Ventricular Peritoneal Shunts
Objective
In cases of hydrocephalus:
• The insertion of a valve system to relieve tension of cerebrospinal fluid from the ventricular system.
Position
Supine, patient head is slightly elevated and turned to the left.
Anesthesia
Local.
Procedure
1. Lines are marked for a right-sided shunt incision.
2. The scalp is incised.
3. The burr hole site in the periosteum is electrocoagulated.
4. The periosteum is incised.
5. Burr hole is made.
6. The dura is electrocoagulated and the outer layer incised.
7. Straight ventricular catheter is passed.
8. A premeasured length of catheter is advanced anterior to the foramen of Munro.
9. The transverse abdominal incision is carried down to the anterior rectus sheath.
10. A distal catheter is passed from the scalp incision to the abdominal incision subcutaneously.
11. The reservoir is attached to the proximal end.
12. A longitudinal incision is made in the anterior rectus sheath.
13. The peritoneum is grasped and incised (1 mm).
14. The peritoneal catheter, passed intraperitoneally, is attached to the reservoir.
15. Wounds may be irrigated with antibiotic solution.
16. The abdominal wound is closed.
17. The scalp incision is closed.
Instruments
• Craniotomy set
• Power drill, cord
• Small bull dog clamp
• Uterine packing forceps or a long passing instrument
• Basin set
• Blades (2) No. 15
• Sterile, plastic adhesive drape
• Suction tubing
• Plastic syringe (3 ml) and blunt needle (18 gauge) to pump through shunt reservoir and tubing
• Shunt
• Bulb syringe
• Graduate
• Cottonoids
• Gell foam and thrombin
• Antibiotic irrigation.
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