NURS-07. PROGRAMMABLE VP SHUNTS: INDICATIONS, SAFETY AND WARNINGS

Abstract

Tumor-associated hydrocephalus is common in pediatric patients with brain tumors, often necessitating placement of a permanent ventriculoperitoneal (VP) shunt. The programmable VP shunt has a magnetic externally adjustable valve that provides the option of changing the opening pressure (valve setting) to regulate the outflow of cerebrospinal fluid (CSF). Maximal resistance adjustments can be used for the administration of chemotherapy or radioimmunotherapy. Integrated reservoirs also provide an easy source of diagnostic CSF sampling. Strong magnetic field interference may cause an unintended change in valve setting. Newer models have a mechanism that provides security against inadvertent readjustment caused by MRI 3 Tesla or less. At MSKCC, 52 pediatric patients with various programmable VP shunt models have been treated. Intrathecal radioimmunotherapy or chemotherapy was given to 17 (33%), all without complication. CSF sampling from the VP shunt was well tolerated without any known iatrogenic infections. The ease of shunt reprogramming varied among the different models;1 patient (2%) presented with an unintentional valve setting change. Nurse practitioners and nurses play a vital role in the successful management of patients with a programmable VP shunt. Knowledge about the indications and management of programmable shunts, associated complications, magnetic field safety, MRI safety, shunt reprogramming technique, and nursing considerations is critical.