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.
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.
1. Assess clinical response to taps, daily head circumference, and weekly cranial ultrasonography.
2. Interval between taps may range from twice a day to
3. Taps should be continued until the infant weighs 2 kg
and is a suitable candidate for shunt placement or until
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.
reservoir is usually necessary.
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.
Fig. 51.1. McComb reservoir. Ventricular access device: lateral
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