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Nephroureteral Stent Placement, [Left]

 

Date of procedure:

[ ]

 

Indication:

Collecting system access prior to PCNL.

 

Operators:

Sarel Gaur MD

 

Medications:

Versed IV:  [ ] ml total

Fentanyl IV:  [ ] ml total

 

Contrast:

[ ] ml of Omnipaque intrapyelous

 

Fluoro time:

[ ] minutes

 

Access site(s):

Left Flank

 

Device(s):

8F x 24 cm Nephroureteral stent

 

Complications:

None

 

Technique and Findings:

 

  1. Informed Consent was obtained.

  2. Patient was brought to the IR suite and placed prone on the table.

  3. The [left] flank was prepped and draped in the usual sterile fashion.

  4. A point of access of the left renal collecting system was marked.

  5. Lidocaine 1% was used for local anesthesia.

  6. Using intermittent fluoroscopy, a long 21 gauge style+cannula was advanced towards the kidney hilum.

  7. The inner stylet was removed and contrast injected to outline the calices.

  8. An upper pole calyx was identified as a target for access.  Air was injected to highlight the posterior calyx.

  9. A second long 21 gauge needle+cannula was then advanced using fluoroscopy towards the upper pole posterior calyx.

  10. The inner stylet was removed and urine was seen within the cannula. 

  11. Contrast injected to confirm intracalyceal placement.

  12. A microwire was advanced through the needle and advanced into the upper ureter.

  13. The needle was removed and a greb sheath+dilator advanced over the wire.

  14. The inner dilator and wire were removed and a 135 cm Amplatz was advanced into the bladder.

  15. A 8F x 24 cm nephroureteral stent was then advanced over the Amplatz, till the tip was in the bladder.  The inner stiffener and wire were removed forming a pigtail in the bladder.

  16. The upper pigtail was formed in the renal pelvis.

  17. The catheter was injected with contrast with an image saved to PACS.

  18. The catheter was secured with 0 silk sutures.  A sterile dressing was placed.

  19. The procedure was terminated

Maximal Sterile Barrier Technique was used during insertion including:  Cap/mask/sterile gown/gloves/large sterile sheet. Hand hygiene/2 % chlorhexidine for cutaneous antisepsis

 

Impression:

Successful placement of a left nephroureteral stent, 8F x 24 cm.

 

Plan or Recommendations:

Left PCNL access placed.  

Nephrostomy Tube Removal, [Left]

 

Date of procedure:

[ ]

 

Indication:

Post PCNL on the [left] side.  For check and possible removal or change

 

Operators:

Sarel Gaur MD

 

Medications:

Lidocaine at site

 

Contrast:

[ ] ml of Omnipaque intrapyelous

 

Fluoro time:

[ ] minutes

 

Access site(s):

Left Flank

 

Device(s):

8F Pigtail drainage catheter, Cook Multipurpose

 

Complications:

None

 

Technique and Findings:

 

  1. Informed Consent was obtained.

  2. Patient was brought to the IR suite and placed prone on the table.

  3. The left nephrostomy catheter was imaged under fluoro.

  4. Contrast was injected through the catheter.

  5. There was good drainage through the ureter and into the bladder

  6. Urology was called and the findings discussed.

  7. The decision was made to remove the catheter.

  8. The catheter was cut and a wire placed through the catheter.

  9. The catheter was removed, and the wire.

  10. There were no post procedural complications.

  11. The procedure was terminated

Maximal Sterile Barrier Technique was used during insertion including:  Cap/mask/sterile gown/gloves/large sterile sheet. Hand hygiene/2 % chlorhexidine for cutaneous antisepsis

 

Impression:

Successful removal of the L nephrostomy catheter.

Normal internal drainage of the L collecting system.

 

Plan or Recommendations:

Dressing management.

 

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Nephrostomy Tube Change, [Left]

 

Date of procedure:

[ ]

 

Indication:

Post PCNL on the [left] side.  For check and possible removal or change

 

Operators:

Sarel Gaur MD

 

Medications:

Lidocaine at site

 

Contrast:

[ ] ml of Omnipaque intrapyelous

 

Fluoro time:

[ ] minutes

 

Access site(s):

Left Flank

 

Device(s):

8F Pigtail drainage catheter, Cook Multipurpose

 

Complications:

None

 

Technique and Findings:

 

  1. Informed Consent was obtained.

  2. Patient was brought to the IR suite and placed prone on the table.

  3. The left nephrostomy catheter was imaged under fluoro.

  4. Contrast was injected through the catheter.

  5. Contrast was seen in the intrarenal calices and the upper ureter.

  6. There was sluggish flow through the ureter.  This was monitored fluoroscopically 5 minutes after injection.

  7. Urology was called and the decision made to change the catheter.

  8. After sterile prep and draping, and after local lidocaine infusion, the catheter was cut and a Amplatz wire introduced.

  9. The catheter was removed and a new 8F Nephrostomy was advanced over the wire.

  10. The catheter was coiled in the L renal pelvis.

  11. Final injection demonstrated good placement within the L renal pelvis.

  12. There was good drainage through the ureter and into the bladder

  13. The procedure was terminated

Maximal Sterile Barrier Technique was used during insertion including:  Cap/mask/sterile gown/gloves/large sterile sheet. Hand hygiene/2 % chlorhexidine for cutaneous antisepsis

 

Impression:

Successful exchange of the L nephrostomy catheter

 

Plan or Recommendations:

The patient will follow up in 2 weeks to assess internal drainage once again.  A capping trial may be initiated at the followup examination.

