Insertion of VP Shunt

Patient Management

POST OPERATIVE BRAIN SURGERY INFORMATION SHEET

Insertion of VP Shunt

GENERAL ADVICE

Give yourself adequate time to recover over the next few weeks to months. Take things slowly and you will feel better off down the track. In this early recovery phase your body benefits from lots of rest and good nutrition. Don’t try to rush back into your pre-operative routines; these can be gradually re-established over the next 8-12 weeks. Avoid undue mental processing or excess physical activity over the first eight weeks. Generally you will either go home from the ward or to a recognized rehabilitation unit. They are experts in this area and will give you good ongoing advice.

WOUND CARE

  • The clips in your head are generally removed on the sixth or seventh day after surgery.
  • The small abdominal wound normally has self absorbing sutures.
  • After day two from surgery, the dressings, should be changed on a daily basis. Normally from about day five after surgery, the wounds can be left open following a daily clean.
  • You can wash your hair gently with a mild shampoo once you are home, use a shower cap initially for normal showering. If the wound gets wet pat the area dry. Your hair can be coloured after 12 weeks if all healing has gone well.
  • However, otherwise keep the wound clean and dry once at home.
  • The ward nurses will also talk to you about wound care for when you go home / to rehab.
  • After the first two weeks, a clean scarf, hat or head covering can be worn, as desired.
  • Let Mr Brendan O’Brien know through the rooms or the St Vincent’s Hospital if there is any:
    • Increasing wound redness, swelling or pain
    • Fever or temperature > 38.0
    • For a low grade fever -record the temperature daily at 8am 12md and 6pm and notify
    • Increasing headache / nausea / altered arm or leg function

Remember: Increasing wound pain or soreness is a RED FLAG

MOVEMENT / EXERCISE REGIME

  • Over the first four weeks, take it very carefully, continuing all medications as planned.
  • Allow extra time to rest, fatigue is a frequent early feeling over the first six weeks, it may help to take an afternoon nap.
  • You may not feel as if your mind is as fast as usual, this is normal and temporary.
  • Important to limit bending, stooping, straining or pushing. Lifting should be done sparingly and very carefully, avoid anything you are not comfortable with, overall this is
  • Get up from a lying position by first turning onto one side.
  • Consider having family or friends assist with everyday chores and childcare over the first 3-4 weeks.
  • Once you are home: try gentle walking in the house then progress to outdoors.
  • Gradually increase the distance you are comfortable with.
  • Start at approximately 5-10 minutes 2-3 times per day, (if you are up to it).
  • Build on what you may have learnt in rehabilitation.
  • In some cases physiotherapy, OT or speech therapy may be utilized to aid your recovery.
  • If you feel increased fatigue, soreness or discomfort- REST and let us know if ongoing.
  • By the fourth week try to walk 2-3 times per day for 20 mins each at a comfortable pace.
  • Contact sports should be avoided until specifically discussed.
  • You should not operate any heavy equipment or machinery in the first six weeks.
  • Do not witness or sign any important documents in the first six weeks.

REMEMBER: THESE ARE GUIDELINES TO EXERCISE – NOT RULES

DRIVING / GENERAL ADVICE

  • It is advisable not to drive until advised, after review in Rooms.
  • Usually driving is avoided / prevented for 12 weeks.
  • Alcohol intake is best avoided until review it may interact with other medications.
  • Make all efforts to refrain from smoking as this definitely delays healing and bone fusion.

IN THE EVENT OF A SEIZURE

  • This is possible after brain surgery (or due to the underlying problem), but much less so when you take regular anti-convulsants.
  • The duration is normally not greater than 30-60 seconds.
  • At the time family or friends should be able to:
    • Assist you onto your side, loosen any shirt clothing to aid breathing.
    • Monitor the time length of the event and any pattern that occurred in movements.
    • If a seizure is prolonged call an ambulance to go to the Hospital Emergency Room.
    • Notify your local GP and Mr Brendan O’Brien to discuss further blood tests or CT/MRI scans.
  • If prone to seizures or new ones develop, be careful to avoid:
    • Working up a ladder or at height where a fall is more hazardous
    • Swimming alone or in deep water
    • Excess tiredness
    • Alcohol overindulgence

MEDICATIONS

On discharge you may be on some of the following medications (apart from your regular ones)

  • Anti-Seizure medication
    • Phenytoin, carbamazepine or sodium valproate are the common ones used.
    • These will continue for 6-12 weeks and blood levels will be monitored as needed.
    • Continue to take them as regularly prescribed.
    • Notify any potential side effects: skin rash, drowsiness, unsteady walking.
    • Any seizure (general or partial) needs to be reported as this can affect your ability to drive and your medications may need to be altered to control them.
  • Analgesics
    • This is usually paracetamol/codeine combinations, tramadol or oxycodone, you will find the doses can be gradually decreased over the first 10-14 days; others used may be endone alone or in association with long acting paracetamol. As a general rule take regular pain relief (eg every 4-6 hours) to avoid any pain rebound. If headaches increase this may be a sign of increasing swelling and must be reported.
  • Dexamethasone
    • This may be used to decrease brain swelling (odema) or to prevent swelling from occurring.
    • This should be continued if prescribed, over the first few weeks, as needed. The dose is usually decreased gradually over this time. Notify us if there is any increasing indigestion or heartburn.

ADVERSE OR UNEXPECTED SYMPTOMS after Discharge: What to Notify?

Notify Mr Brendan O’Brien if any of these occur or you become worried about:

Procedure / Condition Related:

  • Wound or wound care issues: tenderness, increasing pain, redness or fluid discharge.
  • Changes or new difficulty moving, controlling or feeling your legs, feet or hands.
  • New abnormalities in speech or vision.
  • Increased sleepiness.
  • Any Seizure activity or fainting spells.
  • Neck stiffness

General:

  • Fever, chills.
  • Cough, shortness of breath.
  • Calf or ankle swelling or tenderness.
  • Pain passing urine.

CONSIDERATIONS FOR RETURN TO WORK: when appropriate

  • This should be delayed until reviewed in the rooms and you feel well recovered.
  • Some light, seated short term computer work can be done from home if you must.
  • Avoid the temptation to overdo things in the first 6-8 weeks.
  • Return to work is often graduated through lighter duties, increasing by 25% contact hours per week over 2-4 weeks. This will be discussed upon your review and aided with the physio.

FOLLOW UP APPOINTMENT

You will be given a review appointment with Mr Brendan O’Brien for approximately four to six weeks after discharge.
If you are discharged on a weekend, please have a family member call the rooms the next Monday for an appointment.

Please encourage your GP or Rehabilitation Consultant to contact me at any time if he wants to discuss any concerns that