Pediatric Community

  • 1.  VP shunt with abdominal pain

    Posted 06-27-2025 09:21 AM

    We had a teen girl come in complaining of abdominal pain for 3 days, normal BMs. No fever, no HA, no other symptoms. Pt has a VP shunt and we made her an ESI triage 3. We were challenged that it should be a 2 because she had a VP shunt. Does anyone agree with this and why?

    Thanks in advance



    ------------------------------
    Louise McEvoy MS;BSN;RN;EMT-I;CPEN
    Registered Nurse
    Port Washington NY
    (718) 470-4780
    ------------------------------


  • 2.  RE: VP shunt with abdominal pain

    Posted 06-28-2025 07:40 AM
    Yes, she should have been an ESI 2. Abdominal pain may have been due to another cause but in this setting, a pediatric patient (yes, 15 is still pediatric) with a VP shunt is at risk for potential infection of the shunt (could lead to encephalopathy), malfunction of the shunt (could lead to increased ICP), displacement of the shunt (increased ICP). ESI is based upon the number of interventions as well as potential danger to patient. This child would have needed diagnostic imaging (CT of head and abdomen, potentially shunt series), basic labs including blood cultures and U/A, HCG, and possibly an LP. Asking questions like whether there had been recent changes to the shunt, or if the patient had undergone a growth spurt would also help with ruling out shunt problems.

    Penny Blake, MSN Ed, RN, CCRN, CEN
    Market Clinical Educator NICU and Pediatrics
    Palm Beach Health Network





  • 3.  RE: VP shunt with abdominal pain

    Posted 07-09-2025 03:59 PM

    Would depend on whether your facility defines a VP shunt as a high-risk situation.  I could easily see an argument that this patient would not be high risk on the data you have supplied (normal vitals, no neurological symptoms).  If there was concern for shunt malfunction then yes, a 2 would be appropriate.  I think stating a VP shunt puts you at high risk for potential infection, malfunction, or displacement is not as likely in the setting of normal mental status and vitals.



    ------------------------------
    Sean Bartlett RN
    Alexandria KY
    ------------------------------



  • 4.  RE: VP shunt with abdominal pain

    Posted 07-23-2025 10:45 AM

    I agree with Sean Bartlett. It depends if the triage RN felt it was a high-risk situation based on their assessment. 



    ------------------------------
    Ivelisse Sanchez, DNP, APRN, ACCNS-P, CPN, CPEN
    CNS-APRN Coordinator, Pediatric Emergency Departments
    Advocate Children's Hospital
    Oak Lawn & Park Ridge, IL
    ivelisse@ecsmediallc.com
    ------------------------------

    Original Message