Ventricular Shunt Obstruction/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
Consultation
- IV access, labs, blood/urine cx, NPO
- Brain CT for Hydro
- Consider US if abdominal pain or unreliable abdominal examination (myelomeningocele)
- Analgesia/Antipyretics
- 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
Follow-up
Admit to Gen Peds/Adol
Re-evaluation
Re-evaluation
Moderate Risk
- Symptoms of possible infection
- No other clear diagnosis for current symptoms
- Multiple visits for same symptoms
- Vascular shunt
- As clinically indicated
- labs, CXR, UA
- Consider US if abdominal pain
- Analgesia/Antipyretics
Neurosurgical
Consultation
Consultation
- Consider Brain CT for Hydro
- Consider shunt cx/LP
ED Evaluation for Fever
Alternative
Diagnosis
Diagnosis
ED Evaluation for Fever
Low Risk
- Symptoms much more likely due to an alternative source
- Baseline neurologic exam