Guideline for the management of long tunnelled external ventricular drains in chronic hydrocephalus.

This article reports on the journey of a child with an inoperable hypothalamic-origin pilocytic astrocytoma causing hydrocephalus, which was refractory to treatment with shunts, and required a new approach. With multidisciplinary support, excellent nursing care and parental education, the child's hydrocephalus was managed long term in the community with bilateral long-tunnelled external ventricular drains (LTEVDs). This article describes the patient's journey and highlights the treatment protocols that were created to achieve this feat. Despite the difficulties in initially setting up these protocols, they proved successful and thus the team managing the patient proposed that LTEVDs are a viable treatment option for children with hydrocephalus in the context of inoperable tumours to help maximise quality of life.

Hidrocefalia infantil en el África subsahariana: impacto de los cuidados perioperatorios en el archipiélago de Zanzíbar / Infant hydrocephalus in sub-Saharan Africa: Impact of perioperative care in the Zanzibar archipelago

INTRODUCCIÓN: La hidrocefalia infantil en países de bajo y mediano ingreso, representa uno de los problemas éticos y sanitarios más conflictivos con los que se enfrenta el desarrollo de la salud a nivel internacional. Las estimaciones más optimistas señalan que 200.000 nacidos anualmente desarrollarán una hidrocefalia o nacerán con un defecto del tubo neural en África oriental, central y sur de África (ECSA). Se calcula que menos del 10% de estos niños serán operados mediante derivaciones ventriculoperitoneales y, en general, en condiciones de mala calidad o con un índice de complicaciones muy elevado. OBJETIVO: Describir las características generales, la epidemiología y los datos demográficos de la hidrocefalia infantil de los pacientes atendidos en el Instituto NED en el archipiélago de Zanzíbar y valorar los detalles clínicos y los resultados a medio plazo del impacto de los cuidados de enfermería implantados. MATERIAL Y MÉTODOS: Se trata de un estudio observacional descriptivo y analítico de carácter retrospectivo, en pacientes diagnosticados y tratados de hidrocefalia infantil, en el período comprendido entre septiembre del 2016 y septiembre del 2018. Con la implantación de una serie de protocolos perioperatorios de enfermería en dichos pacientes, se describieron y analizaron los resultados obtenidos. RESULTADOS: Un total de 96 pacientes fueron atendidos de hidrocefalia infantil. Un 51% (n = 49) de estos pacientes eran varones, con una media de edad de 9,25 meses. Todas las madres de los pacientes fueron controladas durante el embarazo, pero solamente un 8% de ellas fueron tratadas con ácido fólico durante su gestación. El 81% de los niños nacieron mediante parto vaginal o parto espontáneo no complicado. Con respecto a la etiología, el 27,1% de la hidrocefalia tratada estaba asociada a una causa infecciosa y un 35,4% a una causa desconocida. Se realizaron 67 cirugías de derivación ventriculoperitoneal y 15 ventriculostomías endoscópicas. La tasa de complicaciones fue del 23,17%. CONCLUSIONES: Los resultados de esta investigación indican que la hidrocefalia infantil en Zanzíbar tiene una etiología, una evolución y unas complicaciones similares o menores que las descritas hasta la fecha en el África oriental. El hecho de implantar una serie de protocolos perioperatorios y cuidados estandarizados de enfermería influyen positivamente en los resultados obtenidos. En la actualidad, el Mnazi Mmoja Surgical NED Institute es uno de los escasos centros en África del Este con un registro exhaustivo de la actividad asistencial y el primer centro sanitario que oferta una formación continuada al personal de enfermería

