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    Lithotripsy

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    Lo
    Lithotripsy is a noninvasive procedure that uses shock waves to break up kidney stones or gallstones so they can pass naturally. Extracorporeal shock wave lithotripsy (ESWL) uses high-energy shock waves from outside the body, while percutaneous ultrasonic lithotripsy (PUL) uses ultrasonic waves through the skin. ESWL is commonly used to replace surgery for kidney stones, while gallstone removal is now often done laparoscopically. Complications can include bleeding and obstruction, so nurses monitor vital signs, intake/output, and for complications after the procedure.

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    Lithotripsy

    Uploaded by

    Lo
    18 views3 pages
    Lithotripsy is a noninvasive procedure that uses shock waves to break up kidney stones or gallstones so they can pass naturally. Extracorporeal shock wave lithotripsy (ESWL) uses high-energy shock waves from outside the body, while percutaneous ultrasonic lithotripsy (PUL) uses ultrasonic waves through the skin. ESWL is commonly used to replace surgery for kidney stones, while gallstone removal is now often done laparoscopically. Complications can include bleeding and obstruction, so nurses monitor vital signs, intake/output, and for complications after the procedure.

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    Lithotripsy is a noninvasive procedure that uses shock waves to break up kidney stones or gallstones so they can pass naturally. Extracorporeal shock wave lithotripsy (ESWL) uses high-energy shock waves from outside the body, while percutaneous ultrasonic lithotripsy (PUL) uses ultrasonic waves through the skin. ESWL is commonly used to replace surgery for kidney stones, while gallstone removal is now often done laparoscopically. Complications can include bleeding and obstruction, so nurses monitor vital signs, intake/output, and for complications after the procedure.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    18 views3 pages

    Lithotripsy

    Uploaded by

    Lo
    Lithotripsy is a noninvasive procedure that uses shock waves to break up kidney stones or gallstones so they can pass naturally. Extracorporeal shock wave lithotripsy (ESWL) uses high-energy shock waves from outside the body, while percutaneous ultrasonic lithotripsy (PUL) uses ultrasonic waves through the skin. ESWL is commonly used to replace surgery for kidney stones, while gallstone removal is now often done laparoscopically. Complications can include bleeding and obstruction, so nurses monitor vital signs, intake/output, and for complications after the procedure.

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    of 3

    Nurse's 3-Minute Clinical Reference

    ISBN: 1-58255-670-9 | 2nd_Edition

    (Print pagebreak 662)

    Lithotripsy

    Overview
    Noninvasive procedure for removing obstructive renal calculi or gallstones

    Extracorporeal shock-wave lithotripsy (ESWL): use of high-energy shock waves to break up calculi and allow their normal
    passage

    Percutaneous ultasonic lithotripsy (PUL): invasive procedure using ultrasonic shock waves at close range

    Common replacements for surgical removal of renal calculi (except when kidney is nonfunctional and must be removed)

    Now commonly replaced by laparoscopic cholecystectomy for gallstones

    Contraindicated in urinary or biliary tract obstruction distal to the calculi; in renal or gallbladder cancer; in calculi that are
    fixed to the kidney, ureter, or gallbladder or located below the iliac crest level; in patients with pacemakers; and during
    pregnancy

    Indications

    Potentially obstructive calculi

    Emergency treatment for acute renal obstruction

    Procedure
    The patient receives I.V. or oral sedation, or the use of a transcutaenous electrical nerve stimulator.

    ESWL

    The patient is placed in a semireclining or supine position on the hydraulic stretcher of the ESWL machine on a water-filled
    cushion (or submerged in lukewarm water for gallstones) through which the shock waves are directed from the lithotriptor.

    The generator is focused on the calculi using biplane fluoroscopy confirmation.

    The generator is activated to direct high-energy shock waves through the cushion or water at the calculi.

    Shock waves are synchronized to the patient's R waves on the electrocardiogram (ECG) and fired during diastole.

    The number of waves fired depends on the size, number, and composition of the calculi (500 to 2,000 shocks delivered during
    a treatment).

    PUL

    The patient receives local anesthesia or oral sedation.

    Gallstones can be broken up by several percutaneous fragmentation devices besides ultrasound, such as laser pulses and
    electrohydraulics, utilizing electric sparks.

    Overall procedures for gallstones and renal calculi are similar, except for placement of the percutaneous devices into the
    gallbladder or common bile duct versus the renal pelvis.

    Complications

    Hemorrhage

    cuh999 | 137.189.241.45 | 03 February 2023 8:57:10 Utc


    Nurse's 3-Minute Clinical Reference
    ISBN: 1-58255-670-9 | 2nd_Edition

    Hematomas

    Obstruction (biliary or ureteral)

    Nursing Interventions
    Pretreatment care

    Explain the treatment and preparation to the patient and family.

    Make sure the patient has signed an appropriate consent form.

    Explain postprocedure care. If ESWL will be done for gallstones, explain that the patient may have mild pain afterward.

    Arrange for the patient to see the ESWL device before treatment if possible.

    Posttreatment care

    Administer medications, as ordered.

    Maintain a patent indwelling urinary catheter and I.V. line.

    Strain urine for calculi fragments, and send the specimen to the laboratory.

    Report frank or persistent bleeding.

    Encourage ambulation as early as possible.

    Increase the patient's fluid intake, as ordered.

    Provide comfort measures.

    Report severe pain.

    Nursing Alert
    Immediately report severe unremitting pain, persistent hematuria, inability to void, fever and chills, or recurrent nausea and
    vomiting.

    Monitoring

    Vital signs

    Intake and output

    Complications

    Urine color and pH

    Pain

    Patient teaching

    Be sure to cover:

    medication administration, dosage, and possible adverse effects

    cuh999 | 137.189.241.45 | 03 February 2023 8:57:10 Utc


    Nurse's 3-Minute Clinical Reference
    ISBN: 1-58255-670-9 | 2nd_Edition

    complications

    when to notify the physician

    importance of daily oral fluid intake of 3 to 4 qt (3 to 4 L) for about 1 month after treatment

    straining of all urine for the first week after treatment, saving fragments in the container provided, and bringing the container
    to first follow-up visit

    likelihood of pain occurring as fragments pass, slight redness or bruising, blood-tinged urine for several days, and mild GI
    upset after the procedure

    prescribed activity restrictions

    prescribed dietary recommendations

    ways to prevent new calculi formation

    follow-up care.

    cuh999 | 137.189.241.45 | 03 February 2023 8:57:10 Utc

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