Peritoneovenous Shunt Placement

What is Peritoneovenous Shunt Placement

A peritoneovenous shunt is a medical device that is used to drain fluid from the abdomen back into the bloodstream. During surgery, the shunt is placed under the skin (implanted). It has a pump and catheter that drain fluid out of the abdomen, through the pump, into a large vein in the neck, and back to the heart.

One type of peritoneovenous shunt called a Denver shunt also has a valve inside it that prevents fluid from flowing back into the abdomen. After the procedure, the shunt will work automatically when you lie down. You will also have to pump it two times a day to prevent the pump from clogging.

You may need a peritoneovenous shunt to drain protein-containing fluid (ascites fluid) that builds up in the abdomen due to liver disease or some types of cancer. Returning ascites fluid into your bloodstream is important because the fluid contains proteins that you need. Draining ascites fluid allows you to move and breathe better.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.
  • Any allergies or reactions you have had to X-ray dyes (contrast dye).

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines or dyes.
  • Damage to the intestines, lungs, or blood vessels.
  • A blood clot that forms inside a vein.
  • Leaking of ascites fluid.
  • Blockage in the pump or the shunt catheter.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

  • You may be asked to shower with a germ-killing soap.
  • Plan to have someone take you home from the hospital or clinic.
  • Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
  • Ask your health care provider how your surgical site will be marked or identified.

What happens during the procedure?

  • To lower your risk for infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap or a germ-killing solution on the side of your body where the shunt will be inserted.
    • Hair may be removed from the surgical area.
  • An IV will be inserted into one of your veins.
  • You will be given:
    • Medicine to help you relax (sedative).
    • Medicine to numb the areas where the shunt will be placed (local anesthetic).
    • Antibiotic medicine.
  • An incision will be made in your lower neck area.
  • A small, thin tube (catheter) will be placed into a neck vein that leads to a large blood vessel entering your heart.
  • An incision will be made over your lower rib area on the same side of your chest.
  • At the chest incision site, a pocket will be created under your skin to hold the pump that is attached to the catheter.
  • An upper tunnel will be created under your skin. This tunnel will lead from the pump pocket to your neck incision.
  • The catheter will be moved through the tunnel (from your neck incision to the pump pocket). Then the catheter will be attached to the pump.
  • A lower tunnel will be created under your skin. It will lead from the pump pocket to the top of your abdomen.
  • An incision will be made in your abdomen (abdominal cavity) where the ascites fluid has built up.
  • A catheter will be moved through the lower tunnel and into your abdomen. To make sure the catheter is in the right position, contrast dye may be injected into the catheter and X-rays may be taken. Contrast dye helps the catheter show up on X-rays.
  • The abdominal catheter will be attached to the pump.
  • The pump will be checked to make sure ascites fluid flows through it and drains up to the neck vein catheter.
  • The incisions in your chest and neck will be closed with stitches (sutures) and covered with bandages (dressings).
  • The incision in your abdomen will be closed with sutures and covered with dressings.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • You will be taught how and when to pump your shunt.
  • You may continue to receive antibiotic medicine and pain medicine through an IV as needed. Your IV will be removed when you are able to start drinking fluids.
  • Do not drive for 24 hours if you were given a sedative during your procedure.

Summary

  • Peritoneovenous shunt placement is a procedure done to drain fluid that collects in your abdomen, then return it into your bloodstream.
  • The shunt is placed under your skin. You will need a small incision in your neck, chest, and abdomen.
  • You will be taught how and when to pump your shunt after your procedure.

Peritoneovenous Shunt Placement, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

  • Pain at the incision sites (neck, chest, and abdomen).
  • A small amount of fluid coming from the incision in your abdomen.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Take your antibiotic medicine as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Driving

  • Do not drive or use heavy machinery while taking prescription pain medicine.
  • Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.

Eating and drinking

  • Follow instructions from your health care provider about eating or drinking restrictions. You may need to eat a low-salt (low-sodium) diet.
  • Do not drink alcohol.

Bathing

  • Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

Incision care

  • Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If you cannot use soap and water, use hand sanitizer.
    • Change your bandage as told by your doctor.
    • Leave stitches (sutures) in place. They may need to stay in place for 2 weeks or longer.
  • Check your incision areas every day for signs of infection. Check for:
    • Redness, swelling, or more pain.
    • Blood.
    • New or increased fluid.
    • Warmth.
    • Pus or a bad smell.

General instructions

  • Pump your shunt as told by your health care provider. Most people pump their shunt in the morning and at bedtime. Your shunt works automatically when you lie down. The pump works mostly at night while you sleep.
  • Do not sleep sitting up or with your upper body higher than a 45-degree angle. You may sleep on a regular pillow.
  • Before you have any type of procedure, tell all health care providers that you have a shunt.
  • To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
    • Drink enough fluid to keep your urine pale yellow.
    • Take over-the-counter or prescription medicines.
    • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
    • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have chills or a fever.
  • You have pain that does not get better with medicine.
  • You have redness, swelling, or more pain around an incision.
  • You have blood coming from an incision.
  • An incision feels warm to the touch.
  • You have pus or a bad smell coming from an incision.
  • Your pump becomes too hard to pump, or it does not re-inflate after pumping.
  • You have questions about how to use your pump.
  • Your abdomen starts to get larger.

Get help right away if:

  • You have a lot of blood or fluid coming from an incision.

Summary

  • After the procedure, it is common to have pain at your incision sites. It is also common to have a small amount of fluid coming from the incision in your abdomen.
  • Check your incision areas every day for signs of infection, such as redness or swelling.
  • Pump your shunt as told by your health care provider.
  • Before you have any type of procedure, tell all health care providers that you have a shunt.
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