scholarly journals Technical Nuances of Ventriculoatrial Shunt Using Seldinger Technique for Percutaneous Insertion of Distal Shunt Catheter

2020 ◽  
Vol 9 (03) ◽  
pp. 230-232
Author(s):  
Yerragunta Thirumal ◽  
Vamsi Krishna Yerramneni ◽  
Ram Nadha Reddy Kanala ◽  
Vishwa Kumar Karanth ◽  
Swapnil Kolpakwar ◽  
...  
Keyword(s):  
Guide Wire ◽  
Clinical History ◽  
Seldinger Technique ◽  
Distal Catheter ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Shunt Catheter ◽  
Introducer Needle ◽  
The Right ◽  
Percutaneous Insertion

Abstract Introduction One of the most seen neurosurgical complications is the ventriculoperitoneal (VP) shunt failure. The cause can be often due to peritoneal malabsorption of cerebrospinal fluid. The next safer alternative is to place a ventriculoatrial (VA) shunt. Various methods of access to the right atrium had been described. The percutaneous method of insertion of distal catheter using Seldinger technique is a safer alternative to open method. We describe the percutaneous insertion of distal catheter using Seldinger technique, modifications in the method, and specific tools required for the insertion. Clinical History The patient is a 22-year-old male who is a known case of tubercular meningitis with recurrent failure of VP shunt due to malabsorption at peritoneal end of catheter. During the last hospital visit, he presented with altered sensorium and computed tomography scan brain showed ventriculomegaly. He was planned for VA shunt placement. Surgical Technique The insertion of ventricular end of the catheter is similar to any other shunt placement. The internal jugular vein (IJV) was punctured using introducer needle and guide wire was placed in the IJV at the level of T6-T7 and the serial dilators passed on the guide wire for creating a track for passage of shunt catheter. The shunt catheter was passed over the guide wire to the desired vertebral level and distal shunt catheter is connected proximally to the shunt catheter in the neck. Conclusion The percutaneous insertion of distal catheter with serial dilators using Seldinger technique is a safe and effective method for VA shunt placement.

Ventriculosagittal Sinus Shunt Placement: Technical Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 778-780 ◽  
Author(s):  
Uzma Samadani ◽  
Julian A. Mattielo ◽  
Leslie N. Sutton
Keyword(s):  
Clinical Presentation ◽  
Air Embolism ◽  
Pneumatosis Intestinalis ◽  
Seldinger Technique ◽  
Ventricular Catheter ◽  
Shunt Valve ◽  
Distal Catheter ◽  
Shunt Placement ◽  
Sagittal Sinus ◽  
Theoretical Advantage

Abstract OBJECTIVE AND IMPORTANCE Determining an appropriate site for distal catheter placement for ventricular shunting for some hydrocephalic patients can be difficult. We describe a simplification of the technique for sagittal sinus shunt placement using a guidewire. CLINICAL PRESENTATION A 20-month-old infant with hydrocephalus secondary to Alexander's disease developed erosion of her parieto-occipital ventriculoperitoneal shunt reservoir through an occipital decubitus scalp ulceration. Her hydrocephalus was temporarily treated with a ventriculostomy; however, she developed pneumatosis intestinalis while in the hospital. TECHNIQUE The patient underwent placement of a ventriculosagittal sinus shunt. The ventricular catheter and shunt valve were placed through a burr hole at Kocher's point, and the distal end of the catheter was placed in the superior sagittal sinus by using the Seldinger technique. CONCLUSION Ventriculosagittal sinus shunting may be used as an alternative to traditional methods for patients for whom distal shunt placement is problematic. Our technique has the theoretical advantage of reducing the risks of blood loss or air embolism by not requiring a scalpel incision into the sinus.

The periumbilical approach in ventriculoperitoneal shunt placement: technique and long-term results

2013 ◽  
Vol 11 (5) ◽  
pp. 558-563 ◽  
Author(s):  
Pablo F. Recinos ◽  
Jonathan A. Pindrik ◽  
Mazen I. Bedri ◽  
Edward S. Ahn ◽  
George I. Jallo ◽  
...  
Keyword(s):  
Valsalva Maneuver ◽  
Clinical Results ◽  
Long Term Results ◽  
Shunt System ◽  
Invasive Approach ◽  
Distal Catheter ◽  
Linea Alba ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Operative Revision

