Recovery From Surgery for Managing Hydrocephalus with a Shunt in Children

Postoperative Orders 

• ICU vs. standard care unit: Most patients can stay in the recovery room immediately after shunt placement and then be transferred to a regular ward. Critically ill patients and premature babies must be transferred to the ICU/NICU unit after surgery.
• Vital signs checks: Standard VS checks are recommended for these patients. Critically ill patients must be placed under continuous monitoring.
• IVF and rate: IV fluids should be continued in the postoperative period until proper tolerance to oral intake has been established.
• HOB, positioning, activity, bathing: In some cases, patients with large ventricles are nursed relatively flat in the first 24 hours to avoid subdural collections. Patient with thin skin, i.e., premature infants and neonates, should avoid lying on the shunt valve to prevent skin erosion.
• Medications and dosages including PRN drugs: Adequate analgesia is usually obtained with acetaminophen, supplemented with NSAIDs or opiates. Antiemetic drugs should be used if persistent nausea or vomiting is present. Postoperative doses of the antibiotic administered during anesthetic induction can be administered, according to institutional protocols. In all cases, the use of prophylactic antibiotics should not exceed 24 hours.
• Laboratory studies: CSF sampling can be obtained from multiple points in the system during its assembly or prior to its internalization distally. Gram stain, fungal tests, culture, and antibiogram can be done as needed.
• Radiology studies: Early postoperative imaging (x-rays, ultrasound, or CT) is optional, particularly if there are any concerns.
• Education: Education must be provided to parents or caregivers about signs warning of shunt malfunction that may occur and should warrant a call to the surgeon.
• Discharge within 48 hours: Most children can be discharged within 1 or 2 days of their surgery.

Postoperative Morbidity

• Frequent symptoms: Common symptoms after shunt surgery include mild pain in surgical wounds, neck discomfort, bruising along the shunt tract, mild nausea and occasional vomiting, dizziness with position changes, and mild headache. Parents and caregivers can be reassured about these symptoms.
• Alarm signs: Families should be counseled about alarm signs, such as fever, redness or hyperthermia along the shunt tract, intense headache, persistent vomiting, seizures, CSF leaks, wound secretions, abdominal pain or tenderness, lethargy, or new focal symptoms. If they occur, the child must be brought to the Emergency Unit as soon as possible.