Pumping a V-P shunt

[NurseyBaby'05, BSN, RN]

We recently had a pt who had severe brain mets and was a few weeks s/p crani and shunt placement. For us, his confusion and lack of impulse control continued to increase. Neurosurgery was reconsulted and wrote a MD to Nurse order to pump the pt's v-p shund 20x q2h.

We weren't comfortable doing it. We're an onc floor, not a neuro floor. Even when I did neuro, I don't ever remember doing that. Of course there was no p/p in place (probably b/c we weren't suppossed to doing it). Even when we called the NICU supervisor, she told us that they don't even do it there. The doctors do.

Is it really a doc procedure or a nurse procedure? And would you feel comfortable doing it?

As and aside, said pt was a DNR and probably only had a few more weeks in him at that point. It seems like it was to be done as more of a comfort measure. I guess they figured that we couldn't make things any worse. Dunno . . . . . . .

Any feedback would be greatly appreciated.

[XB9S, BSN, MSN, EdD, RN, APN]

It's not something I would feel comfortable doing and I think the fact you have said the same would suggest you already know the answer to what you have asked.

You sought advice from the neuro unit and they told you that it was not something they do either, I think that if you are going to be expected to undertake procedures that are deviating from normal practice then your hospital management should be putting in place procedures that provide guidence for the situations that they feel it would be acceptable for nurses to do such a thing.

At the end of the day if you are not comfortable with a procedure you have been asked to do then you don't do it.

[NurseyBaby'05, BSN, RN]

Thanks, Sharrie. That's why the Neurosurg person wound up transferring him to their floor. Of course, he was acting like there was something wrong with us for not doing it. I used to work on that other floor and I honestly don't remember us doing it there either.

The guy wasn't my pt. I probably would have done it in this case b/c I really don't think any further damage could have been done to the poor man. It also would have set a precedent though.

I honestly was just wondering if this was standard practice to pump a v-p shunt and was looking for a p/p for us to follow. I'll recheck with our educator on Mon and see if she was able to find anything out either.

[labman]

i work in a neuro icu and we never tap shunts never

[-MNC_RN-]

We dealt with something similar in our Trauma-neuro ICU. In our case it was decided by joint committee (physicians and nurses) to have specially trained charge RNs irrigate ventriculostomies toward the patient (we have always been able to flush them toward the drain), and administer intraventricular medications (antibiotics). Both of these were previously MD-only procedures.

After much investigation we discovered that AACN and AANN both discuss the need for nurses to be specially trained and validated to do these types of procedures; we found no legal contraindication in our state's NPA.

In the end, we started an education and training plan along with validation which includes return demonstration. The education plan included specifics to look for during pre- and post-procedure assessment, and our neurosurgeons were more than willing to oblige and list everything they would want to be called about.

While the staff was very nervous at first, they are much more comfortable with it now. We don't do it that much... maybe once or twice a month; we have annual validation of competency to keep the nurses current.

[EricJRN, MSN, RN]

An interesting question to me. My parents were taught to depress my own VP shunt (to verify refilling if I had s/s of a malfunction) back in the 70's and early 80's.

The current recommendations I've heard mostly discourage anyone touching the shunt other than neurosurgery. I'm surprised that routine pumping would fall under nursing responsibility.

At a recent PALS class, a group of pediatric residents told me, "Neurosurgery says not to touch them, but the peds ER guys do it all the time."

[NurseyBaby'05, BSN, RN]

Thanks for the feedback so far. It seems like it's more hands-off than hands-on for nursing staff. I wasn't sure if it was a regional thing with us or if it was across the board. Fortunately, this won't come-up too often, but I sure want our butts covered when it does.

[futbol84]

I've seen orders to pump a patients shunt and I've done it. Of course if the patient is with it enough they pump their own but most of the time on the hour or every 2 hours we pump the patients shunt.

[Floridanurse]

i work in a neuro icu and we never tap shunts never

i am confused about the question with you saying "tap" and her saying to "pump" the shunt. i say this because i have a friend who has had shunts his whole life and he has to pump his slightly at least every week to make sure it still flows. just like squeezing stripping chest tubes to keep them flowing in other words. all they do is use a finger and press down lightly on the shunt area on their head, so is this what the doctor meant? also, did anyone call the neuro floor charge nurse to ask about this type of order and maybe she could come and show you how to do it? we have done this in the past. we are often called to picu to show them how to deal with chest tubes, swann lines, etc as they don't often get them and off we go and are available for consult for their nurses anytime. we often have pregnant or post partum patients in our icu and we consult the ob floor for these patients. oncology nurses come to do chemo, etc. this makes everyone comfortable.