Right atrial migration of nephrostomy catheter

Abstract

Percutaneous tube nephrostomy (PTN) placement is associated with bleeding complications in a small proportion of cases. We study a case of inadvertent renal vein catheterization during PTN tube change with catheter right atrial migration treated by fluoroscopically monitored catheter removal. CASE REPORTA 63-year-old female who previously underwent pelvic external beam radiotherapy for the treatment of uterine cervical carcinoma that was complicated by distal ureteral obstruction, underwent a CTguided left percutaneous tube nephrostomy (PTN) in August 2003. The catheter was being periodically changed over a guidewire. In March 2004, she came to the urology emergency room 3 days after losing the catheter, with urine dripping from the nephrostomy orifice. A 6F silicone catheter was negotiated with subsequent urine drainage. After 8 hours, this catheter was removed and a new nephrostomy was attempted over a 0.035" angiographic guidewire inserted through the tract, without radiological monitoring. The tract was dilated under local anesthesia, a silicone 12F Foley catheter was placed there, and the balloon filled with 3 mL of diluted contrast.After 1 hour, brisk bleeding was noted through the catheter, which eventually stopped due to tube obstruction from clotted blood. The patient felt dizziness, dyspnea and palpitations, but remained hemodynamically stable. A renal ultrasound did not show any perirenal fluid collection, but failed to locate the catheter. An abdominal CT displayed the catheter piercing the kidney's parenchyma, into the left renal vein and up the inferior vena cava (Figure-1). Chest radiography showed the Foley's balloon inflated on the topography of the right atrium (Figure-2). The balloon was deflated and brought about immediate resolution of her symptoms. A Doppler echocardiogram did not demonstrate atrial thrombi. With a cardiac surgery and anesthesiology team standing by, and with hemodynamic non-invasive monitoring, the catheter was pulled back under fluoroscopic visualization. After 5 days, a new CTguided left PTN was successfully placed under local anesthesia. COMMENTSAlthough hemorrhagic complications in PTN are not uncommon (1,2), interventional treatment is not often necessary; renal artery angiography and embolization is required in 0.8% of the cases in a very large series (3). We were unable to find another report of inadvertent renal vein catheterization dur-

Success, Effectiveness and Safety of Combined Sonographic and Fluoroscopic Guided Percutaneous Nephrostomy in Malignant Ureteral Obstruction

“…The incidence of major complications (4.33%) was similar to previous quoted studies of 1 to 4-5% [21,22]. IVC puncture seen in 1 (1.44%) has been reported earlier as well [23,24]. Significant haemorrhage warranting transfusion or surgery has been uniformly found to be the most common major complications accounting for 5.3% cases [6].…”

Intravenous misplacement of the nephrostomy catheter following percutaneous nephrostolithotomy: two case reports and literature review

“…The catheter can occasionally pierce the renal parenchyma and migrate into the renal vein and even the IVC. Several publications have presented the rare complications with nephrostomy catheter misplacement into the vessel after PCNL [3–9] in the PubMed database. The data from these publications are summarized in Table 1.Similar to the reports of other centers, the incidence of intravenous nephrostomy tube misplacement after PCNL was 0.23% (1/4220) at our institutions.…”

Intravenous misplacement of nephrostomy tube following percutaneous nephrolithotomy: Three new cases and review of seven cases in the literature

“…The proximity of the renal vein and its branches to the renal pelvis and calyces predisposes the veins to be injury during PCNL. The perforation of a large venous trunk by the guidewire and subsequent dilatation of the injured vein can result in catheter migrating to the venous system during the nephrostomy tube exchanging procedure, when radiological monitoring is not used (4). The relatively rigid silicon catheter can easily penetrate the infected renal parenchymal tissue, pass into a major vein, and then to the renal vein and extend into the IVC if the kidney is severely infected (11).…”

“…Furthermore, there has been an increase in surgical complications over the last decade (2). Intravenous misplacement of a urologic catheter is an uncommon complication of percutaneous renal surgery (2)(3)(4)(5)(6). Improper treatment of patients with this complication could lead to serious consequences, such as hemorrhage, embolization, perforation and infection (7,8).…”