Ataxia s/p Brain Tumor

[LockportRN]

First off, I will state that I am not a neuro nurse but could use your valueable input!

I will be caring for a patient with a resected brain tumor that had a shunt placed which remains very unstable, with his last revision done about 3 1/2 weeks ago. At times he has too much fluid buildup and at others it drains too much to the point he will get severe headaches upon sitting.

What are signs that I may need to send him to the ER for shunt failure? Does a shunt failure happen quickly, or slowly with symptoms worsening? Is it always an emergency or do the fluid shifts even out?

Any advice you can give in regards to caring for a person with these types of problems would be greatly appreciated.

Thanks in advance!

[KelRN215, BSN, RN]

Headache, lethargy, vomiting would be the early signs. Yes, a shunt malfunction needs emergency attention. Does he have a programmable shunt? Shunt failure can be abrupt or it can be gradual. Hydrocephalus should not be taken lightly- people have died d/t shunt failures that were not treated fast enough. There was a sentinel event at the hospital I worked at years before I worked there of a baby with hydrocephalus. No one could reach the attending neurosurgeon over night and the resident decided the patient could wait until the next morning. The patient had respiratory arrested by the time anesthesia came to get consent and she died a few days later. There was Board Discipline for the MDs involved and, I believe, a large lawsuit.

[LockportRN]

Thanks for your response. My first instinct is to send to the ER. They have been there so many times and have had no hydrocephalus diagnosed but 'headache' that it becomes frustrating to know when to go to the ER for them.

I have heard of new device made that is based on temperature of shunt placement equalling the temp down the path of the shunt. Do you know if it is use as of yet?