Denver Ascites Shunt Placement

 

What is Ascites?

 

Ascites is a buildup of fluid in the belly (abdominal cavity). It is a common complication of cirrhosis of the liver and many types of cancer. Your doctor has placed a Denver ascites shunt to help manage your ascites using a therapy called peritoneovenous shunting (PVS).

 

This therapy can help:

  • Your body retain nutrients.
  • Improve how well you can  move and breathe.
  • Improve your appetite by reducing the feeling of fullness.
  • Increase blood flow through your kidneys.
  • Increase your body’s ability to get rid of excess fluid.

 

For most patients, the Denver shunt gives them quick relief from ascites symptoms.

 

How the Denver shunt works:

The Denver shunt is made up of a pump chamber that is attached to 2 tubes. Inside the pump chamber there are valves that only let fluid flow in 1 direction. The shunt is implanted, so nothing will show outside your body. One end of the catheter is placed in your abdomen (belly) and the other in one of your veins.

 

The pressure of the ascites in your abdomen forces the fluid to flow through the shunt into your circulatory system. This lets you keep the proteins and nutrients from the fluid in your body. It also helps relieve the discomfort that comes from the pressure. The shunt works automatically, but you will need to pump the chamber every day to help avoid clogging and keep the shunt working. (Please see the information about pumping your shunt in the “Patient instructions” and “Frequently asked questions” sections.) You will know the shunt is working because your ascites symptoms will get much better.

 

Pumping your shunt at home:

To pump your shunt, first find your pump chamber. It should be around your lower rib cage. Lie on your back and follow these instructions.

 

How to pump your shunt:

  • Press the lower half of the pump chamber down as far as you can, then release it. Wait 1 second for the pump chamber to expand, then repeat 20 times. Do this pumping procedure twice per day.
  • Pumping may be uncomfortable at first if the pump chamber is close to the incision site. Once the incision site heals, it should not be painful to pump.
  • It is best to pause for a second between each pump so that the pump chamber re-expands.
  • You must lie flat for the Denver shunt to work. The ascites fluid can only flow through the shunt whenyou are lying flat. It will flow much slower, or even stop, if you are sitting at a 45- to 90-degree angle. Lying down while getting a full night of sleep should be enough to keep the flow going.

 

 

Watch for these signs that the shunt may not be working:

  • Your belly fills with fluid again.
  • The pump chamber is solid and cannot be compressed.
  • The pump chamber, after being compressed, does not re-expand as normal.

 

If your ascites returns or the shunt seems clogged, contact the doctor who implanted your shunt. Your doctor can repair or replace the shunt in most cases.

To avoid the risk of air entering the pump, let your doctors know you have a Denver shunt before any medical procedures, especially laparoscopic surgery.

 

Frequently asked questions:

How do I pump the shunt?

Most of the time, the pump chamber is placed on your lower rib cage. Your doctor may have marked its location with a marker. Follow these steps:

  • Lie flat on your back.
  • Firmly press the center of the lower half of the chamber down as far as you can, then release it.
  • Wait a second for the pump chamber to refill.

 

How often should I pump my shunt?

Unless your doctor gives you different instructions, you should pump the shunt 2 times each day. Pump while you are lying down (20 times in a row) in the morning when you wake up. Pump again (20 times in a row) at night before you go to sleep. Please see the steps in the “Patient instructions” section of this brochure.

 

How much fluid goes through my shunt each time I pump it?

With each pump, 1 milliliter (mL) of fluid is moved from your belly, through the shunt and into your vein. So, with each pumping session, a total of 20 mL of fluid is moved. This is less than an ounce of fluid, or about 4 teaspoons. Remember, the main reason for pumping is to help prevent clogging. Fluid moves on its own through the shunt when you are lying down.

 

I know how much fluid was being drained when I had paracentesis. Can I tell how much fluid is drained by the shunt?

It is hard to guess how much fluid is flowing or at what rate, since each patient is different. Fluid will flow freely through the shunt all through the day. When the ascites fluid creates enough pressure, it will push it up through the shunt and into your vein. This happens most often when you are lying flat.

 

How long will I have my shunt in place?

Your doctor will most likely leave your shunt in place as long as it is controlling your ascites. Some patients have had the shunt in place for a year or longer.

 

What if I don’t lie flat, or I use a pillow while I sleep?

Using a normal pillow is fine, but if you sleep at a 30- to 45-degree angle or greater, the ascites fluid may not flow through the shunt. This can cause the ascites fluid to build up again. If you cannot sleep while lying flat at night, try lying flat at times all through the day. This lets the ascites fluid move through the shunt.

 

What if the ascites fluid starts to build up again?

If the fluid was being controlled, but then starts to build up again, it can be a sign that the shunt is clogged. A clogged shunt can be repaired or replaced relatively easily. Contact the doctor who implanted your shunt.

 

What do I do if I cannot pump the shunt (if the chamber will not compress or re-expand)?

This is most often a sign that the shunt is clogged. A clogged shunt can be repaired or replaced. Contact the doctor who implanted your shunt.

 

Who do I call if I have a problem with my shunt? Should I go to the emergency room?

You should contact the doctor who implanted your Denver shunt for help. A clogged shunt does not always mean a visit to the emergency room.

 

Pain control:

  • It is normal to have some soreness at the puncture site.
  • Ice packs will be helpful for bruising and pain.

 

Wound care:

  • Keep the puncture site dry until the day after your procedure. You may then take a shower.
  • Keep the bandages on for 5 days. Cover the site when you take a shower.
  • No soaking the incisions for 3 months or until fully healed. This means no:
  • Hot tubs
  • Baths
  • Pools

 

How to contact us:

  • For questions or problems during office hours (Monday through Friday, 8 a.m. to 3 p.m.) call the nurse in the cardiac and vascular procedure department:720.848.4480.
  • For questions or problems after regular hours, please call the UCHealth University of Colorado Hospital operator: 720.848.0000. Ask for the interventional radiology fellow on call. The operator will ask the fellow on-call to contact you.
  • For a life-threatening emergency that needs help right away, call 911 or have someone take you to the UCHealth University of Colorado Hospital emergency department or the closest emergency room.
  • To schedule a follow-up appointment in the cardiac and vascular procedure department, call 720.848.7440 and choose option 1 for interventional radiology outpatient scheduling.

 

We appreciate that you chose UCHealth University of Colorado Hospital for your care. Today your care was supervised by a board of certified interventional radiologists.

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©2022, University of Colorado Hospital, Aurora

August 2022

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