VP shunt and epidurals

[oneforfighting]

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Any issues with doing a cervical epidural injection in a patient with VP shunt? Not sure if there's increased risk of infecting the shunt. Can't find much online. Figured I would throw it on here and see everyone's thoughts. Thanks.

 

[SSdoc33]

not a problem. just dont shoot steroids into the ventricles, and you should be OK

 

[oneforfighting]

not a problem. just dont shoot steroids into the ventricles, and you should be OK

daughter was worried the shunt would just carry the steroids away. i was like, that's not what i'm worried about

 

[Agast]

The shunts drain into the abdomen so the trajectory of tubing will carry towards the anterolateral neck. I did cervical epidurals and facet ablations on someone before I realized they had a VP shunt and they were fine.

 

[oneforfighting]

The shunts drain into the abdomen so the trajectory of tubing will carry towards the anterolateral neck. I did cervical epidurals and facet ablations on someone before I realized they had a VP shunt and they were fine.

Since injection is epidural and not intrathecal I figured it wouldn't be an issue anyway but thought I'd ask. Would you have run past neurosurgery first if you knew ahead of time?

 

[RoloTomassi]

Since injection is epidural and not intrathecal I figured it wouldn't be an issue anyway but thought I'd ask. Would you have run past neurosurgery first if you knew ahead of time?

I would not consult. What are you concerned might happen?

 

[Agast]

Since injection is epidural and not intrathecal I figured it wouldn't be an issue anyway but thought I'd ask. Would you have run past neurosurgery first if you knew ahead of time?

Probably not. I just explain to the patient that our injection site is nowhere near the shunt. I guess if you accidentally wet tap them the CSF would still preferentially flow through the shunt.

 

[oneforfighting]

I would not consult. What are you concerned might happen?

infection

 

[RoloTomassi]

infection

Probably the same odds of giving a regular person meningitis from an ESI. Wet tap + compromised sterility would be very rare.

 

[oneforfighting]

Probably the same odds of giving a regular person meningitis from an ESI. Wet tap + compromised sterility would be very rare.

Agreed. Just wasn’t sure if this was a situation where shunt could potentially be seeded or similar to don’t inject a joint after joint replacement situation.