Nephrostomy change

Author: Mikael Häggström
Main steps in a nephrostomy change, with * denoting that the step should be done in fluoroscopy:

1. Fix an obturator inside the new catheter
2. Position the patient on the side
3. Check the position of the previous catheter tip with a few ml of iodinated contrast, preferably in two projections such as lateral and a more frontal one.*
   - If a previous pigtail catheter is located in a calyx, push it in with a guidewire (such as Amplatz).*
4. Loosen any pigtail
5. Insert a guidewire into the renal pelvis or proximal ureter.*
6. Remove the previous catheter while keeping the guidewire in place.*
7. 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.*
8. Enter the renal pelvis with the obturator, and then advance with only the soft catheter.*
9. If proper position of a pigtail catheter, fix the pigtail. If unsure, confirm location within the renal pelvis by injection of a few ml of contrast before fixation.*
10. Confirm functionality by injection of a few ml of contrast, two projections from different directions, as well as aspiration of the contrast.*
11. 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.