Nephrostomy change

Author: Mikael Häggström

Main steps

• denotes the steps that should be done in fluoroscopy.

Preparations

• Fix an obturator inside 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 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).*
• Loosen any pigtail
• Insert a guidewire into the renal pelvis or proximal ureter.*
• Remove the previous catheter while keeping the guidewire in place.*

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 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.*
  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.

Report

• Position of previous catheter.
• Absence of complications, or a description thereof.
• Type and position of new catheter.
• Any blood or pus in the urine.