Paediatrics: Cerebral ventricular tap

Cerebral ventricular tap

Indications

This procedure is done for drainage of CSF in non-communicating hy-drocephalus, to obtain CSF for microbiological testing, e.g. to diagnose ventriculitis, and to administer intraventricular antibiotics.

Equipment 

As for lumbar puncture.

Procedure

• Before the procedure is undertaken, cerebral lateral ventriculomegaly must be confirmed by cranial US.

• Place the baby supine, with an assistant firmly holding the baby’s head.

• Measure the necessary depth required for needle insertion.

• Palpate and locate the lateral corner of the anterior fontanelle on the intended side to drain.

• Shave a small area of the scalp at the needle insertion point if required.

• Set out sample containers +/– CSF pressure manometer if needed.

• Full aseptic technique should be used.

• Wash hands and put on sterile gloves, gown, +/– surgical mask.

• Clean area with antiseptic solution and create a sterile field with sterile drapes.

• Insert needle into the lateral corner of the fontanelle in a direction slightly forward and inward, aiming toward the inner canthus of the ipsilateral eye.

• After the needle is inserted to the predetermined distance, remove stylet and CSF should drip out.

• If CSF pressure measurement is required, attach manometer and allow it to fill until measurement is complete.

• If CSF drainage or sample is required, then allow fluid to drip out spontaneously into containers until required amount is drained.

• Once required CSF has been drained, remove the needle and then cover with adhesive plaster or spray with plastic dressing to seal.

• The child should lie flat for the next 6hr and have hourly neurological observations and BP measurement.