Suspected Neurosurgical Shunt Malfunction Pathway Background & Objectives Ventriculoperitoneal (VP) shunt insertion remains the mainstay of treatment for hydrocephalus despite a high rate of complications. In the United States alone, more than 30,000 procedures to relieve hydrocephalus are performed every year. The 1-year failure rate for VP shunts had been reported at around 40-50% for pediatric patients. VP shunt malfunction remains the most frequent reason for shunt revisions and one of the most frequent complication. Early recognition and treatment improves patient outcomes and decreases hospital stays. The specific objectives of this clinical pathway are to: Improve recognition of shunt malfunction on presentation to ED Initiate appropriate care for patient with suspected shunt malfunction Prevent delay in treatment and management Improve standard of care Improve patient and family satisfaction Algorithm Download Suspected Shunt Malfunction Pathway Algorithm Updated February 12, 2021 Quality Metrics Percent of patients with pathway order set usage Percent of patients with deep wound infections Percent of patients with superficial wound infections Number of patients with organ space infection within 30 days of principal operative procedure Number of patients with shunt malfunction within 90 days of principal operative procedure Percentage of patients with cerebrospinal fluid leak Number of readmissions within 30 days Number of patients with return to the OR within 30 days Educational Module Download Suspected Shunt Malfunction Educational Module Updated February 12, 2021 Key References Aldrich EF, Harmann P. Disconnection as a case of ventriculoperitoneal shunt malfunction in multicomponent shunt systems. Pediatr Neurosurg. 1990-1991;16(6):309–312. Colak A, Albright AL, Pollack IF. Follow-up of children with shunted hydrocephalus. Pediatr Neurosurg. 1997 Oct;27(4):208–210. Kaplan M, Cakin H, Ozdemir N, Gocmez C, Ozturk S, Erol FS. Is the elapsed time following the placement of a ventriculoperitoneal shunt catheter an individual risk factor for shunt fractures? Pediatr Neurosurg. 2012;48(6):348–351. Lee TT, Uribe J, Morrison G, Jagid JR. Unique Clinical Presentation of Pediatric Shunt Malfunction. Pediatr Neurosurg. 1999;30(3):122–126. Pathway Contacts Nella Stoltz, APRN DNP Marcus Bookland, MD Jonathan Martin, MD Disclaimer The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case. View all Clinical Pathways >
