PROCEDURE:
- antegrade nephrostogram
- percutaneous nephrostomy tube exchange
INDICATION:
DATE:
OPERATORS:
MEDICATIONS: Levaquin 500 mg IV, Versed mg IV, fentanyl mcg IV
FLUOROSCOPY TIME: minutes
CONTRAST: ml of nonionic contrast
CATHETER: F nephrostomy tube
COMPLICATIONS: None immediate
TECHNIQUE:
The risks, benefits, and alternatives to the procedure and sedation were explained. Written informed consent was obtained.
The existing catheter and surrounding soft tissues were prepped and draped in sterile fashion. Local anesthetic was injected at the catheter entry site. A scout radiograph was obtained.
Non-ionic contrast was injected through the existing nephrostomy tube and images of the collecting system obtained.
A 0.035-inch Bentson wire was advanced through the nephrostomy tube. The tube was removed over the wire under direct fluoroscopic visualization. A new F nephrostomy tube was advanced over the wire and the Cope loop formed and locked in the renal pelvis. Contrast injection confirmed location. The catheter was sutured to the flank with ___ and attached to gravity drainage. A sterile dressing was applied.
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 ___ .
IMPRESSION:
Uneventful image-guided replacement of a ___ nephrostomy tube as described above.
Frequently Asked Questions
What is a nephrostomy tube exchange?
A nephrostomy tube exchange is a medical procedure where an existing nephrostomy tube, which drains urine from the kidney, is replaced with a new one. This is typically done to maintain proper drainage, prevent infection, or replace a tube that is no longer functioning well. The procedure is performed under fluoroscopic guidance to ensure accurate placement.
Why might someone need a nephrostomy tube exchange?
A nephrostomy tube exchange may be needed for various reasons, such as blockage of the existing tube, infection, or damage. Regular exchanges are also performed to prevent complications and ensure the tube remains functional. This procedure helps maintain kidney drainage and prevent urine buildup, which could lead to further kidney damage.
During a nephrostomy tube exchange, the patient is given sedation and local anesthesia. The existing tube is removed, and a new tube is inserted over a guide wire while monitoring with fluoroscopy (X-ray guidance). The new tube is secured in place, and a contrast agent is used to confirm proper placement in the kidney.
What are the risks associated with a nephrostomy tube exchange?
The risks of a nephrostomy tube exchange include bleeding, infection, and injury to the kidney or surrounding organs. However, these complications are relatively rare. The procedure is generally considered safe, and most patients tolerate it well. Discussing risks with the healthcare provider can provide additional reassurance.
How should one prepare for a nephrostomy tube exchange?
Prior to a nephrostomy tube exchange, patients are usually advised to avoid eating or drinking for several hours. They should inform their doctor of any medications they are taking, especially blood thinners. Arranging for someone to drive them home post-procedure is also recommended, due to sedative effects.
What is an antegrade nephrostogram?
An antegrade nephrostogram is an imaging procedure used to visualize the urinary system. It involves the injection of a contrast dye through the nephrostomy tube to outline the renal pelvis and ureter under X-ray. This helps assess the drainage system and guides the nephrostomy tube exchange.
What medications are commonly used during a nephrostomy tube exchange?
During a nephrostomy tube exchange, patients may receive medications like Levaquin (an antibiotic), Versed (a sedative), and fentanyl (a pain reliever) to minimize discomfort and prevent infections. The specific medications and dosages depend on the patient's health status and doctor's recommendations.