Name of the Procedure:

Puncture of Shunt Tubing or Reservoir for Aspiration or Injection

• Commonly known as: Shunt tap, Reservoir tap

Summary

In this procedure, a medical professional uses a needle to puncture a shunt tube or a reservoir. This allows them to either withdraw (aspirate) fluid or inject medication directly into the shunt system.

Purpose

This procedure is employed to address issues such as shunt malfunction, infection, or blockages in the shunt system. It can also be used to administer medications or obtain cerebrospinal fluid (CSF) samples.

Indications

• Symptoms suggestive of shunt malfunction, such as headache, nausea, vomiting, changes in consciousness, or abnormal neurological findings.
• Suspected infection in the shunt system.
• Need for intrathecal administration of medication.
• Diagnosis requiring direct sampling of cerebrospinal fluid (CSF).

Preparation

• Patients may be advised to fast for a few hours before the procedure.
• Pre-procedure blood tests to check coagulation parameters.
• Imaging studies like MRI or CT scans to assess the shunt placement.

Procedure Description

1. Preparation:
   • The skin over the shunt reservoir is cleaned with antiseptic solution.
   • Local anesthesia is applied to numb the area.
2. Puncture:
   • A sterile needle is inserted into the shunt reservoir or tubing.
   • Fluid is either aspirated for diagnostic examination or medication is injected as needed.
3. Final Steps:
   • The needle is removed and the puncture site is covered with a sterile dressing.

Tools used include needles, syringes, antiseptic solutions, and sometimes imaging equipment for guidance.

Duration

The procedure typically takes around 15-30 minutes.

Setting

This is usually conducted in a hospital or outpatient clinic setting.

Personnel

• Neurosurgeon or trained medical professional.
• Nurse or healthcare assistant.
• Sometimes an anesthesiologist, if deeper sedation is needed.

Risks and Complications

• Infection at the puncture site.
• Bleeding or bruising.
• Damage to the shunt system or adjacent structures.
• Headache or discomfort post-procedure.
• Rare complications like shunt malfunction or CSF leak.

Benefits

• Immediate relief from symptoms caused by shunt malfunction or pressure buildup.
• Accurate diagnosis through CSF sampling.
• Direct delivery of medications to the target site.

Recovery

• Monitor the puncture site for signs of infection or bleeding.
• Rest and avoid strenuous activities for 24-48 hours.
• Follow-up appointments to assess shunt function and ensure resolution of symptoms.

Alternatives

• Non-invasive imaging: MRI or CT scans to assess shunt function (less direct but also less risk).
• Shunt revision surgery: if repeated problems are found (more invasive).

Patient Experience

Patients may feel a brief needle prick or pressure during the procedure. Post-procedure discomfort is usually minimal and manageable with over-the-counter pain medications. Regular monitoring and follow-up care are essential to ensure successful outcomes.