Surgical instruments and catheter damage during ventriculoperitoneal shunt assembly

Area of Science:

• Neurosurgery
• Biomedical Engineering
• Materials Science

Background:

• Sterile assembly of ventriculoperitoneal (VP) shunts is critical for patient safety.
• Current surgical practices utilize common instruments that may compromise shunt integrity.
• Understanding the mechanical impact of assembly on shunt components is essential.

Purpose of the Study:

• To evaluate the effect of different surgical instruments and techniques on the mechanical integrity of VP shunt catheters.
• To identify assembly methods that minimize catheter failure rates.
• To compare the durability of rifampin-coated versus barium-impregnated catheters.

Main Methods:

• Failure testing was performed on rifampin-coated and barium-impregnated VP shunt catheters.
• Five different surgical instruments and two assembly techniques (A: pushing, B: pulling) were employed.
• Catheters underwent 10-repetition-maximum and 100-repetition-maximum assembly/disassembly tests.

Main Results:

• Catheter failure rates varied significantly based on the surgical instrument used (p ≤ 0.001).
• Technique A (pushing) resulted in a significantly lower failure rate (5%) compared to Technique B (81%) (p < 0.001).
• Mosquito forceps with shods demonstrated the lowest failure rate; DeBakey forceps showed the fewest assembly/disassembly repetitions to failure.

Conclusions:

• The choice of surgical instrument and assembly technique critically affects VP shunt catheter mechanical integrity.
• Utilizing mosquito forceps with shods and Technique A significantly reduces catheter failure during sterile assembly.
• DeBakey forceps are identified as the most damaging instrument, leading to earlier failure.