Cerebrospinal fluid (CSF) flow scanning is a nuclear study performed to evaluate patency and filling of the CSF pathways and the reabsorption or leakage of CSF. It is most commonly used to diagnose surgically treatable hydrocephalus and to evaluate shunt patency postoperatively. A radiopharmaceutical is administered by injection into the spinal column via a lumbar puncture. Radionuclides used are 99mTc or indium 111 (111In) administered as technetium Tc 99m DTPA or indium In 111 DTPA, which flow with CSF. Imaging is performed in 1 hour and periodically up to 72 hours after the injection.

• Reflux of CSF into the ventricles; no obstruction of or increase in CSF volume or pressure

• Inability of client to remain still during the procedure, especially if the client is a child

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Indications

• Diagnosing and differentiating between communicating nonobstructive hydrocephalus or non-communicating obstructive hydrocephalus in infants as revealed by reflux into ventricles or absence of reflux into ventricles, respectively
• Evaluating the size of the ventricles with CSF reflux if an obstruction is present or evaluating the ability to reabsorb the fluid revealed by an increased uptake of the radionuclide in the ventricles
• Determining spinal masses or lesions
• Evaluating preoperatively for shunt type and placement and postoperatively for shunt patency and effectiveness

Contraindications

• Pregnancy, unless the benefits of performing the procedure greatly outweigh the risks to the fetus

[Section Outline]

• Indications
• Contraindications

Nursing Care Before the Procedure

Client teaching and physical preparation are the same as for any nuclear scan study (see section under "Brain Scanning").

• Additional teaching should include information about the route of the radiopharmaceutical administration (lumbar puncture) and an explanation of the procedure.
• Inform the client that the schedule of delayed studies may continue up to 3 days and that no medications are administered before the procedure.
• Maintain the client in a supine position after the lumbar puncture.

The client is placed flat on the examining table in a supine position 1 hour after injection of the radiopharmaceutical into the spinal column. A head-down position is also sometimes used. The client is reminded to lie very still while the scanner is operating. The scanner is moved over the head for imaging of ventricular flow. Subsequent imaging takes place in 4, 6, 24, 48, and 72 hours, depending on persistent reflux. Anterior, posterior, vertex, and lateral views are made, with client position changed as needed for the desired projections.

Nursing Care After the Procedure

Care and assessment after the procedure are the same as for any nuclear scan study (see section under "Brain Scanning").

• Assess the puncture site for leakage and apply a small dressing.
• Return the client to the hospital room in a prone position.
• Have the client maintain a prone or supine position for 4 to 8 hours after the study.
• Lumbar puncture: Note and report changes in neurological status, increased blood pressure or temperature, sensory changes in extremities (ting-ling, numbness), irritability, or headache. Adm-inister ordered analgesic for headache. Perform neurological checks every 2 to 4 hours for possible infection or brain or cord damage.