Nephrostomy change

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Author: Mikael Häggström [notes 1]
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. Fix the catheter to the skin.

Notes

  1. 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.

References