Letter: Difficulty in Tracing Manufacturer and Brand Names on Ventriculoperitoneal Shunt Catheters and Valves

Abstract

To the Editor:Ventriculoperitoneal shunt (VPS) implantation, including revision surgeries and reprogramming of adjustable shunt valves, is the most common procedure performed by pediatric neurosurgeons, costing an estimated US$100 million each year in the United States alone. [1][2][3][4][5] In the United States, shunt-related procedures rank 10th among the procedures with the highest readmission rates. 6 Mandatory shunt revision surgeries after VPS malfunctions, especially in children, are challenging for neurosurgeons and may cause long-term painful situations for patients and their families. 1,5,7 Before VPS revision surgery, the surgeon's knowledge of the brand name, type, and pressure setting of the VPS that had been implanted in the patient can provide safer and more practical surgical solutions to the problem. However, many times, it is almost impossible to know the trademark, model, year of manufacturing, and pressure setting of the VPS previously inserted in the patient.Such a problem may not arise when the records of the patient's previous surgery can be accessed or if the patient has an implant card. However, there may be problems in the archive of hospital records. The patient's family may have lost the implant card over the years or the patient may be about to have surgery in a different hospital or country than the hospital where the previous surgery was performed. Thus, more often than not, the surgeon should detect the brand and type of implanted VPS by examining the shape of the valve/reservoir on plain skull graphs. Moreover, visual inspection of the VPS during surgery does not usually reveal any identifying information about the implant. In many cases, none of the ventricular, the peritoneal catheters, or the valve/reservoir is marked with the brand name of the company and the model of the shunt, pressure setting record, and year of manufacturing. Sometimes, some numbers/letters can be noticed on the valve/ reservoir, but it is impossible to trace the actual product identity using them.Clinical ethics in the use of VPS should be respected. Through a global secure network, attending neurosurgeons anywhere in the world should be able to access past information about the patient with a VPS implanted; of course, caring for data protection rules. Unfortunately, health information technology is focused on revenue optimization through support for billing documents for devices rather than monitoring the health of patients with implanted devices. [8][9][10][11] Sharing clinical information about these patients among neurosurgeons is not a priority of profit-driven public management systems and associated information technology. Thus, physicians cannot easily obtain information regarding the medical device implanted and must apply to authorized portals, often in vain. 12