Drainage of Ventricular Reservoirs

 

Approved by Clinical Practice Committee
Re-Issued with minor changes
April  2015
Clinical Guidelines Back Newborn Services Home Page
Indications Contraindications Aims of Treatment Equipment
Precautions Technique Complications References

Ventricular Reservoir External appearance of reservoir

Indications

Contraindications

Aims of Treatment

Click here to open a graph of ventricular index plotted against head circumference for:

Equipment

Precautions

  1. Maintain strict asepsis.
  2. Monitor and correct serum electrolytes every other day if more than 10ml removed daily.
  3. Be prepared to provide rapid fluid replacement should infant not tolerate large volumes removed. Replace fluid removed with intravenous normal saline.
  4. If skin breakdown occurs, select insertion site away from broken area.
  5. Do not place IVs on same side of scalp.

Technique

  1. Consider the use of Sucrose for analgesia if the baby meets the criteria.
  2. Place the infant with head in neutral position in anticipation of a 20 to 25 minute procedure.
  3. Cut any long hair that interferes with the surgical area but do not shave operative area.
  4. Wearing sterile gloves, clean skin with chlorhexidine 5% over the reservoir and a surrounding circle of skin with a diameter of 4cm.
  5. Position sterile drape to maintain a sterile field.
  6. Cut the hub from the butterfly tubing.
  7. Insert butterfly needle through skin just into reservoir bladder.
  1. Allow the cerebrospinal fluid (CSF) to drip into the CSF collection bottles.  As the pressure reduces, the flow rate will reduce accordingly and this should be used as a guide for to when cease the procedure.
  2. Limit total volume of CSF drained at each tapping to no more than 30ml or 15ml/kg (whichever is less).
  3. Sample CSF for culture, cell count, glucose and protein every three days.
  4. Remove needle and hold firm pressure for 2 minutes or until CSF leakage from skin stops.
  5. Repeat drainage at intervals dictated by clinical response +/or ultrasound markers. Repeat once a day but as often as twice daily. Aim to improve daily volume sufficient to prevent progressive ventriculomegaly.
  6. Follow response with cranial ultrasound scans.

Reservoirs are seldom removed even if they are no longer needed.

Complications

References

1

Fletcher M A, MacDonald M G, Schoonover V: Atlas of Procedures in Neonatology 1993. Lippincott Williams & Wilkins.
2 Whitelaw A. Neonatal hydrocephalus - clinical asessment and non surgical treatment. In Fetal and Neonatal Neurology and Neurosurgery. Eds Levene MI, Chervenak FA, Whittle M. Publisher - Churchill LIvingstone 2001