Primary nephrostomy placement

Primary US and fluoroscopic guided nephrostomy placement

OPERATORS:  Dr. [] (radiology resident / interventional radiology fellow) and Dr. ____(interventional radiology attending) performed the procedure. {[]}. Dr ____, attending radiologist, was present and supervising throughout the procedure.
ANESTHESIA: Moderate sedation was provided by administrating divided doses of {[]} mcg of fentanyl and {[]} mg of Versed throughout the total intra-service time of {[]} during which the patient's hemodynamic parameters were continuously monitored by an independent trained radiology nurse.
MEDICATIONS: {[pre-procedure antibiotics]}
CONTRAST: {[]} ml of {[OPTIRAY/VISIPAQUE]} contrast.
FLUOROSCOPY TIME AND DOSE:  {[]} min, {[]} mGy
1. {[]} ultrasound guided renal collecting system access. 
2. {[]} nephrostogram.
3. {[]} nephrostomy tube placement.
PROCEDURE DETAILS: Following the discussion of the risks, benefits and alternatives to the procedure, a written informed consent was obtained {[from the patient/from the healthcare proxy/using an interpreter]}. The patient was then brought to the angiography suite and placed {[prone]} on the exam table. A pre-procedure time-out was performed per BIDMC protocol. The {[right/left/both flanks]} were prepped and draped in the usual sterile fashion.
After the injection of 5 cc of 1% lidocaine in the subcutaneous soft tissues, the {[right/left]} renal collecting system was accessed under ultrasound guidance using a 21 gauge Cook needle. Ultrasound images of the access were stored on PACS. Prompt return of urine confirmed appropriate positioning.  Under fluoroscopic guidance, a Nitinol wire was advanced into the renal collecting system.  After a skin nick, the needle was exchanged for an Accustick sheath.  One the tip of the sheath was in the collecting system; the sheath was advanced over the wire, inner dilator and metallic stiffener.  The wire and inner dilator were then removed and diluted contrast was injected into the {[right/left]} collecting system to confirm position.  An Amplatz wire was advanced through the sheath and coiled in the collecting system.  The sheath was then removed and {[]} nephrostomy tube was advanced into the renal collecting system.  The wire was then removed and the pigtail was formed in the collecting system. Contrast injection confirmed appropriate positioning. The images were stored on PACS. The catheter was then flushed, 0 silk stay sutures applied and the catheter was secured with a Stat Lock device and sterile dressings. The catheter was {[attached to a bag]}.
{[Successful placement of the {[right/ left]} 8F nephrostomy,]}
Interventional Radiology
2017-11-28 15:56:26
2017-11-28 15:56:26
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Olga Brook


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