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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