Percutaneous Nephrostomy Tube Placement Flashcards
Percutaneous
Access thru the skin
Nephro
Kidney
Ostomy
Surgical Opening
It refers to the placement of a small,
flexible catheter through your skin into
your kidney
Percutaneous Nephrostomy
It was first described by Urologist ______.
Dr. Willard Goodwin in 1995
Functions of the kidneys
1.) Remove Nitrogenous wastes
2.) Regulate water levels in the body
2.) Regulate acid-base balance and electrolyte levels of the blood.
Normal creatine levels for adults
0.6 to 1.5mg/dl
BUN (Blood urea Nitrogen) levels should range between ______.
8 and 25 mg/100 ml
Indications for Percutaneous Nephrostomy
1.) Drainage only
2.) Stone treatment
3.) Urine diversion
4.) Other therapeutic intervention
5.) Diagnosis of obstruction
Procedure of choice when transurethral access is impossible or has already failed at relieving an obstructed urinary system from extrinsic mass effect
Draining only
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.
Pyonephrosis and Obstructive Pyelonephritis
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.
Nephrolithiasis treatment
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.
Urine diversion
Contraindications
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
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 ____________.
Bleeding diathesis
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
Hyperkalemia
> 7
Approaches & Methods
Eye of the needle approach and One-stick or Two-stick technique
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.
Eye of the needle Approach
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
One-stick, Two-Stick technique
Devices & Equipment Used
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
Contrast material
Water-Soluable Contrast Media
- Visualization of the renal collecting system
- Assessment of urine flow
- Detection of complications
- Safety and compatibility:
Medications
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
Positionings
Prone, Prone Oblique, or lateral position, depending on clinical circumstances and patient comfort
Complications
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
After care
Bed rest, Normal to have blood stained pee, take care of the nephrostomy tube, adequate hydration.
