49427 Injection procedure (eg, contrast media) for evaluation of previously placed peritoneal-venous shunt

Name of the Procedure:

Injection procedure for evaluation of previously placed peritoneal-venous shunt
Common Name(s): Shuntogram, Peritoneal-Venous Shunt Evaluation

Summary

In layman's terms, this is a medical procedure where a special dye is injected to assess the functionality of a shunt that drains fluid from the abdomen into a vein.

Purpose

This procedure addresses issues with a peritoneal-venous shunt, which is a device implanted to drain excess abdominal fluid (ascites) into the venous system. The goal is to ensure the shunt is functioning correctly and to diagnose any potential blockages or malfunctions.

Indications

• Persistent or worsening ascites despite having a shunt.
• Symptoms suggesting shunt dysfunction, such as abdominal pain or swelling.
• Recent infections that may affect shunt functionality.
• Patients with a history of shunt complications.

Preparation

• Patients may be required to fast for a few hours before the procedure.
• Inform the healthcare provider of any medications or allergies.
• Baseline diagnostic tests, such as blood tests or imaging studies, may be needed.

Procedure Description

1. The patient is positioned, often lying down.
2. A local anesthetic is administered to numb the injection site.
3. A contrast agent (dye) is injected into the shunt.
4. X-rays or fluoroscopy are used to track the flow of the contrast agent and evaluate the shunt.
5. Images are reviewed to assess for blockages, kinks, or other issues.

Equipment used includes needles, syringes, contrast dye, and imaging technology such as X-ray or fluoroscopy. Local anesthesia is commonly used, and in some cases, mild sedation may be administered.

Duration

The procedure typically takes between 30 minutes and 1 hour.

Setting

This procedure is usually performed in a hospital's radiology or imaging department.

Personnel

• Radiologist or Interventional Radiologist
• Nurses
• Radiologic Technologist

Risks and Complications

• Infection at the injection site
• Allergic reaction to the contrast dye
• Bleeding or bruising
• Discomfort or pain at the injection site
• Rarely, injury to surrounding tissues

Benefits

• Accurate assessment of shunt functionality
• Identification of any issues for prompt treatment
• Potential improvement in symptoms if shunt issues are resolved

Recovery

• Patients typically can go home the same day.
• Post-procedure instructions may include rest and monitoring the injection site for signs of infection.
• Normal activities can often be resumed within a day.
• Follow-up appointments may be scheduled to discuss results and any further action needed.

Alternatives

• Ultrasound or other imaging modalities without contrast
• Regular monitoring of symptoms without immediate intervention
• Alternative drainage procedures, if the shunt is found to be non-functional

Comparison: Alternatives may be less invasive but provide less detailed information on shunt functionality.

Patient Experience

During the procedure, patients may feel slight pressure or discomfort at the injection site. Afterward, they may experience some mild soreness. Pain management typically involves over-the-counter pain relievers. Most patients can resume normal activities shortly after the procedure, although they should monitor for any signs of infection or other complications.