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Ventricular Shunt Obstruction/Infection — Concern for Shunt Infection — Clinical Pathway: Emergency, ICU and Inpatient

Ventricular Shunt Obstruction/Infection Clinical Pathway — Emergency, ICU and Inpatient

Concern for Shunt Infection

High Risk
  • Fever and CNS Symptoms
    • Significant HA
    • Meningismus
    • Altered Mental Status
  • Pain, erythema over shunt site or tubing
Neurosurgical Notification
Neurosurgical
Consultation
  • Review labs, Brain CT for Hydro
  • Consider shunt cx/LP
  • Discuss indication for antibiotics with Neurosurgery
  • Consider ID consult for:
    • Bacteria identified on CSF gram stain
    • Positive CSF cultures
    • Other high suspicion for CSF infection
      (e.g., brain abscess or empyema)
Admit PICU or OR 4-5544
Discharge Criteria
Follow-up
Admit to Gen Peds/Adol
Re-evaluation
Moderate Risk
  • Symptoms of possible infection
  • No other clear diagnosis for current symptoms
  • Multiple visits for same symptoms
  • Vascular shunt
Neurosurgical
Consultation
ED Evaluation for Fever
Alternative
Diagnosis
ED Evaluation for Fever
Low Risk
  • Symptoms much more likely due to an alternative source
  • Baseline neurologic exam

 

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