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Chapter 51 ■ Tapping a Ventricular Reservoir 369

14. Send CSF sample for culture, cell count, glucose, and

protein (the frequency of testing CSF varies among

institutions from daily to weekly). If fluid is dark and

bloody, it is reasonable to send only a culture sample.

F. A Successful Tap

1. At the end of the procedure, the anterior fontanelle

should be soft and flat (not sunken), and the cranial

bones should be approximated well at the sutures.

2. If sufficient volume is removed, the fontanelle may be

full 24 hours later, but the sutures should not be separated.

3. If the fontanelle remains flat, the interval for tapping

may be lengthened to every other day and/or the

amount of CSF removed at each tap reduced.

G. Follow-Up

1. Assess clinical response to taps, daily head circumference, and weekly cranial ultrasonography.

2. Interval between taps may range from twice a day to

once every 2 to 3 days.

3. Taps should be continued until the infant weighs 2 kg

and is a suitable candidate for shunt placement or until

the hydrocephalus resolves.

H. Complications

See Table 51.1 (4,7–9)

Fig. 51.2. Tapping a ventricular reservoir.

Table 51.1 Complications of Ventricular Reservoir Drainage

Problem (Incidence) What To Do

Hyponatremia (20%–60%) Monitor serum electrolytes every other day and supplement sodium intake.

Hypoproteinemia (15%) Ensure adequate protein intake. Monitor serum albumin weekly.

Infection (0%–8%) A combination of intravenous and intrareservoir antibiotics may rarely be successful. Removal of the

reservoir is usually necessary.

Subgaleal CSF collection (0%–9%) Percutaneous aspiration of fluid using a different needle at the same time as the reservoir is tapped. Tap

larger volume of CSF from the reservoir or increase frequency of taps to reduce pressure.

CSF leaks through incision (0%–3%) Increase frequency of reservoir taps.

Ventricular access device occlusion (0%–10%) Replace reservoir.

Trapped contralateral ventricle (6%) Place second reservoir.

Fresh bleeding into the ventricle (0%–40%) Prevent by using 25- or 27-gauge needle, aspirate slowly or let CSF drain spontaneously rather than

aspirating.

Bradycardia, pallor, hypotension (rare) Stop aspiration. Infuse 10–15 mL/kg of normal saline IV rapidly. Remove a smaller volume at aslower rate

at next tap.

Skin breakdown over reservoir (rare) Avoid abraded skin when tapping the reservoir. Avoid excoriating skin while prepping site.

Fig. 51.1. McComb reservoir. Ventricular access device: lateral

(top) and superior (bottom) views.