INTRODUCTION: Child hydrocephalus in low- and middle-income countries represents one of the most sensitive ethical and health problems facing international health development. The most optimistic estimates indicate that 200,000 newborns annually will develop hydrocephalus or be born with a neural tube defect in East, Central and South Africa (ECSA). It is estimated that less than 10% of these children will be operated by ventriculoperitoneal shunts, and in general in poor quality conditions or with a very high complication rate. OBJECTIVE: To describe the general characteristics, epidemiology and demographic data of childhood hydrocephalus of patients treated at the NED Institute in the Zanzibar archipelago, and assess the clinical details and medium-term results of the impact of the set-up nursing care. MATERIAL AND METHODS: This is a descriptive and analytical observational study of a retrospective nature, in patients diagnosed and treated with childhood hydrocephalus, in the period from September 2016 to September 2018. With the implementation of a series of perioperative nursing protocols in these patients, the results obtained were described and analyzed. RESULTS: A total of 96 patients were treated for childhood hydrocephalus. 51% (n = 49) of these patients were male, with a mean age of 9.25 months. All the mothers of the patients were monitored during pregnancy, but only 8% were treated with folic acid during pregnancy. 81% of children were born through vaginal delivery or uncomplicated spontaneous delivery. Regarding the etiology, 27.1% of treated hydrocephalus was associated with an infectious cause and 35.4% with an unknown cause. 67 ventriculoperitoneal shunt surgery and 15 endoscopic ventriculostomies were performed. The complication rate was 23.17%. CONCLUSIONS: The results of this research indicate that childhood hydrocephalus in Zanzibar has etiology, evolution and complications that are similar to or less than those described to date in East Africa. Implementing a series of perioperative protocols and standardized nursing care positively influences the results obtained. Currently, the Mnazi Mmoja Surgical NED Institute is one of the few centers in East Africa with an exhaustive record of healthcare activity and is the first health center that offers further training to nurses

Nursing Care of Infants With a Ventriculoperitoneal Shunt.

BACKGROUND: Infants with congenital or posthemorrhagic hydrocephalus may require a ventriculoperitoneal (VP) shunt to divert the flow of cerebrospinal fluid, thus preventing increase in intracranial pressure. Knowledge on various aspects of caring for a child with a VP shunt will enable new and experienced nurses to better care for these infants and equip parents for ongoing care at home. PURPOSE: To review the nurses' role in care of infants with hydrocephalus, care after VP shunt placement, prevention of complications, and parental preparation for home care. METHODS/SEARCH STRATEGY: A literature review involving electronic databases, such as CINAHL and MEDLINE, Cochrane Database Systematic Reviews, and resources from the Web sites of the National Hydrocephalus Foundation and Hydrocephalus Association, was performed to gather evidence for current practice information. FINDINGS AND IMPLICATIONS FOR PRACTICE AND RESEARCH: Vigilant care can help with early identification of potential complications. The younger the infant at VP shunt placement, the higher the occurrence of complications. All neonatal intensive care unit nurses must be equipped with knowledge and skills to care for infants with hydrocephalus and those who undergo VP shunt placement. Monitoring for early signs of increased intracranial pressure can facilitate timely diagnosis and prompt surgical intervention. Equipping families will be helpful in early identification and timely management of shunt failure. Research on infants with VP shunt placement is essential to develop appropriate guidelines and explore experiences of families to identify caregiver burden and improve parental preparation.

Blazing a trail.

These are challenging times in the NHS,' says RCN north west regional director Estephanie Dunn. 'We are endeavouring to safeguard already diminishing budgets and services while there are increasing pressures on staff.

[Knowledge of caregivers of children with hydrocephalus]. / Conhecimento do cuidador de crianças com hidrocefalia.

Knowledge of caregivers of children with hydrocephalus is not well assessed. This study identifies the fonts of information to assume activities how to care; to verify caregivers' knowledge about hydrocephalus. Fifty-four caregivers answered the interview from november 2007 to august 2008, with absolute predominance of females. Twenty-nine (53.7%) learned to take care by themselves. Only four caregivers (16.0%) received information at the hospital. 29 (53.7%) regarding the definition, 11 (20.4%) the cause of hydrocephalus. It was observed that caregivers with eight years of study had bigger knowledge. The education level of the caregiver had a positive correlation to on increased knowledge about hydrocephalus, but the caregivers have little concerns about important hydrocephalus' aspects.

Conhecimento do cuidador de crianças com hidrocefalia / Knowledge of caregivers of children with hydrocephalus / Conocimiento del cuidador de niños con hidrocefalia

Pouco se discute sobre conhecimentos dos cuidadores de crianças com hidrocefalia. Este estudo buscou identificar as fontes de informação dos cuidadores e verificar seus conhecimentos sobre hidrocefalia. Foram entrevistados 54 cuidadores com idade entre 18 a 52 anos no período de novembro de 2007 a agosto de 2008. O gênero do cuidador foi predominantemente feminino. Vinte e nove cuidadoras (53,7 por cento) aprenderam a cuidar sozinhas. Apenas quatro cuidadoras (16,0 por cento) receberam orientações na alta hospitalar. Vinte e nove (53,7 por cento) conhecem a definição e 11 (20,4 por cento) conhecem as causas da hidrocefalia. Verificou-se maior conhecimento entre cuidadoras com mais de oito anos de estudo. A escolaridade teve relação significativa para maior conhecimento, entretanto as cuidadoras possuem pouco conhecimento sobre aspectos importantes da hidrocefalia.

