Difference between revisions of "Nephrostomy change"
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===Removal of previous catheter=== | ===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.* | + | *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 | *Loosen any pigtail | ||
| − | *Insert a guidewire (such as Amplatz) into the renal pelvis or proximal ureter.* | + | *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.* | + | *Remove the previous catheter while keeping the guidewire in place.* [[#Troubleshooting|Troubleshooting: Catheter stuck]] |
===Insertion of new catheter=== | ===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 | + | *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.* |
*Enter the renal pelvis with the obturator, and then advance with only the soft catheter.* | *Enter the renal pelvis with the obturator, and then advance with only the soft catheter.* | ||
| − | *If proper position of a pigtail catheter, | + | *If proper position of a pigtail catheter, 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, two projections from different directions, as well as aspiration of the contrast.* <br>Check whether there is blood or pus in the aspirate. | + | *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. | *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== | ==Troubleshooting== | ||
;Catheter in calyx | ;Catheter in calyx | ||
| − | If a previous pigtail catheter is located in a calyx, push it in with a 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. | + | 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 | ;Cannot advance guidewire | ||
Revision as of 13:36, 16 January 2019
Author:
Mikael Häggström [notes 1]
Contents
Main steps
* denotes the steps that should be done in fluoroscopy.
Preparations
- Insert an obturator in the new catheter.
- Position the patient on the side
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: Catheter in calyx
- Loosen any pigtail
- Insert a guidewire (such as Amplatz) into the renal pelvis or proximal ureter.* Troubleshooting: Cannot advance guidewire
- Remove the previous catheter while keeping the guidewire in place.* 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.*
- Enter the renal pelvis with the obturator, and then advance with only the soft catheter.*
- If proper position of a pigtail catheter, 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.*
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).*
If this is not successful, possibly use a hydrophilic guidewire to reach the renal pelvis, on which to switch catheters.
- Cannot advance guidewire
This is probably because of kidney stones in the catheter. Possible measures:
- Try a hydrophilic or smaller guidewire in order to get through the catheter.
- Advance around the catheter with a larger tube
- If the catheter has been used for weeks, it can generally be pulled out, and a new catheter inserted through the same tunnel without any guidewire.
- Catheter stuck
If a previous pigtail catheter can not be pulled out after loosening of the pigtail threads, it may help to cut off the threads by the external tip, or even cutting off the entire external tip in order to hopefully loosen the threads.
Report
- Position of the previous catheter.
- Absence of complications, or a description thereof.
- Type, size and position of the new catheter.
- Any blood or pus in the urine.
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
