Ventriculoperitoneal (VP) Shunt

If too much fluid builds up in your child’s head, this creates pressure that can be harmful, even life threatening. A ventriculoperitoneal (VP) shunt drains away this extra fluid so that the pressure does not build up.

What is a VP shunt?

A ventriculoperitoneal (VP) shunt is a long, plastic tube placed in the ventricle of the brain. It drains body fluid (cerebrospinal fluid or CSF) away from your child's brain to another part of their body.

A VP shunt has 3 parts:

1. The proximal (ventricular) catheter also known as the collection catheter, is a plastic tube that goes through a small opening in the skull and travels to a part of the brain called the ventricle. The tip of the tube has holes in it.
2. A one-way valve with a tapping chamber controls how much pressure is on the brain. The tapping chamber collects CSF for testing, and the doctor uses it to see if the shunt is working correctly.
3. A long plastic tube, the distal catheter, also known as a peritoneal catheter, travels from the valve to another space in the body, such as the belly cavity (peritoneal cavity).
    

The long tube (distal catheter) runs under the skin, behind your child's ear. The tube travels down the neck and chest inside the body until it reaches the peritoneal space (see picture). The fluid does not go into the stomach. The body can take up the liquid or pass it into the urine.

Your child's shunt may drain into a bag outside their body (an externalized shunt). An externalized (external) shunt is always temporary until the doctor puts it inside the body or removes it. See "External Shunts" on together.stjude.org.

Why is a VP shunt needed?

CSF fluid usually stays at a normal level and drains from the brain. If too much fluid builds up and it does not drain out, the brain pressure rises. This rise in pressure can hurt the brain and be life-threatening. The VP shunt drains the extra CSF from the brain and lowers the pressure,

Fluid build-up in the brain is hydrocephalus. A child may have hydrocephalus if they:

• Are born with it
• Injure their head
• Have cancer

Caring for a VP shunt

Some VP shunts are programmable, and some are not; ask your doctor which kind your child has. If your child has a programmable shunt:

• Your doctor can adjust fluid drainage and pressure.
• Your doctor needs to check and program the shunt every time your child has an MRI. The strong magnets used for MRIs may change the setting. Changes to shunt settings make it work improperly and hurt your child.

Patients with VP shunts usually need them for life. The shunt must work properly and keep the brain pressure safe, so they stay healthy.

Watch for warning signs that the shunt is not working or is infected.

Warning signs of shunt malfunction (not working)

Your child's health can vary daily, and problems happen quickly. Watch for (1) or more of these warning signs that a shunt is not working properly:

• Your child has a headache that gets worse, or they act anxious, irritated, or whiny (this may be the only sign of a headache in young children who can't talk).
• Vomiting (throwing up) without feeling sick to their stomach (nausea)
• Seizure (shaking and twitching)
• Not alert as usual – if you cannot wake your child, take them to the nearest emergency room right away or call 911
• Personality changes (an easy-going child who becomes hard to handle or does not act right)
• Swollen skin along the path of the VP shunt
• If your baby's head is still open, look for a bulging soft spot (fontanelle)
• Vision problems (blurry vision, double vision, or not being able to see)
• Loss of mental and physical abilities they already had
• Trouble balancing or walking
• Urinating (peeing) more than usual

Warning signs of a shunt infection

Bacteria (germs) can cause a VP shunt infection. The shunt may stop working correctly if there is an infection. Pressure can rise causing harm that may be life threatening.

Watch for these signs of shunt infection:

• A fever of 100.4 degrees Fahrenheit or more (38.0 degrees Celsius)
• Redness or swelling of the skin along the path of the VP shunt
• Pain around the shunt or tubing
• Stiff neck
• Nausea or vomiting
• Signs of shunt malfunction, which commonly happens with an infection
  (See Fever and Signs of Infection in Childhood and Adolescent Cancer on together.stjude.org.)

Prepare for shunt emergencies

Carry this information with you at all times:

• The name and contact information for your child's neurosurgeon who cares for shunt malfunctions or infections
• The name and kind of shunt
• If possible, CT or MRI images of brain ventricles when the shunt is working (ask your doctor or care providers for this information)

Tell others about your child's shunt:

• Speak with your child's neurosurgeon or doctor if their shunt is not working correctly or is infected. Ask providers to send MRI images or CT scans of the brain to your child's doctor or neurosurgeon.
• Have your child wear a medical alert bracelet or necklace stating that they have a VP shunt (See Medical Alert Bracelets and Medical ID Products on together.stjude.org).
• Tell others living with or near your child about their shunt.
• If your child lives away from home, one person living with or near them should know about their shunt (a close friend, relative, co-worker, or neighbor). This person can learn the signs of shunt malfunction or infection. It is helpful if they agree to watch for these signs and get medical help quickly if needed.

For more information