Knowledge of caregivers of children with hydrocephalus is not well assessed. This study identifies the fonts of information to assume activities how to care; to verify caregivers' knowledge about hydrocephalus. Fifty-four caregivers answered the interview from november 2007 to august 2008, with absolute predominance of females. Twenty-nine (53.7 percent) learned to take care by themselves. Only four caregivers (16.0 percent) received information at the hospital. 29 (53.7 percent) regarding the definition, 11 (20.4 percent) the cause of hydrocephalus. It was observed that caregivers with eight years of study had bigger knowledge. The education level of the caregiver had a positive correlation to on increased knowledge about hydrocephalus, but the caregivers have little concerns about important hydrocephalus' aspects.

Poco se discute sobre los conocimientos de los cuidadores de niños con hidrocefalia. Este estudio identificó las fuentes de información de los cuidadores y verificó sus conocimientos acerca de la hidrocefalia. Se entrevistó 54 cuidadores con 18 a 52 años desde noviembre de 2007 a agosto de 2008. El género del cuidador fue predominantemente femenino. Veinte y nove cuidadoras (53,7 por ciento) aprenderán a cuidar solas. Apenas cuatro cuidadoras (16,0 por ciento) tuvieran orientaciones a la salida del hospital. Veinte y nove (53,7 por ciento) conocen la definición y 11 (20,4 por ciento) conocen las causas da hidrocefalia. Se observó mayor conocimiento entre cuidadoras con más de ocho años de estudio. La escolaridad tuve relación significativa para mayor conocimiento, todavía las cuidadoras posee poco conocimiento acerca de aspectos importantes da hidrocefalia.

Ações de enfermagem fundamentadas à criança portadora de hidrocefalia / Nursing actions directed to hydrocephalus infant

A hidrocefalia é um problema permanente em que a criança necessitará de avaliação e acompanhamento regularmente. O tratamento para a criança com hidrocefalia é uma tarefa difícil, tanto para a família quanto para os profissionais de saúde. A assistência prestada para com a criança portadora de hidrocefalia deve ser realizada com sólido conhecimento técnico-científico, para que as ações sejam praticadas de forma segura. Considerando a importância da assistência do enfermeiro à criança portadora de hidrocefalia, objetivou-se, com o presente estudo, descrever as ações do enfermeiro durante a assistência ao hidrocéfalo. Trata-se de um trabalho de revisão bibliográfica. Considerando que a Hidrocefalia Infantil (HI) é uma condição que afeta o paciente por toda sua vida, priorizar a assistência de enfermagem, humanizada, pautada na promoção da qualidade de vida da criança é indispensável. Nesse sentido, cabe ao enfermeiro elaborar e implementar estratégias que melhorem não somente o quadro clínico da doença, bem como promover a saúde em seu contexto bio-psico-social, pois esse profissional é responsável por identificar e intervir nos problemas reais e potenciais.

Hydrocephalus is a permanent problem in which infants need a regular evaluation and accompaniment. The treatment is a difficult duty for the family as well as for health professionals. The assistance taken with hydrocephalus infant should be carried out with a solid technical and scientific knowledge that the actions would be practice in a secure way. Considering the importance of nursing assistance to the hydrocephalus infant it was aimed at the present study to describe through a bibliographical revision nursing actions hold during this process. It is indispensable to prioritize a humanized nursing assistance promoting the quality of life of the infant due to the fact that hydrocephalus is a condition that affects the patient for the whole life. It is the nurse responsibility to identify and intervene in the real and potential problems by elaborating and implementing strategies to improve the clinical chart of the illness as well as to promote health in the bio-psico-social context.

The role of the pediatric home healthcare nurse.

