Prep
Have patient seated upright
Prepare tap site in sterile manner using iodine (hair does not need to be shaved)
23ga needle or butterfly attached to a manometer is inserted into the reservoir
If no fluid returns or flow ceases, a proximal obstruction is likely
Measure opening pressure (nl = 12 +/- 2)
Measure while reservoir outflow is occluded
Opening pressure >20 indicates distal obstruction; low pressure indicates proximal
Fluid removal (for increased ICP)
Remove slowly to avoid choroid plexus bleeding
Remove until pressure is 10-20
Have patient seated upright
Prepare tap site in sterile manner using iodine (hair does not need to be shaved)
If no fluid returns or flow ceases, a proximal obstruction is likely
Measure while reservoir outflow is occluded
Opening pressure >20 indicates distal obstruction; low pressure indicates proximal
Remove slowly to avoid choroid plexus bleeding
Remove until pressure is 10-20
Ventriculoperitoneal shunt drainage
Therapeutic hypothermia
Lumbar puncture
Ventriculoperitoneal shunt obstruction
Acetazolamide
Transjugular intrahepatic portosystemic shunt
Ventriculoperitoneal shunt infection
Ventriculoperitoneal shunt overdrainage