Name of the Procedure:

Peritoneal-venous shunt patency test (e.g., for LeVeen, Denver shunt)

Summary

A peritoneal-venous shunt patency test evaluates whether a surgically implanted shunt (like LeVeen or Denver shunt), which drains excess fluid from the abdominal cavity into the venous system, is functioning correctly.

Purpose

The test checks for the proper operation of a peritoneal-venous shunt used to treat conditions like refractory ascites, where excess fluid accumulates in the abdominal cavity, causing discomfort and health complications. The goal is to ensure the shunt is patent (open and unobstructed) and effectively draining fluid as intended.

Indications

• Persistent or recurrent ascites unresponsive to medical therapy
• Symptoms of fluid accumulation like abdominal distension, discomfort, or difficulty breathing
• Suspected malfunction or blockage of an existing shunt

Preparation

• Patients may be asked to fast for a few hours before the test.
• Inform your healthcare provider of any medications you are currently taking; some may need to be adjusted.
• Blood tests or imaging studies (e.g., ultrasound, CT scan) might be performed beforehand.

Procedure Description

1. Patient Positioning: The patient lies down, typically in a supine position.
2. Sterilization: The skin over the shunt site is cleaned and sterilized.
3. Injection: A small amount of contrast dye or radioactive tracer is injected into the catheter of the shunt.
4. Imaging: X-rays or scintigraphy (a type of nuclear medicine scan) are used to track the flow of the dye or tracer, observing if it moves unimpeded from the abdominal cavity into the venous system.
5. Assessment: The imaging results are analyzed to check for any blockages or abnormalities in the flow through the shunt.

Tools used may include imaging equipment (X-ray or scintigraphy machines), contrast dye, or radioactive tracers. Anesthesia is typically not required.

Duration

The procedure usually takes about 30 to 60 minutes.

Setting

The test is performed in a hospital radiology department or an outpatient imaging facility.

Personnel

• Radiologist
• Radiologic technologists
• Sometimes a nurse for patient care and preparation

Risks and Complications

• Allergic reaction to contrast dye or radioactive tracer
• Infection at the injection site
• Minor discomfort or pain at the injection site
• Rarely, false-positive or false-negative results

Benefits

• Confirms the proper functioning of the shunt
• Helps to diagnose any issues early, preventing complications like infection or obstruction
• Guides potential necessary adjustments or interventions

Recovery

• Patients can usually resume normal activities immediately after the test.
• Follow any specific post-procedure instructions given by the healthcare provider.
• You might be scheduled for a follow-up appointment to discuss the results.

Alternatives

• Ultrasound or CT scan of the shunt path to evaluate for blockages
• Paracentesis (removing fluid from the abdomen with a needle) and lab analysis for comparison
• Monitoring and adjusting diuretic medications

Patient Experience

• Mild discomfort or pressure during the injection of contrast dye or tracer.
• You will need to lie still during imaging.
• Most patients experience little to no pain and can return to normal activity shortly after the test. Pain management measures are usually unnecessary, but inform your healthcare provider if you experience significant discomfort.