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===Removal of previous catheter===
*Check the position of the previous catheter tip with a few ml of iodinated contrast, preferably in two projections such as a lateral and a more frontal one.*[[#Troubleshooting|Troubleshooting: Catheter in calyx]]
*Loosen any pigtail
*Insert a guidewire (such as Amplatz) into the renal pelvis or proximal ureter.*[[#Troubleshooting|Troubleshooting: Cannot advance guidewire]]*Remove the previous catheter while keeping the guidewire in place.*[[#Troubleshooting|Troubleshooting: Catheter stuck]]
===Insertion of new catheter===
*Insert the new catheter with obturator over the guidewire, keeping the same direction as the guidewire through the tissues to avoid pulling or kinking it, in fluoroscopy as it approaches the kidney.*
*Enter the renal pelvis with the obturator, and then advance with only the soft catheter.*
*If proper position of a pigtail catheter, fix lock the pigtail. If unsure, confirm location within the renal pelvis by injection of a few ml of contrast before fixation.**Confirm functionality by injection of a few ml of contrast, and two projections from different directions, as well as aspiration of the contrast.* <br>Check whether there is blood or pus in the aspirate.
*Attach the catheter to the skin, preferably both directly at insertion as well as enough to the side to have a soft S-shaped bend of the catheter in order to give certain room for stretching without pulling out the catheter.
==Troubleshooting==
;Catheter in calyx
If a previous pigtail catheter is located in a calyx, push it in with a stiff guidewire (such as Amplatz).* <br>If this is not successful, possibly use a hydrophilic guidewire to reach the renal pelvis, on which to switch catheters.
;Cannot advance guidewire