Object The aim of this study was to examine the feasibility and safety of ventriculoperitoneal (VP) shunt placement using a periumbilical approach for distal peritoneal access. By using this minimally invasive approach, the authors hypothesized that the cosmetic outcomes would be better than could be achieved by using a traditional minilaparotomy and that clinical results would be comparable. Methods A periumbilical approach was used for distal catheter insertion during a first-time VP shunt placement in 20 patients (8 males and 12 females). Median age at time of surgery was 3.0 months (range 7 days–11.9 years) and mean follow-up time was 17.8 months (range 1.2–28.0 months). The median weight of the patients was 3.99 kg (range 1.95–57.0 kg). A single incision was made along the natural crease inferior to the umbilicus. The linea alba was exposed and a 1-mm incision made while the patient was temporarily held in a Valsalva maneuver. A peritoneal trocar was then inserted through the fascial incision and the distal catheter was passed into the peritoneal space. Results The incision line in all patients healed well, did not require operative revision, and was described as minimally visible by the patients' families. Mean operative time was 35 minutes. Eight patients required revision surgery. One distal failure occurred when the distal shunt tubing retracted and became coiled in the neck; this was repaired by conversion to a minilaparotomy for distal replacement. There was 1 shunt infection (5%) requiring shunt removal and replacement. One patient had significant skin thinning around the valve and proximal catheter, which required replacement of the entire shunt system, and another patient underwent a conversion to a ventriculoatrial shunt due to poor peritoneal absorption. In the remaining 4 patients who required operative revision, the peritoneal portion of the shunt was not involved. Conclusions The periumbilical approach for peritoneal access during VP shunt placement is technically feasible, has low infection rates, and has cosmetically appealing results. It may be considered as an alternative option to standard VP shunt placement techniques.

Ventriculofemoroatrial shunt: a viable alternative for the treatment of hydrocephalus

1997 ◽  
Vol 86 (6) ◽  
pp. 1063-1066 ◽  
Author(s):  
Matthew F. Philips ◽  
Steven B. Schwartz ◽  
Alexander D. Soutter ◽  
Leslie N. Sutton
Keyword(s):  
Superior Vena ◽  
Femoral Vein ◽  
Vena Cava ◽  
Distal Catheter ◽  
Content Type ◽  
Shunt Placement ◽  
Shunt Catheter ◽  
Intercurrent Disease ◽  
Feasible Alternative

✓ Children with shunted hydrocephalus often have a myriad of other medical conditions. When these concomitant problems involve the pleura, peritoneum, and/or the venous system, placement of the distal catheter may prove to be problematic. This report presents preliminary results in three hydrocephalic children following ventriculofemoroatrial shunt placement. The peritoneal and pleural cavities in each of these children were compromised and there was no vascular access into the superior vena cava due to intercurrent disease. An alternative technique for ventriculoperitoneal shunt placement was performed via the femoral vein. Fluoroscopic guidance was used to confirm the intraatrial position of the distal end of the shunt catheter. Follow-up review to date shows no complications. This newly described technique provides a feasible alternative to distal shunt catheter placement in patients in whom more traditional sites are unavailable.

Intracranial entrapment of a haemodialysis catheter guidewire

2020 ◽  
Vol 13 (8) ◽  
pp. e232535
Author(s):  
Natasha Hemicke Langer ◽  
Lars Hein ◽  
Morten Heiberg Bestle
Keyword(s):  
Vital Signs ◽  
Jugular Foramen ◽  
Seldinger Technique ◽  
Chronic Obstructive ◽  
Close Monitoring ◽  
Obstructive Pulmonary Disease ◽  
Haemodialysis Catheter ◽  
The Wire ◽  
Introducer Needle ◽  
The Right

A 49-year-old man with chronic obstructive pulmonary disease was hospitalised due to pneumonia and pulmonary embolisms. After subsequently developing septic shock and acute renal failure, he required dialysis. A haemodialysis catheter was planned inserted into the right subclavian vein, the guidewire was introduced using the Seldinger technique. When the guidewire’s 20 cm marker entered the introducer needle, it suddenly encountered resistance. Repeated attempts to remove the guidewire failed. Vital signs and haemodynamic parameters remained unchanged throughout the procedure. CT angiography revealed cranial displacement of the wire into the right internal jugular vein, with the tip of the wire just cranial to the jugular foramen in the right sigmoid sinus. Interventional radiological removal attempts were unsuccessful. Thoracic and neurosurgical interventions were considered impossible and the guidewire was left in place. Due to the pulmonary embolism and the foreign object in the patient, life-long anticoagulation was considered, with close monitoring of compliance with the patient’s comorbidity and medication.

