Percutaneous Nephrostomy Tube Placement

Question 1

Percutaneous

Answer 1

Access thru the skin

Question 2

Nephro

Answer 2

Kidney

Question 3

Ostomy

Answer 3

Surgical Opening

Question 4

It refers to the placement of a small,
flexible catheter through your skin into
your kidney

Answer 4

Percutaneous Nephrostomy

Question 5

It was first described by Urologist ______.

Answer 5

Dr. Willard Goodwin in 1995

Question 6

Functions of the kidneys

Answer 6

1.) Remove Nitrogenous wastes
2.) Regulate water levels in the body
2.) Regulate acid-base balance and electrolyte levels of the blood.

Question 7

Normal creatine levels for adults

Answer 7

0.6 to 1.5mg/dl

Question 8

BUN (Blood urea Nitrogen) levels should range between ______.

Answer 8

8 and 25 mg/100 ml

Question 9

Indications for Percutaneous Nephrostomy

Answer 9

1.) Drainage only
2.) Stone treatment
3.) Urine diversion
4.) Other therapeutic intervention
5.) Diagnosis of obstruction

Question 10

Procedure of choice when transurethral access is impossible or has already failed at relieving an obstructed urinary system from extrinsic mass effect

Answer 10

Draining only

Question 11

The most common reason for emergency PCN placement is to provide drainage in an acutely obstructed, infected kidney (pyonephrosis or obstructive pyelonephritis) in a septic patient, due to
the high mortality risk as well as the permanent renal impairment it can cause.

Answer 11

Pyonephrosis and Obstructive Pyelonephritis

Question 12

The first step in accessing the renal collecting system to enable percutaneous insertion

Creates a tract through which lasers, ultrasonic probes, and retractable baskets can be inserted for mechanical; crushing, vaporization and stone retrieval.

Answer 12

Nephrolithiasis treatment

Question 13

Healing of injured urinary tract tissue, such as in the setting of
urinary leak or fistula and hemorrhagic cystitis, may be
accelerated if urine is preferentially rerouted away from the
region of inflammation through bilateral nephrostomies.

Answer 13

Urine diversion

Question 14

Contraindications

Answer 14

1.)Bleeding diathesis (most commonly) uncontrollable coagulopathy)
2.)Uncooperative patient.
3.)Uncontrolled hypertension.
Severe hyperkalemia (>7 mEq/L); this should be corrected with hemodialysis before the procedure

Question 15

It refers to an increased susceptibility to bleeding or bruising. Patients with Hemophilia is usually an inherited bleeding disorder in which the blood does not clot properly and are prone to ____________.

Answer 15

Bleeding diathesis

Question 16

it is a medical problem in which you have too much potassium in your blood.

Severe __________ (__ mEq/L); this should be corrected with hemodialysis before the procedure

Answer 16

Hyperkalemia

> 7

Question 17

Approaches & Methods

Answer 17

Eye of the needle approach and One-stick or Two-stick technique

Question 18

This uses the C-arm or fluoro placed so that the needle is parralel and pointed directly at the target calyx or stone.

Depth of penetration is determined by rotation or angulation of the x-ray unit.

Answer 18

Eye of the needle Approach

Question 19

Typically, for PCNL, there is an existing, radio-opaque stone that can be used as a target allowing the ___________________.

In the __________________, the first needle puncture is used only to opacify the collecting system with contrast so that the final or definitive stick with another needle can be optimally directed. Since the first stick is just for opacification, a smaller needle is
suggested and it can be targeted directly at the renal pelvis. A small amount of air carbon dioxide can be injected into the renal pelvis to help visualize the posterior
calyces as the gas will preferentially fill them in prone patients providing an obvious

Answer 19

One-stick, Two-Stick technique

Question 20

Devices & Equipment Used

Answer 20

Ultrasound or fluoroscopy guidance
Local anesthesia with 1% or 2% lidocaine
18 gauge puncture needle, an alternative would be to use micropuncture set
with a 21 or 22 gauge needle
0.035 inch stiff guidewire (an 0.018 guidewire is also used with a
micropuncture set)
Water-soluble contrast media
Dilators ranging from 7-9 french
Pigtail drain (typically 8 french)
1

Question 21

Contrast material

Answer 21

Water-Soluable Contrast Media

• Visualization of the renal collecting system
• Assessment of urine flow
• Detection of complications
• Safety and compatibility:

Question 22

Medications

Answer 22

Prophylactic antibiotics - typically a 3rd generation cephalosporin in selected patients, antibiotic use is not routine 3

Analgesia (e.g. meperidine; fentanyl) - not routinely used, but can aid in cooperation in selected patients

Sedation - a short-acting benzodiazepine (e.g. midazolam) may be used in selected patients

Question 23

Positionings

Answer 23

Prone, Prone Oblique, or lateral position, depending on clinical circumstances and patient comfort

Question 24

Complications

Answer 24

1.) Bleeding
2.) Pneumothorax
3.) Bowel Injury anf Peritonitis
4.) Urine leak
5.) Puncture of adjacent organs
6.) Catheter Encrustation and Obstruction
7.) Catheter Displacement - Reported At 20% After A few Months 6

Question 25

After care

Answer 25

Bed rest, Normal to have blood stained pee, take care of the nephrostomy tube, adequate hydration.