PERIOP BRIEFING

PROCEDURE AT A GLANCE

Ventriculoperitoneal shunt

IN D ICATIONS F OR PROCEDUR E
A ventriculoperitoneal (VP) shunt transfers fluid
from the lateral ventricle to the peritoneal cavity.1
It is placed to permanently control hydrocephalus,
which can be caused by such conditions as spina
bifida, tumors, intracranial or intraventricular
hemorrhage, aqueductal stenosis, and Chiari
malformations.2 The surgeon decides what type
of shunt to use and the location of insertion (i.e.,
frontal, parietal, occipital).2

PAT IE NT POSITIONING
Patients are placed in a modified supine position,
with the head placed right or left on a donut,
depending on shunt placement. A shoulder roll is
also used.2 BASIC WORKFLOW FOR PROCEDURE
To place a VP shunt, the surgeon will
1. make a U-shaped incision;
2. retract the skin flap;
3. free the periosteum from the skull;
4. make a 1- or 2-centimeter burr hole;
5. coagulate and incise the dura;
6. use an electrosurgical unit to coagulate the pia
at the site where the catheter will be inserted;
7. insert a ventricular catheter perpendicularly into
the lateral ventricle using an introducer;
8. after the ventricle is penetrated and the
introducer is removed, confirm flow of
P RE PARING FOR PROCEDURE cerebrospinal fluid (CSF);
• Neurologic assessment (e.g., Glasgow Coma 9. attach and secure the reservoir and valve;
Scale) is performed in patients preoperatively to 10. create a subcutaneous tunnel from the burr hole
determine a baseline and postoperatively to assess to a neck incision;
neurologic status. 11. connect the peritoneal catheter;
• The patient’s hair is removed from the location 12. make a subxiphoid or lateral abdominal incision
of the burr hole to behind the ear and reaching to expose the peritoneum;
down to the neck. 13. tunnel from the neck to the abdomen;
• For skin antisepsis, the location of the burr hole, 14. pass the catheter through the tunnel;
neck, chest, and abdomen on the side where the 15. confirm CSF flow;
shunt will be placed are prepped. 16. pass the distal end of the peritoneal catheter
• The VP shunt system includes ventricular and into the peritoneal cavity;
peritoneal catheters, a reservoir, and a valve. After 17. leave additional length of the catheter to allow
assembly and before implanting the system, it is for movement or growth; and
placed in normal saline and antibiotic solution 18. affix the catheter to the peritoneum with sutures
and primed.2 and close the incisions.2

10.1002/aorn.12029
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VENTRICULOPERITONEAL SHUNT

PO S S IBL E C O M PL ICATIO N S
• Approximately one-half of shunts require
replacement or revision after six years.3 They
can fail because of such causes as obstruction,
disconnection, malfunction, or infection.2
• Other complications include
o subdural or intracerebral hematoma,
o seizures, and
o abdominal problems (e.g., pseudocysts, bowel
perforation, hernia).5
• Symptoms and signs that there may be a
complication with the shunt include
o vomiting;
P RO CE DURAL VARIATIONS
o headache;
• The peritoneum is the most common location for
o vision problems;
drainage, but if this placement is contraindicated
o tiredness, or difficulty waking up or staying
(e.g., infection), other options include the right
awake;
atrium of the heart (ventriculoatrial shunt),
o swelling or redness near the shunt tract;
pleural cavity (ventriculopleural shunt), or
o changes in personality;
gallbladder (ventriculo-gallbladder shunt).2-4
o loss of balance or coordination;
• The catheter may be placed in the ventricle via
o declining performance at work or school; and
endoscopy.1
o fever.6
• A temporary externalized ventriculostomy
catheter can also alleviate intracranial pressure,
making it an alternative treatment option.1,2 To
place an externalized ventriculostomy catheter, the
surgeon will
1. make a burr hole to access the right or left
ventricle;
2. pass the catheter into the ventricle;
3. confirm CSF flow;
4. pass the distal end of the catheter beneath the
scalp, posterior to the burr hole;
5. affix the catheter to the scalp with sutures; and
6. attach the externalized end of the catheter to a
drainage system.2

P OSTOPERATIVE RECOVERY CO U R S E
• The patient is typically observed for 24 hours, and hospitalization lasts approximately two to five days.3,7
• Physical or occupational therapy or rehabilitation may be recommended.3
• Computed tomography may be performed one to two days after surgery to confirm correct placement of the
catheter.7
• The incision staples or stitches will be removed seven to 10 days after surgery.7
• Patients should avoid activities in which they may hit their heads for six weeks.8
• Education for the patient and his or her family is important to assist the patient in returning to his or her
optimal quality of life.2
• The patient and family should be taught how to monitor for and recognize possible complications (e.g.,
weakness, seizures, pain, infection, change in mental status).2

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RE FE RE NCES
1. Perioperative pediatrics. In: Phillips N. Berry & Kohn’s Operating Room Technique. 13th ed. St. Louis, MO: Elsevier
Mosby; 2017:118-152.
2. Germanovich SJK. Neurosurgery. In: Rothrock, JC, McEwen DR, eds. Alexander’s Care of the Patient in Surgery. 15th
ed. St. Louis, MO: Elsevier Mosby; 2015:768-822.
3. Neurology and neurosurgery. Johns Hopkins Medicine. http://www.hopkinsmedicine.org/neurology_neurosurgery/
centers_clinics/cerebral-fluid/procedures/shunts.html. Accessed November 14, 2017.
4. Hasslacher-Arellano JF, Arellano-Aguilar G, Funes-Rodríquez JF, López-Forcén S, Torres-Zapiain F, Domínguez-
Carrillo LG. Ventriculo-gallbladder shunt: an alternative for the treatment of hydrocephalus [in Spanish]. Cir Ciruj.
2016;84(3):225-229.
5. Complications of shunt systems. Hydrocephalus Association. http://www.hydroassoc.org/complications-of-shunt-
systems/. Accessed November 14, 2017.
6. Signs and symptoms of complication. Hydrocephalus Association. http://www.hydroassoc.org/signs-and-symptoms-
of-complication/. Accessed November 14, 2017.
7. About your ventriculoperitoneal (VP) shunt surgery. Memorial Sloan Kettering Cancer Center. https://www.mskcc.
org/cancer-care/patient-education/about-your-ventriculoperitoneal-vp-shunt-surgery. Updated April 3, 2017.
Accessed November 14, 2017.
8. Ventriculoperitoneal shunt surgery: what to expect at home. Kaiser Permanente. https://healthy.
kaiserpermanente.org/health/poc?uri=content:health-encyclopedia&hwid=zy1684&locale=en-
us&type=pi&kpSearch=Ventriculoperitoneal%20Shunt%20Surgery. Accessed November 14, 2017.

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