1910003985-20PPA Patient Instructions BD Curve …...BD® Curve Ascites Shunt Ascites, an accumulation of fluid in the abdominal cavity, is a common complication of cirrhosis of the

Patient informationBD® Curve Ascites Shunt Ascites, an accumulation of fluid in the abdominal cavity, is a common complication of cirrhosis of the liver and various types of cancer.

The BD® Curve Ascites Shunt can help relieve your ascites symptoms and help you regain a better quality of life using a therapy called peritoneovenous shunting (PVS).1,2

Key benefits of PVS:

• May enable nutrients to be retained3,4

• May improve mobility and activities of daily living5

The information presented here is for informational purposes only. It is recommended that you discuss the proper usage of the BD® Curve Ascites Shunt with your doctor, and that you follow any directions or instructions provided by your doctor relating to the product. Please consult the product’s Instructions for Use for additional information.

Figure BThe BD® Curve Ascites Shunt placed inside the body

How does the BD® Curve Ascites Shunt work?The BD® Curve Ascites Shunt consists of a pump chamber (see no. 1 in Figure A)attached to two catheters (see nos. 2 and 3 in Figure A). Inside the pump chamber are either one or two valves (depending on the specific shunt your doctor has chosen for you) that permit fluid flow in only one direction. The shunt is implanted internally, so nothing will show outside your body.

One end of the catheter is placed in your abdomen and the other in one of your veins (see Figure B). The pressure of the ascites in your abdomen forces the fluid to flow through the shunt into your circulatory system. This allows you to retain the proteins and nutrients from the fluid in your body while helping relieve the discomfort associated with chronic ascites.

The shunt works automatically, but you will need to pump the chamber every day to help avoid clogging and keep the shunt working. You’ll know the shunt is working if your ascites symptoms improve.

Venous limb (placed in your vein)

Peritoneal limb (placed in your abdomen)

Pump chamber (to be used for daily pumping)

Figure A

2

1

3

Patient spotlight—new hope for Marvin M.After being diagnosed with lymphoma, Marvin began building fluid internally and developed chronic ascites. He underwent several paracentesis procedures to drain off up to 66 liters of fluid—along with key nutrients—drawn from his abdomen. The treatments left him without nutrients…or hope. “I knew I couldn’t last. I was so low. I hadn’t [eaten] anything for probably 4 months. I lost 40 pounds,” said Marvin. But after changing caregivers, he underwent PVS. It changed his life. “I’ve been able to regain a lot of my life that I had lost…Really, it was the biggest part of the reason I’m here today.”

The BD® Curve Ascites Shunt

Things to know about the BD® Curve Ascites ShuntWhat are some questions that I should ask my doctor?

• Will I have a single- or double-valved shunt?

• Can you mark the location of the pump chamber on my body so that I can easily find it to pump?

What should I do after placement of the BD® Curve Ascites Shunt?

• In order for the shunt to function correctly, you must pump the shunt twice per day in accordance with the Instructions for Use.

• You must lie flat in order for the shunt to function. Lying flat while getting a full night’s rest typically allows normal flow to occur.

How do I pump my double-valved shunt?

• Locate the pump chamber, which should be in the area of your lower rib cage. Lie on your back.

• Press the center of the 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 (see Figure C).

• 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.

• Pause for a second between each pump so that the pump chamber can reexpand.

How do I pump my single-valved shunt?

• Locate the pump chamber, which should be in the area of your lower rib cage. Lie on your back.

• Press the center of the chamber down as far as you can. Before releasing it, press or pinch the tubing that you feel under your skin, about an inch above the pump chamber. As you continue to press or pinch the tubing, release the pump chamber. Then release the tubing. Continue to pump in this alternating fashion 20 times. Repeat 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.

• Pause for a second between each pump so that the pump chamber can reexpand.

Call your doctor if:

• Your abdomen is distended and you feel discomfort even after you pump the shunt, as directed by your doctor.

• The pump chamber is solid and cannot be compressed.

• The pump chamber, after being compressed, does not reexpand as normal.

To avoid the risk of air entering the chamber pump, let your doctors know you have a BD® Curve Ascites Shunt before any medical procedures, especially laparoscopic surgery.

Figure C View of the shunt pump chamber underneath the skin

Frequently asked questions How often should I pump my shunt?

Unless otherwise instructed by your doctor, you should pump the shunt while lying down, 20 consecutive times in the morning upon waking up and 20 consecutive times at night before you go to sleep.

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

With each pump, 1 milliliter (mL) of fluid is moved from your abdomen, through the shunt and into your vein. So with each pumping session, 20 mL of fluid is moved, which 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 a paracentesis. Can I tell how much fluid is drained by the shunt?

It is difficult to estimate how much fluid is flowing or at what rate, since each patient is different. Fluid will flow spontaneously through the shunt throughout the day, whenever the ascites fluid creates enough pressure to push it up through the shunt and into your vein. This will typically occur when you are lying flat.

How long will I have my shunt in place?

The decision on whether and when to remove the shunt will be made by your doctor.

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 30–45º angle or greater, the ascites fluid may not automatically flow through the shunt. This may cause the ascites fluid to build up again. If you cannot sleep while lying flat at night, try lying flat periodically throughout the day to allow for the ascites fluid to move through the shunt.

What if the ascites fluid starts to build up again?

If fluid has been controlled, then starts to build up again, it is typically an indication that the shunt is clogged. Please contact your doctor.

What do I do if I can’t pump the shunt (if the chamber won’t compress or reexpand)?

This is typically an indication that the shunt is clogged. A clogged shunt may be repaired or replaced relatively easily. Please contact your doctor.

Who do I call if I have a problem with my shunt?

If you have a problem with your shunt, please contact your doctor.

BD, Vernon Hills, IL, 60061, U.S.

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References

1 Tomiyama K, Takahashi M, Fujii T, et al. Improved quality of life for malignant ascites patients by Denver peritoneovenous shunts. Anticancer Res. 2006;26(3B):2393-2395.

2 Orsi F, Grasso RF, Bonomo G, Monti C, Marinucci I, Bellomi M. Percutaneous peritoneovenous shunt positioning: technique and preliminary results. Eur Radiol. 2002;12(5):1188-1192.

3 Noguchi K, Funakoshi S. Indication and practice of Denver peritoneovenous shunt for refractory ascites. Kan Tan Sui. 2005;50(5):775-781.

4 Seike M, Maetani I, Sakai Y. Treatment of malignant ascites in patients with advanced cancer: peritoneovenous shunt versus paracentesis. J Gastroenterol Hepatol. 2007;22(12):2161-2166.

5 Won JY, Choi SY, Ko HK, et al. Percutaneous peritoneovenous shunt for treatment of refractory ascites. J Vasc Interv Radiol. 2008;19(12):1717-1722.