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

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient with Suspected Ventricular Shunt
Obstruction or Infection

Triage

Transfer Adult
Patient to HUP

History and Physical Exam

Concern for Shunt Malfunction

Concern for Shunt Infection

Critical ICP Management

Airway Management
IV Access, NPO
3% saline (5 mL/kg IV bolus)
Consider Tapping Shunt
Brain CT for Hydro

Imaging Recommendations

Brain CT for Hydro
Indications for Shunt
Radiographs
Abdominal Ultrasound

Antibiotic Recommendations

for Suspected Shunt Infection

Recommended Laboratory Studies

Analgesia /
Antipyretics

Posted: July 2014
Revised: March 2016, January 2018 (Reviewed), May 2018
Authors: G. Heuer MD; R. Marchese MD; J. Zorc MD; E. Schwartz MD; C. Harris MD; D. Albert RN;
T. Metjian PharmD; J. Gerber MD, PhD, L. Bell MD, J. Huh MD

Learn more

George KJ, Roy D. A low radiation computed tomography protocol for monitoring shunted hydrocephalus. + Surg Neurol Int. 2012; 3: 103.
Udayasankar UK, Braithwaite K, et al. Low-Dose Nonenhanced Head CT Protocol for Follow-Up Evaluation of Children with Ventriculoperitoneal Shunt: Reduction of Radiation and Effect on Image Quality. + AJNR April 2008; 29: 802-806.
Zorc J, et al. Radiographic evaluation for suspected cerebrospinal fluid shunt obstruction. Pediatric Emergency Care 2012; Vol. 18, No. 5.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.