Nephrostomy tube conversion to PCNU Technique and Dictation

PROCEDURE: 

1. Bilateral antegrade nephrostograms
2. Bilateral percutaneous nephrostomy tube exchange for nephroureteral catheters.

INDICATION: __ year old female with cervical cancer and obstructive uropathy. Had bilateral PCN placed _____. Is in process of converting to internalization. PCNU to be placed at present time.

DATE: 

OPERATORS: 

MEDICATIONS: Levaquin 500 mg IV, Versed 2 mg IV, fentanyl 100 mcg IV

FLUOROSCOPY TIME: 6.3 minutes

CONTRAST: 30 ml of nonionic contrast

CATHETER: 8 F x 24 cm nephroureteral catheters bilaterally

COMPLICATIONS: None immediate

TECHNIQUE:

The risks, benefits, and alternatives to the procedure and sedation were explained. Written informed consent was obtained.

The existing catheters and surrounding soft tissues were prepped and draped in sterile fashion. A surgical timeout was performed. Local anesthetic was injected at the catheter entry sites. A scout radiograph was obtained.

Attention was first focused on the patient’s left nephrostomy tube. A stiff angled Glidewire was advanced into the nephrostomy tube and the tube removed. A 5 French Kumpe catheter was advanced over the Glidewire and the combination of the Kumpe catheter/Glidewire were advanced into the ureter and into the patient’s urinary bladder. The Glidewire was removed and a stiff Amplatz wire was advanced into the urinary bladder thorugh the Kumpe catheter. The Kumpe catheter was subsequently removed. At this time a 24 cm nephroureteral stent was advanced over the Amplatz wire and the Amplatz wire removed. The cope loop was formed within the renal pelvis as well as within the urinary bladder. Contrast was then injected into the PCNU to confirm adequate position. The catheter was secured to the skin with 2-0 Prolene and sterile dressing applied.

Attention then focused on the patient’s right nephrostomy tube. A stiff angled Glidewire was advanced into the nephrostomy tube and the tube removed. A 5 French Kumpe catheter was advanced over the Glidewire and the combination of the Kumpe catheter/Glidewire were advanced into the ureter and into the patient’s urinary bladder. The Glidewire was removed and a stiff Amplatz wire was advanced into the urinary bladder thorugh the Kumpe catheter. The Kumpe catheter was subsequently removed. At this time a 24 cm nephroureteral stent was advanced over the Amplatz wire and the Amplatz wire removed. The cope loop was formed within the renal pelvis as well as within the urinary bladder. Contrast was then injected into the PCNU to confirm adequate position. The catheter was secured to the skin with 2-0 Prolene and sterile dressing applied.

The catheters were capped.

The procedure was well tolerated, and the patient was discharged from the angiography suite in satisfactory condition.

FINDINGS: Comparison is made to a previous exam dated _____.

1. Antegrade nephrostograms demonstrate mild narrowing of the distal ureters bilaterally without large obstruction. Contrast flows freely into the urinary bladder
2. Uneventful placement of bilateral nephroureteral catheters.

IMPRESSION: 

Uneventful image-guided replacement of bilateral nephroureteral catheters as described above.

PLAN: Patient to have catheters capped to ensure he/she is able to tolerate internalization. If she experiences fevers, abdominal pain, nausea or vomiting, she is instructed to connect to gravity drainage and to contact IR on call physician. Otherwise, he/she should return in one week, and if tolerating capping, will be internalized to double J stents.