PERCUTANEOUS

NEPHROSTOMY
TUBE
PLACEMENT and
RELATED
PROCEDURES
PREPARED BY: MMVT, RRT, MPH
 INDICATION
URETERAL BLADDER
BLOCKAGE BLOCKAGE
 MATERIALS

1. NEPHROSTOMY
TUBE
 Has multiple side holes
 Range: 8-12 Fr
 Length: 12 inches (30
cm)
 May be used for patients
with kidney stones

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 NEPHROSTOMY TUBE IN
RADIOGRAPHY

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 MATERIALS
2. Bag/ Drainage
 Connected to the
Nephrostomy tube
where urine is
drained
 Connected to the
proximal end of the
drainage catheter

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 MATERIAL: URETERAL STENT
● Double ended pig tail catheter
that can remain inside the body
(one end in renal pelvis and the
other into the bladder)
● USED WHEN: constricted
ureter or ureterovesicular
junction
● It provides internal passageway
for urine across the area of
blockage
 I. PROCEDURE: Percutaneous
Nephrogram
 For opacification of the renal pelvis: TARGET FOR
PERCUTAENOUS NEPHROSTOMY TUBE
PLACEMENT

1) Patient is in prone/ anterior oblique position

2) Administer local anesthesia
3) 7 inch (17 cm) thin wall cannula needle is passed thru
the back (THIS PROCEDURE IS FLUORO-GUIDED)-
cannula is returned. (THE NEEDLE WILL BE EXAMINED
FOR DRAINAGE OF URINE).
4) If there is reflux/ urine in the needle, the CM is
introduced
 II. PROCEDURE: Nephrostomy tube
placement via posterior calyx

1) Introduce local anesthesia

2) 7 inch (17 cm) cannula needle is inserted to the renal pelvis
(via posterolateral aspect of the back)
3) C-arm is angled at 90 degrees oblique to check if the
needle tip has reached the renal pelvis or the calyx
4) A guide wire is passed through the needle and maneuvered
until proximal ureter for additional support.
5) Needle is removed
6) The tract is dilated
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with-a_fig1
 II. PROCEDURE: Nephrostomy tube
placement via posterior calyx
7) The drainage catheter is passed over the guide
wire (the pig tail end of the catheter must be
within the renal pelvis)
8) The position is maintained by attaching it to a
fixation disk or other device that is then sutured
or taped to the body wall.
9) FIXATION DEVICE/ DRESSING PURPOSE:
Prevents the catheter to be kinked
10) A dressing is applied over the entry site
 III. PROCEDURE: Changing of a
permanent catheter

1) Guide wire is inserted to the existing

catheter and the catheter is removed.
2) A new nephrostomy tube is passed
over the guide wire and positioned in
the renal pelvis.
 PERCUTANEOUS
NEPHROLITHOTOMY
● For surgical removal of small kidney
stones. Large stones may require
surgery/ ultrasonic lithotripsy
● Begins with a nephrostomy tube
placement
● GUIDEWIRE to renal pelvis-
DILATORS/ANGIOPLASTY BALLOON
CATHTER for dilation of tract-
SHEATH for removal of stone
● STONE BASKET/ RETRIEVAL
CATHETER: manipulate or grasp the
stone
 ADDED INTERVENTIONAL
PROCEDURES

 Angioplasty of stenoses in the

ureteral system
 Renal cyst puncture with drainage
 Percutaneous antegrade ureteral
stent placement