Paediatrics: Cerebral ventricular tap

2021-03-05 12:00 AM

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

Cerebral ventricular tap

Indications

This procedure is done for drainage of CSF in non-communicating hydrocephalus, 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 a manometer and allow it to fill until the 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.