VENTRICULAR TAPPING

Introduction:

Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. Cerebrospinal fluid acts as a cushion, protecting the brain and spine from injury. The fluid is normally clear. The test is also used to measure pressure in the spinal fluid.Neurological diagnostic procedures are performed in a variety of setting including radiology department , special procedure areas and patient care unit ventricular tapping is mainly to diagnose the infections of the ventricle.

Definition:-

Insertion of a needle into the lateral ventricle . In infants no:22 needle with a stylet is introduced through the scalp into the anterior frontanelle.

Indication:- A ventricular tap is indicated to:

- Drain cerebrospinal fluid in non-communicating hydrocephalus - Diagnose ventriculitis - Administer intraventricular drugs

A ventricular tap is performed by medical staff deemed competent in the procedure and is a sterile aseptic procedure. Prior to a ventricular tap, an ultrasound should be performed to confirm ventriculomegaly and measurements taken to confirm the depth and direction of needle insertion.

Procedure Pre procedure care:-

Ultrasonography or CAT scan study before the procedure Obtain informed written consent Preparation of the area- Shave atleast 5 cm lateral and posterior to the anterior frontanel and anteriorly

upto the forehead Monitor the baseline vital signs and record it Sedation if necessary- chlorpromazine Assemble all the articles

Equipment

Articles Purpose

A sterile tray containing:

1. Specimen bottle2. Needle(size 22G or 23G) 3. Syringe 5ml4. Kidney tray5. Slit towel6. Sponge holding forceps7. Thumb forceps8. Bowl-2

A clean tray containing

1. Bottle with transfer forceps

To collect CSF To insert into the ventricle To withdraw the CSF To discard the waste To drape the area To clean the site To discard the used cotton To collect the solution

To take sterile items To clean the area

2. Bottle with betadine3. Bottle with spirit4. Bottle with tincture benzoine5. Shaving set

A sterile pack containing

1. Gown, glove and towel

To clean the area To seal the area To prepare the part

To create a sterile field

Technique Position the infant supine with the top of the infant’s head facing toward the operator. Insert the spinal needle into the lateral ventricle of the fontanelle and advance it toward the inner angle

of the ipsilateral eye. The needle should be inserted smoothly without change of direction to minimise trauma to the brain.

Once the ventricle has been penetrated, the stylet is removed and the CSF should drip out rather than be aspirated.

Once the required amount of CSF is obtained the needle should be removed and pressure applied to the area to prevent leakage of CSF.

Wash off chlorhexidine when the procedure is completed. Apply tincture benzoine seal over the punctured site Apply pressure dressing The infant’s tolerance of the procedure should be noted in the infants progress notes

Post procedure care

Watch the child closely Monitor the signs of collapse Monitor the vital signs Place the child with head end elevated or can allow the child to sit for some time

Complication:

Fever Haemorrhage Infection Leaking of CSF

Conclusion:-

Patient who is undergoing ventricular tapping need a general explanation of the procedure with special emphasis on what to expect. The patient or care givers support is needed in conducting the procedure.

Bibliography1. Prajapathi B. Essential procedures in Pediatrics. Jaypee brothers ; NewDelhi:20032. http://www.wnhs.health.wa.gov.au/services/nccu/guidelines/documents/7380.pdf3. http://www.nlm.nih.gov/medlineplus/ency/article/003428.htm4. http://adam.about.com/encyclopedia/CSF-collection.htm5. http://www.springerlink.com/content/k8072wx642911345/

Procedure demonstration

OnVentricular

tappingSubmitted to: Submitted By:

Mrs. Reshma Razak Ms. Shesly P. Jose

Lecturer II Year MSc (N)

NUINS NUINS

Submitted On:16.08.2010