 

 

Nephrostomy Tube to Double J Ureteral Stent Conversion, [Left]

 

Date of procedure:

[ ]

 

Indication:

Post PCNL on the [left] side.  For check and possible removal or change

 

Operators:

Sarel Gaur MD

 

Medications:

Lidocaine at site

 

Contrast:

[ ] ml of Omnipaque intrapyelous

 

Fluoro time:

[ ] minutes

 

Access site(s):

Left Flank

 

Device(s):

8F Pigtail drainage catheter, Cook Multipurpose

 

Complications:

None

 

Technique and Findings:

 

  1. Informed Consent was obtained.

  2. Patient was brought to the IR suite and placed prone on the table.

  3. The left nephrostomy catheter was imaged under fluoro.

  4. Contrast was injected through the catheter.

  5. Contrast was seen in the intrarenal calices and the upper ureter.

  6. There was sluggish flow through the ureter.  This was monitored fluoroscopically 5 minutes after injection.

  7. Urology was called and the decision made to internalize the stent, ie change to a double J internal ureteral stent.

  8. After sterile prep and draping, and after local lidocaine infusion, the catheter was cut and a Amplatz wire introduced.

  9. The wire was advanced into the bladder.

  10. The existing catheter was removed.

  11. A 8F vascular sheath was placed.

  12. The 24 cm x 8F double J stent was assesmbled and advanced over the wire.

  13. The distal pigtail was formed in the bladder.

  14. The proximal pigtail was formed in the L renal pelvis.

  15. The wire and sheath were removed.

  16. Final image demonstrated good positioning of the double J stent.

  17. The procedure was terminated

Maximal Sterile Barrier Technique was used during insertion including:  Cap/mask/sterile gown/gloves/large sterile sheet. Hand hygiene/2 % chlorhexidine for cutaneous antisepsis

 

Impression:

Successful conversion from L nephrostomy to L double J stent.

 

Plan or Recommendations:

The patient will follow up with Urology to have the stent removed through the bladder.  The patient is advised to follow up with Urology as outpatient.

Nephrostomy Tube Placement, [Left]

 

Date of procedure:

[ ]

 

Indication:

L renal obstruction secondary to nephrolithiasis.  Addt’l history of sepsis.

 

Operators:

Sarel Gaur MD

 

Medications:

Lidocaine at site

IV medications:

 

Contrast:

[ ] ml of Omnipaque intrapyelous

 

Fluoro time:

[ ] minutes

 

Access site(s):

Left Flank

 

Device(s):

8F Pigtail drainage catheter, Cook Multipurpose

 

Complications:

None

 

Technique and Findings:

 

  1. Informed Consent was obtained.

  2. Patient was brought to the IR suite and placed prone on the table.

  3. The L flank was prepped and draped in the usual sterile fashion.

  4. The Greb set was utilized.

  5. A long 21 gauge stylet-cannula was advanced towards to the L renal pelvis.

  6. The cannula was aspirated with a syringe.  After urine was encountered, contrast injected to outline the calices.

  7. Air was injected to localize a posterior interpolar calyx for access.

  8. A second 21 gauge stylet-cannula was advanced towards this calyx.

  9. After urine was encountered, a nitrix wire was advanced into the renal pelvis.

  10. A greb catheter was advanced over the wire.

  11. The inner dilator was removed and a Amplatz wire was advanced into the L upper ureter.

  12. The 8 F nephrostomy catheter was advanced into the L kidney over the wire.

  13. The catheter was coiled in the L renal pelvis.

  14. The catheter was secured with silk suture and a sterile dressing placed.

  15. The catheter was connected to tubing and a gravity drainage bag.

  16. The procedure was terminated.

Maximal Sterile Barrier Technique was used during insertion including:  Cap/mask/sterile gown/gloves/large sterile sheet. Hand hygiene/2 % chlorhexidine for cutaneous antisepsis

 

Impression:

Successful placement of a L nephrostomy catheter.

 

Plan or Recommendations:

We will follow and manage the nephrostomy catheter.

Reporting Activities

Examination
Right kidney PCNL access/right nephrostomy placement  
 
 
Clinical History
 
 
Technique
 

 

  1. Informed Consent was obtained from the patient's family.

  2. Patient was brought to the IR suite and placed prone on the table.

  3. The right flank was prepped and draped in the usual sterile fashion.

  4. The Greb set was utilized.

  5. A long 21 gauge stylet-cannula was advanced towards to the right renal pelvis, towards the proximal aspect of the right double-J stent.

  6. The cannula was aspirated with a syringe. After urine was encountered, contrast injected to outline the calices.

  7. A second 21 gauge stylet-cannula was advanced towards and mid to upper pole posteriorly oriented calyx

  8. After urine was encountered, a nitrix wire was advanced into the renal pelvis.

  9. A greb catheter was advanced over the wire. Contrast study was performed to confirm placement of the catheter within the right renal collecting system.

  10. The Greb catheter was secured with silk suture and a sterile dressing placed.

  11. The procedure was terminated.

Dr. Suprenant was present for the entire procedure. 
Maximal Sterile Barrier Technique was used during nephrostomy Insertion including: Cap/mask/sterile gown/gloves/large sterile sheet. Hand hygiene/2 % chlorhexidine for cutaneous antisepsis 
 
Technologist Comments
5.5 MINUTES FLUORO 
 
 
Comparison
 
Findings
Right double-J stent in place. Mild dilated right kidney collecting system. Prominent stone in the right renal pelvis. Successful access of a upper pole calyx with the Greb catheter.  
 
Impression
Successful placement of a Greb catheter as a PCNL access within the right kidney collecting system, through a mid to upper pole calyx.

 

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