title: What is the risk of infecting a cerebrospinal fluid-diverting shunt with percutaneous tapping?
abstract: OBJECTIVE
  Most CSF-diverting shunt systems have an access port that can be percutaneously tapped. Tapping the shunt can yield valuable information as to its function and whether an infection is present. The fear of causing a shunt infection by tapping may limit the physician's willingness to do so. The authors of this study investigate the risk of infecting a shunt secondary to percutaneous tapping.
  
  
  METHODS
  Following institutional review board approval, CSF specimens obtained from tapping an indwelling CSF-diverting shunt during the 2011 and 2012 calendar years were identified and matched with clinical information. A culture-positive CSF sample was defined as an infection. If results were equivocal, such as a broth-only-positive culture, a repeat CSF specimen was examined. The CSF was obtained by tapping the shunt access port with a 25-gauge butterfly needle after prepping the unshaven skin with chlorhexidine.
  
  
  RESULTS
  During the study period, 266 children underwent 542 shunt taps. With 541 taps, no clinical evidence of a subsequent shunt infection was found. One child's CSF went from sterile to infected 11 days later; however, this patient had redness along the shunt tract at the time of the initial sterile tap.
  
  
  CONCLUSIONS
  The risk of infection from tapping a shunt is remote if the procedure is done correctly.
authors.affiliation: School of Medicine, University of California, Irvine; and.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Spiegelman
authors.forename: Richa
authors.initials: R
authors.lastname: Asija
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Da Silva
authors.forename: Mark D
authors.initials: MD
authors.lastname: Krieger
authors.forename: J Gordon
authors.initials: JG
authors.lastname: McComb
mesh_terms: D000293:Adolescent; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007239:Infections / Q000209:etiology* / Q000382:microbiology; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D013048:Specimen Handling / Q000009:adverse effects* / Q000379:methods*
keywords: cerebrospinal fluid–diverting shunt; hydrocephalus; shunt infection; shunt tapping; ventriculoperitoneal shunt