scholarly journals Immediate Removal of an Entrapped Central Venous Catheter Guide Wire

2019 ◽  
Vol 120 (1) ◽  
pp. 18-23
Author(s):  
Jan Bruthans ◽  
Stanislav Trča
Keyword(s):  
Central Venous Catheter ◽  
Guide Wire ◽  
Rare Complication ◽  
Relevant Literature ◽  
Venous Catheter ◽  
Central Venous Line ◽  
Seldinger Technique ◽  
Surgical Removal ◽  
Central Venous ◽  
The Right

Extravasal guide wire entrapment due to fraying during central venous catheter placement using the Seldinger technique is a rare complication, which should be resolved as soon as possible. A 68-year-old male was scheduled for open right-side decortication. After the induction of general anesthesia, an attempt was made to place a central venous line in the right subclavian vein. However, the guide wire was entrapped extravasally between the right clavicle and the first rib. The exact site was located by palpating the bend of the guide wire in the subclavian triangle and the thoracic surgeon was available. Therefore, it was decided not to try to visualize the guide wire any further and to immediately proceed with surgical removal of the guide wire. The platysma muscle was dissected allowing access to the subclavian triangle. Venotomy of the external jugular vein was performed and the entrapped guide wire was removed via the venotomy. The whole complication was resolved within 30 minutes and the primary procedure was then performed. Managing rare complications of central venous line placement requires skill, ingenuity and, sometimes, interdisciplinary cooperation, either with a radiologist or a surgeon. The decision to proceed with immediate surgical removal of the guide wire proved a right one, and, to the best of our knowledge, such a strategy has not been described in the relevant literature to date.

A simple method for distal catheter lengthening of ventriculoatrial shunts

1980 ◽  
Vol 53 (2) ◽  
pp. 229-232 ◽  
Author(s):  
Michael B. Pritz
Keyword(s):  
Right Atrium ◽  
Simple Technique ◽  
Guide Wire ◽  
Simple Method ◽  
Distal Catheter ◽  
Content Type ◽  
The Right ◽  
Gain Access ◽  
Fine Print

✓ A simple technique to lengthen the distal catheter of ventriculoatrial shunts is described in eight children. This method, which uses a Swan-Ganz introducer set, has proved successful even when a guide wire by itself has been inadequate to gain access to the right atrium.

Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases

2011 ◽  
Vol 115 (1) ◽  
pp. 151-158 ◽  
Author(s):  
Robert P. Naftel ◽  
Joshua L. Argo ◽  
Chevis N. Shannon ◽  
Tracy H. Taylor ◽  
R. Shane Tubbs ◽  
...  
Keyword(s):  
Blood Loss ◽  
Catheter Insertion ◽  
Shunt Failure ◽  
Shunt Surgery ◽  
Distal Catheter ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Asa Score ◽  
Distal Obstruction ◽  
Shunt Obstruction

Object Traditional ventriculoperitoneal (VP) shunt surgery involves insertion of the distal catheter by minilaparotomy. However, minilaparotomy may be a significant source of morbidity during shunt surgery. Laparoscopic insertion of the distal catheter is an alternative technique that may simplify and improve the safety of shunt surgery. Methods The authors performed a retrospective review of hospital records of all patients undergoing new VP shunt insertion at a tertiary care center between 2004 and 2009. Patient characteristics and outcomes were compared between patients undergoing open or laparoscopic insertion of the distal catheter. Independent variables in the analysis included age, sex, race, body mass index, surgical technique, previous VP shunt placement, previous abdominal procedures, American Society of Anesthesiology (ASA) score, and indication for shunt placement. Dependent variables included the occurrence of shunt failure, cause of shunt failure, complications, length of stay (LOS), LOS after shunt placement, estimated blood loss, and operative time. Results The authors identified 810 patients who met the inclusion criteria; open or laparoscopic distal catheter insertion was performed in 335 and 475 patients, respectively. There were no significant differences between the groups regarding age, race, ASA score, or indication for shunt placement. The most common indication was hydrocephalus due to subarachnoid hemorrhage, followed by tumor-associated hydrocephalus, normal pressure hydrocephalus (NPH), and hydrocephalus due to trauma. The incidence of shunt failure was not statistically different between cohorts, occurring in 20.0% of laparoscopic and 20.9% of open catheter placement cases (p = 0.791). With analysis of causes of shunt failure, shunt obstruction occurred significantly more often in the open surgery cohort (p = 0.012). In patients with a known cause shunt obstruction, distal obstruction occurred in 35.7% of the open cohort obstructions and 4.8% of the laparoscopic cohort obstructions (p = 0.014). The relative risk of distal obstruction in open cases compared with laparoscopic cases was 7.50. Infections occurred in 8.2% of laparoscopic cases compared with 6.6% of open cases (p = 0.419). Within the NPH subgroup, the laparoscopically treated patients had significantly more overdrainage (p = 0.040), whereas those in the open cohort experienced significantly more shunt obstructions (p = 0.034). Laparoscopically treated patients had shorter operative times (p < 0.0005), inpatient LOS (p < 0.001), and inpatient LOS after VP shunt placement (p = 0.01) as well as less blood loss (p = 0.058). Conclusions To our knowledge this is the largest reported comparison of distal VP shunt catheter insertion techniques. Compared with minilaparotomy, the laparoscopic approach was associated with decreased time in the operating room and a decreased LOS. Moreover, laparoscopy was associated with fewer distal shunt obstructions. Laparoscopic shunt surgery is a viable alternative to traditional shunt surgery.

