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About Your Programmable VP Shunt for Pediatric Patients

This information will help you learn about your programmable ventriculoperitoneal (VP) shunt. For the rest of this resource, our use of the words “you” and “your” refers to you or your child.
 
A VP shunt is used to drain extra fluid that circulates around the brain and spinal cord. This fluid is called cerebrospinal fluid (CSF). It is found in the ventricles of the brain and the spinal canal. If too much CSF is in the ventricles, it puts pressure on the brain and skull. This is called hydrocephalus (see Figure 1).
 
Figure 1: Brain without and with hydrocephalus Figure 1: Brain without and with hydrocephalus
To help drain the extra CSF from the brain, a VP shunt is inserted into the head. The shunt takes the fluid out of the brain and moves it into the abdomen, where it is absorbed by the body. This decreases the pressure and swelling in the brain.
 
Figure 2: VP shunt Figure 2: VP shunt A VP shunt has 3 parts (see Figure 2):
 
  • A one-way valve and reservoir 
  • A short catheter (thin, flexible tube)
  • A long catheter 
The valve controls the flow of fluid. It is attached to the short catheter to drain the fluid away from your brain. The short catheter can be placed in the front, back, or side of your head. The long catheter is also attached to the valve. It is then tunneled under your skin, behind your ear, down your neck, and into your abdomen. 
 
As the VP shunt drains excess CSF and decreases the pressure in your brain, it may relieve your symptoms. Some symptoms will disappear immediately after the VP shunt is inserted. Others will go away more slowly, sometimes over a few weeks. 
 
Below are common questions that people have about a programmable VP shunt.
 

How will my programmable VP shunt be placed?

Your programmable VP shunt will be placed during surgery. Your nurse will give you more information about it.
 

What does “programmable” mean?

“Programmable” means that your doctor can adjust how much fluid is drained by your VP shunt, even after it has been placed. The amount is changed by adjusting the pressure setting.
 

What do the different shunt settings mean?

In general, a higher shunt setting means that less fluid is being drained. A lower setting means that more fluid is being drained. The settings vary for each manufacturer.  
 
Write down the type of programmable VP shunt that you have and the pressure setting below and keep this information with you at all times.
 
Type of programmable VP shunt: ____________________________  
 
Pressure setting: ____________________________  
 

Your nurse will also give you a wallet card that states you have hydrocephalus with a programmable VP shunt. Carry it with you at all times.

Can a programmable VP shunt be used to give certain medications?

Yes. Some antibiotics, chemotherapy medications, and monoclonal antibodies can be given through the shunt reservoir. The shunt can then be turned off for several hours.
 

What precautions do I need to take if I have a programmable VP shunt?

Magnets

The pressure setting of some programmable VP shunts may accidently change if you come too close to a magnet. This depends on the model.
 
Ask your neurosurgeon if you need to take precautions when coming into contact with magnets. Be sure to follow the manufacturer’s guidelines for magnetic field precautions specific for your type of shunt.
 
Here are some general rules for many shunts:
 
  • Keep all products with magnets at least 2 inches away from the valve implant site.
  • Do not use magnetic therapy pads and pillows.
  • Do not use the iPad 2 if you have a Medtronic Strata® programmable VP shunt.
  • Do not use audio headsets without checking the shunt manufacturer’s guidelines.

Magnetic resonance imaging (MRI)

If you are having magnetic resonance imaging (MRI), you must tell your MRI technologist that you have a programmable VP shunt before you have the procedure. Your technologist will need to know the model of your shunt and the setting. You can show your technologist the wallet card that your nurse gave you.
 
Depending on the model of your programmable VP shunt, the magnet in the MRI scanner may change your shunt’s pressure setting. After your MRI, the pressure setting will need to be checked and/or reprogrammed by your neurosurgeon or nurse practitioner. You may need to have x-rays to help determine if the pressure setting has changed. 
 
Before you have your MRI, you must make arrangements with your neurosurgeon or nurse practitioner to have your shunt reprogrammed after your MRI. Your shunt should be reprogrammed within 4 hours after your MRI. 
 
Some types of programmable VP shunts are not affected by MRI. Ask your neurosurgeon or nurse practitioner if your shunt will need to be reprogrammed after an MRI. 
 
You do not need to take any precautions if you are having a computed tomography (CT) scan or x-ray.
 

MedicAlert® jewelry 

You should always wear a MedicAlert® bracelet or necklace stating that you have hydrocephalus with a programmable VP shunt. If you are ever seriously ill or hurt and need medical help, this item will inform emergency services workers about your shunt. You can purchase this type of bracelet or necklace at most drug stores. For more information, visit the MedicAlert® website at: www.medicalert.com
 

Abdominal surgery

If you ever need to have abdominal surgery, you must tell your neurosurgeon so that precautions can be taken. Tell your neurosurgeon if you have peritonitis or diverticulitis requiring emergency surgery or antibiotic treatment. 
 

Are there any restrictions on my activities?

You cannot participate in any contact (collision) sports (i.e., football, boxing, wrestling). You can participate in all noncontact sports (i.e., swimming, running). Remember to wear a helmet to decrease the risk of head injury, if needed. Ask your neurosurgeon for specific guidelines on wearing a helmet.
 

When should I call my doctor or nurse practitioner? 

Call your doctor or nurse practitioner if you are having any of the following signs and symptoms that your programmable shunt is not working properly: 
 
  • Vomiting with little or no nausea 
  • A constant, unrelieved headache 
  • Vision problems (blurry, double vision, or loss of vision)
  • Irritability
  • Fatigue
  • Personality changes 
  • Loss of coordination or balance 
  • Swelling, redness, or both, along the shunt path 
  • A bulging soft spot on an infant’s head
  • Difficulty waking up or staying awake 
  • Decrease in school performance 
Call your doctor or nurse practitioner if you are having signs and symptoms of a VP shunt infection. A VP shunt infection develops when bacteria infect the tissue around a VP shunt. When the tissue is infected, it can cause the VP shunt to stop working properly and increase pressure in the brain. The signs and symptoms of a VP shunt infection include: 
 
  • A temperature of 100.4° F (38° C) or higher
  • Redness, swelling, or both, of the skin that runs along the shunt path 
  • Pain around the shunt or around the shunt tubing from the head to the abdomen 
These warning signs can appear quickly. If any of these signs or symptoms develop, call your doctor or nurse practitioner immediately. 

    If you cannot wake your child, call 911, or go to the nearest emergency room immediately.