Is a ventriculoperitoneal (VP) shunt a relative contraindication for peritoneal dialysis catheter placement?

From the Guidelines

A ventriculoperitoneal (VP) shunt is a relative contraindication for peritoneal dialysis catheter placement.

Key Considerations

• The presence of a VP shunt is considered a fresh intra-abdominal foreign body 1, which increases the risk of leakage or dialysis-related peritonitis with potential spread to the prosthetic device or material.
• The recommended waiting period after implantation of an abdominal prosthesis, such as a VP shunt, is 4 months before initiating peritoneal dialysis 1.
• This waiting period allows for sufficient healing and reduces the risk of complications associated with peritoneal dialysis in the presence of a VP shunt.

Relative Contraindications

• Other relative contraindications for peritoneal dialysis include peritoneal leaks, body size limitations, intolerance to PD volumes, inflammatory or ischemic bowel disease, abdominal wall or skin infection, morbid obesity, severe malnutrition, and frequent episodes of diverticulitis 1.
• The decision to use peritoneal dialysis in patients with a VP shunt or other relative contraindications should be individualized, taking into account the patient's specific circumstances and potential risks and benefits 1.

From the Research

Ventriculoperitoneal Shunt and Peritoneal Dialysis Catheter Placement

• The presence of a ventriculoperitoneal (VP) shunt is considered a relative contraindication for peritoneal dialysis (PD) catheter placement by some authors 2.
• However, more recent reports suggest that PD under close monitoring is not contraindicated in patients with a VP shunt 2.
• A study reported a case of a 17-year-old girl with a VP shunt who underwent PD and had an uneventful course initially, but later developed fungal peritonitis 2.
• The study highlights the importance of considering the potential complications, especially infectious complications, before initiating PD in patients with a VP shunt 2.

Alternative Shunt Placement Options

• Ventriculopleural (VPL) shunting is a safe and viable second-line procedure for cases where VP shunts are unsuitable 3.
• VPL shunts have a high revision rate, but their complication rate is comparable to that of VP shunts 3.
• A review of literature on VPL shunting highlights the unique complications associated with this procedure, including pleural effusion and pneumothorax 4.

Peritoneal Dialysis Catheter Placement Techniques

• A novel type of peritoneocentesis trocar-assisted distal VP shunt placement with supervision via a one-port laparoscope has been described 5.
• This technique may reduce the risk of malfunction complications and has the advantages of reduced trauma and simpler surgery 5.

Hemodialysis in Children with Ventriculoperitoneal Shunts

• Hemodialysis (HD) in children with a concomitant VP shunt is rare, but registry data suggest that it is safe 6.
• A survey of 11 cases of HD with a VP shunt reported no episodes of VP shunt infection or meningitis, but frequent symptoms of hemodynamic instability were observed 6.