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LeVeen or Denver Shunt Patency

LeVeen or Denver Shunt Patency. By: Jose Mongalo. OBJECTIVES. To provide information about the Radionuclide used for the procedure. To provide information about the radadiopharmaceutical and localization. To provide information about the equipment used for the procedure.

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LeVeen or Denver Shunt Patency

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  1. LeVeen or Denver Shunt Patency By: Jose Mongalo

  2. OBJECTIVES • To provide information about the Radionuclide used for the procedure. • To provide information about the radadiopharmaceutical and localization. • To provide information about the equipment used for the procedure. • To provide information about the method of administration and adult dose range. • To provide information of the indication and contraindication. • To provide pertinent information needed for the patient history. • To provide detail information about the procedure. • To provide information about the normal results and abnormal results. • To provide a list of artifacts that may affect the procedure or image. • To provide advantages and disadvantages of the leveen shunt. • To provide a brief detail of when to use a leveen shunt. • To provide cases where a leveen shunt has become use full in the operating table. • To provide the class with 5 questions • To provide answer • Conclusion • Word note

  3. RADIONUCLIDE • Radionuclide: • Technetium 99m • T 1/2 : 6.01hrs • Energy: 140keV • Emission: Gamma

  4. RADIOPHARMACEUTICAL • Radiopharmaceutical • Tc99m-MAA or HAM • MAA= Macroaggregated Albumin • HAM= Human Albumin microsphere • Tc99m- SC • SC=Sulfur Colloid • Localization • Compartmental, peritoneal to blood circulation.

  5. EQUIPMENT • Camera • Large field of View • Collimator • LEAP or LEHR • Computer set-up • Flow; Denver shunt; 3 sec/frame for 60 seconds. Injection in to the pump • Static; 180-300 sec/image or 500,000 counts • Whole body: 8-10cm/min, • note: check the Patient length.

  6. METHOD OF ADMINISTRATION & ADULT DODE RANGE • Method of Administration: • Intraperitoneal injection with local anesthetic by Dr. • Adult Dose Range • Tc99m-MAA; 1.5-5mCI (55.5-187MBq) • Tc99m-SC; 3mCi (111MBq)

  7. INDICATIONS & CONTRAINDICATIONS • Indication: • Evaluation of Leveen shunt Patency. • Evaluation of Denver Shunt patency. • Evaluation of ascites secondary to the implanted shunt, increased sodium consumption, inadequate diuretic agents, hepatic cirrhosis or heart failure • Contra indications: • Patient with pulmonary hypertension may be a consideration with Tc99m-MAA

  8. PATIENT HISTORY • History or family history of cancer. • If yes, what type and how long? • Chief complain of abdominal pain. • Does the patient have abdominal distention (swollen). • If yes, more that before surgery?

  9. PROCEDURE • Place the patient on the table in the supine position. Ensure that there are no attenuating objects on patient or cloths.

  10. PROCEDURE • Set your acquisition to flow study positioning the camera anterior over the ROI (abdomen/thorax) to visualize a much of the pump and tubing as possible. Start the camera on injection

  11. PROCEDURE • Inject in the lower left quadrant. Note this is done by the physician.

  12. PROCEDURE • Leveen: Perform Ballottement (abdominal palpation) to distribute radiotracer or roll the patient from side to side. • Denver: Instruct the patient to pump the system vigorously after injection as is normal operation.

  13. PROCEDURE Obtain Images: Immediate: Anterior Abdominal image. Anterior abdomen and thorax at 15, 30 ,45, and 60 minutes after injection. Option: W/B sweep from head to pelvis. Obtain 2-4hrs delays if no lung or liver visualization.

  14. NORMAL RESULTS • Lung present within 60 minutes. Usually this is rapid visualization( within 10-30 minutes of injection). • If Tc99m-SC is used, liver is the target organ within 60 minute. This method is not presently used as much because of the difficulty of separating the liver for the ascites.

