B-21: Nephrostomy Catheter Change
  • Indications
    • Routine catheter maintenance or ancillary to other urological interventions
  • Contraindications
    • None
    • Caution in patients with severe coagulopathy
  • Patient Evaluation
    • Ability to lie prone, hold breath, and cooperate during procedure
    • Consider anesthesia (MAC or general)
  • Preprocedure Orders
    • Routine
    • Antibiotics: IV start night before procedure; PO start 3 days prior to procedure
  • Tools
    • Coons or Amplatz wire, Cope nephrostomy catheter w/ metal stiffener
    • Molnar disk, ligature (#2 silk), Tegaderm, drainage bag and connecting tubing
  • Entry site
    • Established
  • Technique
    • Preliminary nephrostogram with study of entire system to level of obstruction. With partial obstruction, fill collecting system and close catheter. Repeat film after 5 minutes. Divide nephrostomy catheter and insert guide wire. Coil guide wire in renal pelvis or manipulate into ureter. Remove old nephrostomy tube. If additional films necessary to fully evaluate obstruction, a 6 Fr. vascular sheath or a 5 Fr. diagnostic catheter can be introduced over the guide wire. Insert new nephrostomy over guide wire. Form catheter in renal pelvis. Aspirate contrast from collecting system. Secure catheter and place to bag drainage
  • Post-procedure Note
    • Note type and size of catheter(s) placed, any ancillary procedures done
    • Note scheduled follow-up appointment
  • Post-procedure Orders
    • Inpatient
      1. Nephrostomy tube to gravity drainage
      2. Record output q shift
      3. Antibiotic coverage (PO or IV) per H/O to continue for 72 hours minimum
      4. Resume other preprocedure orders
    • If interventional procedure performed:
      1. Check and record VS:
        • q 15 min x 2, then
        • q 30 min x 4, then
        • q 1 hour x 4, then
        • q 4 hours if stable
      2. Call H/O for any change in VS
    • Outpatient
      1. Continue antibiotics for 3 days following procedure
      2. Begin PO antibiotics 3 days prior to next scheduled appointment
      3. Dressing changes as instructed PRN
      4. Seek care from local physician or emergency department, or call Dept of Radiology for dislodged tube, leakage, flank pain, swelling or tenderness at site, fever, or chills

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