The acuity and number of children with life-threatening, life-limiting, and chronic conditions has increased dramatically over the past decade. The pediatric home care nurse needs a special body of knowledge and repertoire of tools to accurately assess, intervene, manage, evaluate, and provide resources to this most vulnerable population. Inherent in caring for these children is the need to support the family, nurturing the parents who care for chronically ill children at home.

Ventricular reservoir punctures performed by nurses: an improvement in quality of care.

Management strategies in the treatment of infants with posthemorrhagic ventricular dilation include the placement of a ventricular reservoir. Traditionally, ventricular punctures of these reservoirs have been performed only by physicians. In the pilot project described in this article, we taught nursing staff to perform punctures of a cerebral ventricular reservoir in neonates with hydrocephalus to give nurses more control in their daily care of these infants.All consecutive punctures performed between August 2006 and March 2007 (n = 302) were studied. The chart was reviewed for the infant's state during the puncture, the caregiver who performed the puncture, and the timeliness of the puncture with respect to schedule and to infant state. During the day shift, there was no significant difference in timeliness, whether the puncture was performed by a physician, a nurse, a physician assistant (PA), or a nurse under the supervision of a physician. On the night shift, punctures were performed on schedule significantly more often when they were carried out by nurses (p>.001). This pilot project demonstrated that nurses can learn to perform cerebrospinal fluid removal from a ventricular reservoir. Because it increased the timeliness with which punctures were performed and gave nurses more control in planning rest periods for these infants, this policy change was judged a success.

Benchmarking best practice for external ventricular drainage.

Sharing of best practice and use of all available evidence is important in developing effective clinical guidelines for nursing practice. This can be achieved through benchmarking. Sharing of good practice and achieving consensus guidelines can avoid repetition of effort by nurses engaged in similar fields of practice. The Pan London Neuroscience Practice Development Forum was established in 1998 to share best practice within the field of neuroscience nursing across London. The Pan London Forum has now achieved consensus and developed evidence-based clinical guidelines for the management of external ventricular drainage. Within the scope of this article, the principles of external ventricular drainage will be highlighted, before identifying the evidence base for nursing management of patients. Approaches for troubleshooting common problems will also be discussed and the benchmarked clinical guidelines will be presented.

Chiari I malformation: clinical presentation and management.

Chiari malformations are cerebellar anomalies. The four types of Chiari malformations, as described more than 100 years ago by Dr. Hans Chiari, have neither anatomic nor embryologic correlation. Their only commonality is that they all involve the cerebellum. Chiari I malformation consists of herniation of the cerebellar tonsils into the foramen magnum, thus crowding the craniocervical junction. Chiari II malformation is almost exclusively associated with myelomeningocele and hydrocephalus. It consists of herniation of not only the tonsils but also all the contents of the posterior fossa into the foramen magnum. This herniation involves the brainstem, fourth ventricle, and cerebellar vermis. Chiari III and IV malformations are rare. Chiari III represents an encephalocele (external sac containing brainstem and posterior fossa contents); thus, the cerebellum and brainstem are descending not only into the spine, but also into an external sac. Chiari IV consists of cerebellar hypoplasia. The Chiari I malformation has the latest mean age of clinical presentation. A Chiari type I anomaly presenting in adulthood is the focus of this article. Surgery is indicated with neurological dysfunction, symptomatic syrinx, or hydrocephalus. Of all Chiari I patients, 15%-20% will have hydrocephalus. For some of them, the hydrocephalus will resolve with ventriculoperitoneal shunting, alleviating the need for a Chiari decompression. Long-term prognosis for patients with symptomatic Chiari type I malformations who undergo surgical treatment is variable, based on the patients' presenting symptoms and spinal cord cyst response.

External ventriculostomy: a practical application for the acute care nurse.

External ventricular drainage systems (EVDs), or external ventriculostomies, are challenging additions for the neurosurgical patient. An EVD involves a catheter placed in the ventricular space. It is used to drain off excess cerebrospinal fluid that is causing hydrocephalus and increased intracranial pressure. The cerebrospinal fluid is produced in the brain and flows through the four ventricles, to the arachnoid space around the spinal cord, then is absorbed by the arachnoid villi in the brain. The causes of hydrocephalus include tumors and hemorrhage. The nursing responsibilities include monitoring for infection, bleeding, herniation, documenting aspects of the drainage system and providing emotional support for the patient and family.