title: Percutaneous gastrostomy tube placement in patients with ventriculoperitoneal shunts.
abstract: OBJECTIVE
  The purpose of this study is to determine the risk of CNS and/or peritoneal infection in children with ventriculoperitoneal shunts in whom a percutaneous gastrostomy tube is placed.
  
  
  METHODS
  We placed 205 gastrostomy or gastrojejunostomy tubes from January of 1991 to December 1996. Twenty-three patients (10 boys, 13 girls) had ventriculoperitoneal shunts at the time of placement. All shunts were placed at least 1 month prior to placement of the gastrostomy tube. The patients ranged in age from 8 months to 16 years with a mean age of 6 years, 9 months. Patient weight ranged from 2 kg to 60 kg. All 23 children required long-term nutritional support due to severe neurologic impairment. No prophylactic antibiotics were given prior to the procedure. Of the patients, 21/23 had a 14-F Sacks-Vine gastrostomy tube with a fixed terminal retention device inserted, using percutaneous fluoroscopic antegrade technique. Two of the 23 patients had a Ross 14-F Flexi-flo gastrostomy tube which required a retrograde technique due to a small caliber esophagus in these children.
  
  
  RESULTS
  All 23 children had technically successful placements of percutaneous gastrostomy (7) or gastrojejunostomy (16) tubes. Of the children, 21/23 (91%) had no complications from the procedure. Two of 23 (9%) patients demonstrated signs of peritonitis after placement of their gastrostomy tubes and subsequently had shunt infections. In both, children CSF culture grew gram-positive cocci. The antegrade technique was used in both children who developed peritonitis.
  
  
  CONCLUSIONS
  Our study indicates children with ventriculoperitoneal shunts who undergo percutaneous gastrostomy are at greater risk for infection and subsequent shunt malfunction. Therefore, we recommend prophylactic antibiotic therapy to cover for skin and oral flora.
authors.affiliation: Department of Radiology, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Sane
authors.forename: A
authors.initials: A
authors.lastname: Towbin
authors.forename: E A
authors.initials: EA
authors.lastname: Bergey
authors.forename: R D
authors.initials: RD
authors.lastname: Kaye
authors.forename: C R
authors.initials: CR
authors.lastname: Fitz
authors.forename: L
authors.initials: L
authors.lastname: Albright
authors.forename: R B
authors.initials: RB
authors.lastname: Towbin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D015641:Radiography, Interventional; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt