Use of Bovie (Electrosurgical Unit) in Patients with VP Shunts
Yes, a Bovie can be safely used in patients with VP shunts with appropriate precautions, as there is no absolute contraindication to electrosurgery in these patients.
Key Safety Principles
The primary concern with electrosurgical devices in patients with implanted hardware is the potential for electrical current to travel through conductive pathways and cause thermal injury or device malfunction. However, VP shunts differ fundamentally from cardiac devices or neurostimulators in their susceptibility to electromagnetic interference.
Why VP Shunts Are Generally Safe with Electrocautery
VP shunts are passive devices consisting of silicone tubing and mechanical valves (or programmable valves with magnetic components), without active electrical circuits that could malfunction from electromagnetic interference 1, 2.
The shunt hardware does not conduct electricity in a manner that would create a pathway for cautery current to reach the brain or cause thermal injury, as the silicone material is non-conductive 3.
Standard surgical procedures are routinely performed on patients with VP shunts, including abdominal surgeries where electrocautery is used extensively without shunt externalization or special precautions beyond standard infection prevention 4.
Specific Precautions for Programmable Valves
For patients with programmable (adjustable) VP shunt valves, take these additional steps:
Avoid placing the Bovie grounding pad directly over the valve to prevent localized heating of the magnetic components 2.
Keep the electrocautery tip away from the valve housing (typically located in the scalp behind the ear or on the skull) to avoid direct thermal injury to the valve mechanism 1.
Check the valve setting after surgery if the procedure involved significant electrocautery near the head or neck, as strong magnetic fields (not typical electrocautery) can potentially reprogram certain valve types 2.
Practical Surgical Approach
When using electrocautery in any patient with a VP shunt:
Place the grounding pad on the opposite side of the body from the shunt when possible to minimize current pathway through the shunt hardware 4.
Use bipolar cautery when working near the shunt tubing (scalp, neck, chest, or abdomen along the shunt tract) as it confines current between the two tips of the forceps rather than through the body 4.
Avoid prolonged or repeated cautery directly on or immediately adjacent to the shunt tubing to prevent thermal damage to the silicone 4.
Evidence from Abdominal Surgery Experience
The most relevant clinical evidence comes from patients undergoing abdominal surgery with VP shunts in place:
In a series of 39 abdominal operations (including 32 open procedures) in patients with VP shunts, electrocautery was used routinely without shunt externalization, and no shunt malfunctions attributable to electrocautery were reported over 2-10 years of follow-up 4.
Clean-contaminated procedures involving bowel opening were performed safely without removing or externalizing the shunt, demonstrating that standard surgical technique with electrocautery poses minimal risk 4.
Common Pitfalls to Avoid
Do not confuse VP shunts with cardiac devices: Unlike pacemakers or implantable cardioverter-defibrillators, VP shunts do not have active electronics that can be disrupted by electromagnetic interference from standard electrocautery 1, 2.
Do not unnecessarily externalize or manipulate the shunt: The evidence shows that routine surgical procedures can be performed without shunt manipulation, and unnecessary intervention increases infection risk 4, 5.
Do not assume all programmable valves are equally susceptible: Modern programmable valves are designed with shielding, but older models may be more susceptible to magnetic field interference (though not from standard electrocautery) 2.