck, and chest, until it reaches the incision in your abdomen.
• A tube that has a light and camera on the end of it (endoscope) may be inserted through your abdominal incision. This helps make sure that the catheter is positioned correctly in the peritoneum.
• A valve will be placed under your skin, usually behind your ear.
• Both catheters will be connected to the valve, and tested.
• The valve will be opened to allow excess CSF in the brain to flow through the catheter and into the abdomen. The valve will do this automatically when excess pressure builds up in the brain.
• The flap of scalp that was lifted to expose the skull will be put back in place.
• Your incisions will be closed with staples or stitches (sutures) and covered with bandages (dressings).

The procedure may vary among health care providers and hospitals.

What happens after the vp shunt procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• You will lie flat for a while after surgery, and get up slowly.
• Do not drive for 24 hours if you were given a sedative.

Summary

• A ventriculoperitoneal shunt is a medical device that is used to drain fluid from the brain into a sac in the abdomen (peritoneum).
• The shunt is made of two thin tubes (catheters) and a valve. One catheter is placed in the brain, one catheter is placed in the abdomen, and a valve is placed behind the ear.
• You will be given a medicine to make you fall asleep (general anesthetic) for this procedure.

Care After Ventriculoperitoneal Shunt Placement

Here is the information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the Ventriculoperitoneal Shunt Placement ?

After the vp shunt placement, it is common to have some swelling and soreness:

• Around your scalp incision.
• Around your abdominal incision.
• In your neck and chest on the side of your shunt.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Driving

• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandages (dressings). If soap and water are not available, use hand sanitizer.
  • Change your dressings as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
• Rest and return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

General instructions

• Before you have any type of procedure, tell all health care providers that you have a ventriculoperitoneal (VP) shunt.
• Make sure you know what kind of VP shunt you have. Some shunt settings cannot be changed after they have been set (nonprogrammable shunt). Others can be adjusted (programmable shunt) by your health care provider.
  • If you have a programmable shunt and you need an MRI, it is very important to talk to your surgeon before you have the MRI. Many programmable shunts are sensitive to the magnets used during MRIs.
• If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
  • Take an over-the-counter or prescription medicine for constipation.
• Follow instructions from your health care provider about any eating or drinking restrictions.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you:

• Have a poor appetite.
• Have low energy.
• Feel restless, confused, or irritable.

Get help right away if you have:

• A fever.
• Redness, more swelling, or pain around an incision.
• Fluid or blood coming from an incision.
• An incision that feels warm to the touch.
• Pus or a bad smell coming from an incision.
• An incision that opens up.
• Any signs or symptoms that your shunt is not working properly (malfunctioning). These include:
  • Headaches.
  • Nausea and vomiting.
  • Swelling along where the VP shunt is.
  • Changes in your vision.
• No control over when you urinate (bladder incontinence).
• A seizure.
• Trouble walking.

Summary

• Follow all of your health care provider’s recommendations for medicines, activity restrictions, and incision care.
• Rarely, serious side effects can occur. Contact your health care provider immediately if you develop a fever, signs of infection around an incision, headache, changes in vision, or if you have a seizure.
• Keep all follow-up visits as told by your health care provider. This is important.

Ventriculoperitoneal Shunt Home Guide

A ventriculoperitoneal shunt is a small plastic tube that is used to drain the cerebrospinal fluid (CSF) from your brain into the space in your abdomen (peritoneum). The peritoneum absorbs this fluid and gets rid of it.

The CSF cushions your brain and spine. Normally, your brain releases this fluid and then reabsorbs it through drainage channels. If your brain’s drainage channels are not working properly, this fluid builds up and will need to be redirected with a shunt.

You may need a VP shunt if you have too much CSF inside your brain (hydrocephalus).

Your health care provider determines how much fluid needs to be drained and adjusts the settings on the shunt. Some shunt settings cannot be changed after they have been set (nonprogrammable shunt).

Others can be adjusted by your health care provider (programmable shunt). You may feel the tube behind your ear and under your skin where it passes down your neck and your chest before it enters your abdomen.

If you have a shunt, you need to take certain precautions and be aware of signs that may indicate a problem with the shunt. After your shunt is placed, it is important to have the following information with you:

• The contact information for the surgeon who placed your shunt.
• The name and type of VP shunt that you have.

When will I have my Ventriculoperitoneal Shunt removed?

Your Ventriculoperitoneal Shunt may be temporary or permanent, depending on your condition. For some people, a VP shunt is a lifelong device.

What precautions must I follow?

• Contact your health care provider if you have a programmable shunt and need to have an MRI for any reason. This is very important because many programmable shunts are sensitive to magnets in MRI machines.
• Tell your health care provider about your shunt before you have surgery, especially abdominal surgery. You may need to take antibiotic medicines before having a procedure.
• Do not wear tight-fitting hats or headgear.
• Ask your health care provider which activities are safe for you.

What are the warning signs of a shunt malfunction?

A Ventriculoperitoneal shunt can malfunction or become clogged. If the shunt is not working properly, it will not drain the CSF.

This can cause an increase in brain pressure. It is important to know the warning signs of a shunt malfunction because they can start suddenly.

Warning signs of a malfunction include:

• A headache that gets worse over time.
• Vomiting without cause.
• Feeling sleepier than usual.
• Loss of appetite.
• Low energy.
• Irritability.
• Personality change or confusion.
• Vision changes, such as blurry vision, double vision, or loss of vision.
• Swelling of the skin that runs along the path of the shunt.
• A return of your original symptoms.
• Trouble walking.
• Inability to control your bladder (urinary incontinence).
• Having a seizure.

What are the warning signs of a shunt infection?

If germs (bacteria) get into the tissue around the shunt, you can develop an infection. This can cause your shunt to stop working properly.

Watch for signs of infection, such as:

• Fever.
• Redness or swelling of the skin along the shunt path.
• Pain around the shunt or shunt tubing.
• A headache or a stiff neck.
• Nausea or vomiting.

Get help right away if you:

• Are sleepier than usual or have trouble waking up.
• Vomit for no reason.
• Have a fever.
• Notice redness or swelling along the shunt path.
• Have a headache that is getting worse.
• Start to twitch or shake (seizure).
• Develop vision problems.
• Lose coordination or balance.
• Become irritable or start to behave abnormally.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• A ventriculoperitoneal shunt is a small plastic tube used to drain the cerebrospinal fluid (CSF) from your brain into your peritoneum.
• You may need a VP shunt if you have hydrocephalus. Your shunt may be temporary or permanent, depending on your condition.
• A VP shunt can malfunction or become clogged. If the shunt is not working properly, it will not drain the CSF. The shunt can also get infected.
• Warning signs of shunt malfunction include headache, vomiting, drowsiness, loss of appetite, low energy, irritability, vision changes, urinary incontinence, and seizures.
• Warning signs of shunt infection include fever, redness or swelling of skin along the shunt path, pain around the shunt, headache, stiff neck, nausea, or vomiting.