VP shunt...yikes

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Specializes in Med-Surg/Oncology, Psych.

Hi guys,

Today I had a pt come up from the PACU who was s/p VP shunt revision. Apparently his previous VP shunt had had a crack in it, and was leaking CSF fluid. For the pt, this manifested as increasingly painful headaches. He came to me, VSS, neuros WNL (with the exception of being disoriented to date), PERRLA, everything looking good. After he had been on the floor for a few hours, I was getting ready to leave his room, and he said "come here. Listen to this." Having no idea what he was talking about, I put my head near the head of the bed. What I heard was an audible sloshing noise coming from this guy's head, clear as day, just as if there were a pair of tiny boots walking through a puddle. :uhoh3: I called the neurosurgical PA immediately, who mentioned that there had been a large amount of fluid built up due to the broken VP shunt, but she also said that it was unusual. No new orders. My question to everyone is, have you ever been able to hear fluid in a patient's head? We rarely deal with shunts on our floor and it just rattled me a bit. I had to clarify to the PA that it was me, the RN, who heard the sloshing, not just the pt. The pt is still fine, VSS, neuros intact. Anyone have any experience with this? Thanks!

-Erin

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Specializes in Med-Surg/Oncology, Psych.

To clarify, I heard the sloshing as the pt was quickly putting his head back onto the pillow from an upright sitting position, not when he was sitting still. Thanks for any input!

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Specializes in Pediatric Rehabilitation.

Wow!! Never, in over 15 years of caring for VP shunt revisions have I heard of that!! I would think there would be some obvious neuro changes with that drastic pressure change.

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Specializes in chemical dependency detox/psych.

I've only had a couple of VP shunts--no sloshing. That would have freaked me out a bit, too.

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Specializes in ER.

Sloshing to me would mean that there was air getting in, as well as fluid leaking out. I would also have called the doc immediately, and expected him at the bedside. After that I'm clueless...

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Wow.....I've hear a lot of strange things....this is a new one on me. I'd risk being yelled at by the attending and call him.......I am seldom at a loss of words.....this is really weird. Let us know

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Specializes in Cardiac Step Down, PICU.

I agree with all of the above posters. I've never heard of this. I'll ask our Neuro surg. what he thinks but am curious as to what happened to your patient. Please give an update :)

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We commonly get patients s/p externalization of VPS, and never did I get any complaints of sloshing sound. I would be scared :eek: to hear it.

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Specializes in pediatrics.

My daughter has a shunt, has had a couple of revisions - have been connected to parents who have kids with hydrocephalus and shunted - have NEVER heard of anything like this. Very very weird.

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Specializes in Med-Surg/Oncology, Psych.

Hi guys!

Thanks for all the replies. Reviewed the sloshing again today with the neurosurgeon, who directed the day nurse to the CT scan of the pt's brain. I took a peek at it myself. About 40% of the space in his head is abnormal fluid collection.....it basically looked like the majority of the L hemisphere was missing and there was a collection of fluid instead. I wish I could share it with you! Unbelievable! The pt is still doing well, and having seen the diagnostics, I have an increased appreciation for how well he is able to function.

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Specializes in Cardiac Step Down, PICU.

Thanks for the update. It's truely unbelievable that he is functioning so well. I'm still trying to wrap MY brain around the fact that his is "sloshing" I do hope he has a positive outcome and that the sloshing goes away soon!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Hi guys!

Thanks for all the replies. Reviewed the sloshing again today with the neurosurgeon, who directed the day nurse to the CT scan of the pt's brain. I took a peek at it myself. About 40% of the space in his head is abnormal fluid collection.....it basically looked like the majority of the L hemisphere was missing and there was a collection of fluid instead. I wish I could share it with you! Unbelievable! The pt is still doing well, and having seen the diagnostics, I have an increased appreciation for how well he is able to function.

WOW! That's alot of fluid! I am glad the patient is doing so well! I hope that will continue....THX for sharing

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