Successful ventricle to direct heart shunt placement as a salvage cerebrospinal fluid diversion technique

2009 ◽  
Vol 3 (6) ◽  
pp. 521-524 ◽  
Author(s):  
Eric M. Thompson ◽  
Stephen G. Giles ◽  
Howard K. Song ◽  
Zachary N. Litvack ◽  
Kiarash J. Golshani ◽  
...  
Keyword(s):  
Median Sternotomy ◽  
Complex Case ◽  
Atrial Wall ◽  
Shunt System ◽  
Distal Catheter ◽  
Shunt Placement ◽  
Cerebrospinal Fluid Diversion ◽  
Large Pericardial Effusion ◽  
The Right ◽  
Shunt Obstruction

The authors report a complex case in a 35-year-old woman who underwent shunt placement at birth for myelomeningocele. She had previously undergone more than 30 shunt revisions, with placement of the distal catheter in the peritoneum multiple times, and also in the pleura, the gall bladder, and the upper venous system. All shunts had failed and the possible placement sites were now anatomically hostile. A median sternotomy was performed as the next option. The catheter was placed directly into the appendage of the right atrium and secured with a pursestring suture. One month postoperatively, the patient presented with a large pericardial effusion after the distal catheter migrated out of the atrium and into the pericardial space. A repeat sternotomy was performed to drain the pericardial CSF collection. The catheter was reinserted into the atrial appendage, and a tunnel was created in the atrial wall to fix the device more securely. At 1 year postoperatively, the patient had no further symptoms of shunt obstruction or cardiac tamponade, and imaging studies suggested that the shunt system was functional. The authors report the first successful ventricle to direct heart shunt in an adult.

A simple method to reduce infection of ventriculoperitoneal shunts

2010 ◽  
Vol 5 (6) ◽  
pp. 569-572 ◽  
Author(s):  
Atiq-ur Rehman ◽  
Tausif-ur Rehman ◽  
Hassaan H. Bashir ◽  
Vikas Gupta
Keyword(s):  
Shunt Infection ◽  
Control Group ◽  
Simple Method ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Shunt Catheter ◽  
Skin Flora ◽  
Group A ◽  
Group B ◽  
Shunt Infections

Object Postoperative shunt infection is the most common and feared complication of ventriculoperitoneal (VP) shunt placement for treatment of hydrocephalus. The rate of shunt infection is highest in the 1st postoperative month. The most common organisms responsible for shunt infection include coagulase-negative Staphylococcus and Staphylococcus aureus. This suggests a transfer of patient's skin flora via the surgeons' glove as a possible means of infection. The authors conducted a study to determine if the rate of postoperative shunt infections could be reduced simply by changing gloves before handling the shunt catheter. Methods A total of 111 neonates born with congenital hydrocephalus requiring a VP shunt were enrolled retrospectively and divided into 2 groups: a control group of 54 neonates treated with standard protocol VP shunt placement (Group A) and a treatment group of 57 neonates in whom, after initially double gloving, the outer pair of gloves was removed before handling the shunt catheter (Group B). Shunt infection rates were compared up to 6 months postoperatively. Results There was a statistically significant reduction of infection rate from 16.33% in Group A (control) to 3.77% in Group B (p = 0.0458). Conclusions The study shows that a changing of gloves before handling the shunt catheter may be a simple and cost-effective way to reduce the burden of postoperative shunt infections.

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