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Virtual Pediatric Hospital: Paediapaedia: Percutaneous Nephrostomy Paediapaedia: Cardiovascular Procedure Descriptions

Percutaneous Nephrostomy

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Patient Preparation:
None

Contrast:
None

Technique:
Cover patient with Abx
Find kidneys under fluoro - 1 hand width lat to L1-L2 transverse process (or go below 12th rib just medial to post axillary line)
Numb patient up and go down with 22G Chiba until urine returns - aspirate some out
Slowly inject contrast thru 22G Chiba to opacify collecting system
Slowly inject CO2 thru 22G Chiba to mark post calyx
Remove 22G Chiba
Go down on post calyx with 18 G - down the barrel until urine returns
Guidewire thru needle
Dilate tract
Put in 8-10 Fr VTC catheter and pig it by twisting it counterclockwise
Lock the pig by twisting the stopcock
Suture in place

Have tract irrigated with cold sterile saline q shift x 2 days

Views to Take:
Not applicable

References:
See References Chapter.

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