Monday, September 25, 2017

Imaging percutaneous nephrostomy

Percutaneous Nephrostomy (PCN)
Objectives
In cases of upper urinary tract obstruction:
   Drainage of supravesical upper urinary tract
   Pyonephrosis drainage and assessment of recoverable function
   Access to upper urinary tract for stone removal, stricture dilatation, stent placement.
Patient Preparation
• Blood prothrombin time
  Antibiotic cover if required
  Fasting for 6 hours
  Children to be well hydrated
  Surgical cleaning and draping of the back.
Position
Prone with sandbang under abdomen.
Anesthesia
   IV sedation with diazepam
   Local infiltration analgesia with 1% xylocaine, 10 ml
   General anesthesia may be required for infants and uncooperative children.
Instruments
   18 G, 20 cm long needle with stilet
   0.035" or 0.038" diameter, 100 cm long J-shaped guidewire
   Sterile surgical blades
   Graded teflon dilators 7F-10F
   Drainage catheter 8F-10F, pigtail with multiple holes/Malecot catheter
   Suture and needle for fixation of catheter
   Adhesive tape
   Connector
   3-way stopcock
   Urine collection bag.
Procedure
   1.  Sonographic or fluoroscopic guidance depending on operators’ convenience and choice.
   2.  Calyx to be punctured, chosen depending on indication for PCN.
   3.  Puncture as laterally as possible, through renal paren­chyma.
   4.  Puncture chosen calyx under guidance with 18 G needle.
   5.  Remove stilette of needle; pass guidewire. Check position of guidewire within pelvicaliceal system.
   6.  Stab incision along needle tract.
   7.  Dilate tract to one size above catheter size.
   8.  Place catheter in pelvicaliceal system over guidewire.
   9.  Remove guidewire.
10.  Connect catheter to urine collection bag.
11.  Suture catheter and skin wound.
12.  Secure catheter to skin with adhesive tape.
Complications
  Perinephric hematoma

  Hematuria.

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