VENTRICULAR TAPPING

Introduction:

Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal
cord. Cerebrospinal fluid acts as a cushion, protecting the brain and spine from injury. The fluid is normally
clear. The test is also used to measure pressure in the spinal fluid.Neurological diagnostic procedures are
performed in a variety of setting including radiology department , special procedure areas and patient care unit
ventricular tapping is mainly to diagnose the infections of the ventricle.

Definition:-

Insertion of a needle into the lateral ventricle . In infants no:22 needle with a stylet is introduced
through the scalp into the anterior frontanelle.

Indication:-
A ventricular tap is indicated to:
- Drain cerebrospinal fluid in non-communicating hydrocephalus
- Diagnose ventriculitis
- Administer intraventricular drugs

A ventricular tap is performed by medical staff deemed competent in the procedure and is a sterile aseptic
procedure. Prior to a ventricular tap, an ultrasound should be performed to confirm ventriculomegaly and
measurements taken to confirm the depth and direction of needle insertion.
Procedure
Pre procedure care:-
− Ultrasonography or CAT scan study before the procedure
− Obtain informed written consent
− Preparation of the area- Shave atleast 5 cm lateral and posterior to the anterior frontanel and anteriorly
upto the forehead
− Monitor the baseline vital signs and record it
− Sedation if necessary- chlorpromazine
− Assemble all the articles

Equipment

Articles Purpose

A sterile tray containing:

1. Specimen bottle − To collect CSF

2. Needle(size 22G or 23G) − To insert into the ventricle

3. Syringe 5ml − To withdraw the CSF
4. Kidney tray − To discard the waste
5. Slit towel − To drape the area
6. Sponge holding forceps
− To clean the site
 7. Thumb forceps − To discard the used cotton

8. Bowl-2 − To collect the solution

A clean tray containing

1. Bottle with transfer forceps − To take sterile items

− To clean the area
2. Bottle with betadine − To clean the area
− To seal the area
3. Bottle with spirit − To prepare the part
4. Bottle with tincture benzoine
− To create a sterile field
5. Shaving set

A sterile pack containing

1. Gown, glove and towel

Technique
− Position the infant supine with the top of the infant’s head facing toward the operator.
− Insert the spinal needle into the lateral ventricle of the fontanelle and advance it toward the inner angle
of the ipsilateral eye. The needle should be inserted smoothly without change of direction to minimise
trauma to the brain.
− Once the ventricle has been penetrated, the stylet is removed and the CSF should drip out rather than be
aspirated.
− Once the required amount of CSF is obtained the needle should be removed and pressure applied to the
area to prevent leakage of CSF.
− Wash off chlorhexidine when the procedure is completed.
− Apply tincture benzoine seal over the punctured site
− Apply pressure dressing
− The infant’s tolerance of the procedure should be noted in the infants progress notes −
Post procedure care

• Watch the child closely

• Monitor the signs of collapse

• Monitor the vital signs

• Place the child with head end elevated or can allow the child to sit for some time

Complication:

− Fever

− Haemorrhage

− Infection

− Leaking of CSF
Conclusion:-

Patient who is undergoing ventricular tapping need a general explanation of the procedure with special
emphasis on what to expect. The patient or care givers support is needed in conducting the procedure.

Bibliography

1. Prajapathi B. Essential procedures in Pediatrics. Jaypee brothers ; NewDelhi:2003

2. http://www.wnhs.health.wa.gov.au/services/nccu/guidelines/documents/7380.pdf
3. http://www.nlm.nih.gov/medlineplus/ency/article/003428.htm
4. http://adam.about.com/encyclopedia/CSF-collection.htm
5. http://www.springerlink.com/content/k8072wx642911345/

Procedure
demonstration
On
Ventricular
tapping
Submitted to: Submitted By:
Mrs. Reshma Razak Ms. Shesly P. Jose
Lecturer II Year MSc (N)
NUINS NUINS

Submitted On:16.08.2010