of Ventricular Reservoirs
|Approved by Clinical Practice
|Re-Issued with minor changes
- Clinical symptoms of increased intracranial pressure. Symptoms may
- Apnoea, bradycardia
- Poor feeding
- Ultrasound evidence of progressive ventriculomegaly
- Low circulating blood volume
- Cellulitis or abrasion over reservoir site
- Sunken fontanelle
Aims of Treatment
Click here to open a graph of
plotted against head circumference for:
- Chlorhexidine 5% skin preparation solution
- 25 gauge butterfly needle (may need 23g if CSF tenacious)
- Standard infant lumbar puncture set
- Sterile drapes to allow for maintenance of a
- Maintain strict asepsis.
- Monitor and correct serum electrolytes every other day if more than 10ml
- Be prepared to provide rapid fluid replacement should infant not tolerate
large volumes removed. Replace fluid removed with intravenous normal saline.
- If skin breakdown occurs, select insertion site away from broken area.
- Do not place IVs on same side of scalp.
- Consider the use of
for analgesia if the baby meets the
- Place the infant with head in neutral position in anticipation of
a 20 to 25 minute procedure.
- Cut any long hair that interferes with the surgical area but do not shave
- Wearing sterile gloves, clean skin with chlorhexidine 5% over the reservoir
and a surrounding circle of skin with a diameter of 4cm.
- Use light but firm contact.
- Allow to dry (2 minutes).
- Position sterile drape to maintain a sterile
- Cut the hub from the butterfly tubing.
- Insert butterfly needle through skin just into reservoir bladder.
- Select an insertion site different from the one most recently used.
- Angle needle at 30 to 45 degrees from the skin.
- The base of the reservoir is metal so cannot
- 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.
- Limit total volume of CSF drained at each
tapping to no more than 30ml or 15ml/kg (whichever is less).
- The initial puncture should not exceed 10ml in volume and can be
increased on sequential taps at a rate of not more than 5ml/day.
- Sample CSF for culture, cell count, glucose and protein every three days.
- If fluid is blood-stained (from old haemorrhage), biochemical analysis
may not be helpful.
- Culture dark fluid every three days.
- Remove needle and hold firm pressure for 2 minutes or until CSF leakage
from skin stops.
- 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.
- The volume taken off each day should result in initial concavity of
the fontanelle, with some overlapping of the cranial sutures.
- If the sutures are still overlapping and the fontanelle concave the
following day, the interval between aspirations should be lengthened
- Follow response with cranial ultrasound scans.
Reservoirs are seldom removed even if they are no longer
- Local skin breakdown
- Hyponatraemia (check electrolytes every 2-3
- Wound or reservoir infection
- CSF leak from puncture site
- Obstruction of ventricular catheter
- May precipitate further haemorrhage if large amounts of CSF removed
|Fletcher M A, MacDonald M G,
Schoonover V: Atlas of Procedures in Neonatology 1993. Lippincott Williams
||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