  15. ABNORMAL RESULTS • Tc99m-MAA: no activity in the lung after 4-hrs delays, indicating obstruction. • Activity stops at abdominal pump; very little or no activity in tubing( indicating valve failure or obstruction in tubing.

  16. ARTIFACTS • Risk of infection with injection. Patient should be monitor. • Jewelry, medallions, buttons, items in shirt or pockets, or belt buckle can cause artifact. Also note any surgically inplanted devices.

  17. ARTIFACTS • Tc99m: Test should be performed with reduced amount of radiotracer ( and hence reduced number of injected particles) on patient with known compromised pulmonary function (known disease, shunting, arteriole malformation, liver disease) or one lung, and consideration should be made as to whether to perform the test on patient with pulmonary hypertension,

  18. ARTIFACTS • If little or no visualization of lung with visualization of superior vena cava and right heart, check patient history for compromising diseases, operation and cancers. • If no visualization of radiotracer in abdomen, check needle and radiotracer tag.

  19. ADVANTAGES • Surgical placement of a Levine shunt) from the abdominal space (peritoneum) to the jugular vein may reduce ascites and reverse some of the symptoms of kidney failure. • Treatment is aimed at improving liver function, and ensuring that the amount of blood in the body and the heart pumping action are adequate.

  20. DISADVANTAGES There several risks when placing a shunt examples are: • Risks for any anesthesia • Risks for any surgery are • Malfunction or blockage

  21. CIRRHOSIS PATIENT • 43 year old male • Prognosis with cirrhosis due to alcohol drinking • 1997 The patient was implanted a shunt.

  22. OUTCOME • 4 weeks after the implantation the patient did not show any complication due to the operation.

  23. ASCITES • In medicine (gastroenterology), ascites (also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more archaically as abdominal dropsy) is an accumulation of fluid in the peritoneal cavity. Although most commonly due to cirrhosis and severe liver disease, its presence can portend other significant medical problems.

  24. ASCITES • This is a CT Scan of the previous patient the patient the later of ascitic fluid between the abdominal wall and liver.

  25. CONCLUSION • Even thought the Leveen shunt is a great asset to the medical doctors there is always risk that. . Because of this procedure is leading to high rate of early complications, the person is usually kept in intensive care for a few days. This procedure is done by a vascular surgeon, neurosurgeon or a general surgeon in a hospital.

  26. QUESTIONS • What are the two radiopharmaceuticals are used in the Leveen Shunt Patency exam? • What is adult dose range? • Name a contraindication for the Leveen Shunt Patency? • What position must the patient be placed on the table? • Name the two collimators used in the LeVeen Shunt Study? • What is another name for the LeVeen Shunt?

  27. ANSWER • Macroaggregated Albumin & Sulfur Colloid. • Tc99m-MAA; 1.5-5mCI (55.5-187MBq) • Tc99m-SC; 3mCi(111MBq) • Supine • LEAP or LEHR • Denver shunt

  28. WORD SITE • http://www.unitedhealthdirectory.com/leveen_shunt-536.html • http://www.umecopr.com/pages/medical_surgical/leveen_shunt.html • http://www.marylandhiv.com/ency/article/000489trt.htm • http://images.ask.com/fr?q=Leveen+Shunt&desturi=http%3A%2F%2Ffaculty.mc3.edu%2Frbenfiel%2FNUR211%2FNutritionassessa%2Fsld028.htm&fm=i&ac=24&ftURI=http%3A%2F%2Fimages.ask.com%2Ffr%3Fq%3DLeveen%2BShunt%26desturi%3Dhttp%253A%252F%252Ffaculty.mc3.edu%252Frbenfiel • www.scielo.cl/scielo.php?pid=S0034-9887199900... • www.gihealth.com/html/education/ascites. • http://www.nym.org/healthinfo/docs/075/doc75ascites.html • http://www.emedicine.com/med/topic3183.htm

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