Quality Improvement Guidelines for Percutaneous Nephrostomy

Pabon‐Ramos, Waleska M.; Dariushnia, Sean R.; Walker, T.G.; d’Othée, Bertrand Janne; Ganguli, Suvranu; Midia, Mehran; Siddiqi, Nasir H.; Kalva, Sanjeeva P.; Nikolic, Boris

doi:10.1016/j.jvir.2015.11.045

Cited by 90 publications

(73 citation statements)

References 66 publications

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“…Poor visualization makes for difficult targeting, and secure guidewire navigation into the renal pelvis and down the ureter is demanding because of the absence of distention (27). Our results showed the technical success rate of contrast-enhanced US-assisted PCN was 100% per patient and 100% per kidney, which was higher than the rate of 80% reported by the Society of Interventional Radiology (16). Perhaps the administration of contrast-enhanced US through puncturing needle and catcher contributes to the success of PCN in patients with nondilated collecting system.…”

Section: Vascular and Interventional Radiology: Contrast-enhanced Us-mentioning

confidence: 55%

“…As previous studies reported, US-guided PCN can be successfully performed in 96.6%-100% of kidneys with dilated renal collecting system and with low major and minor complication rates (6,(16)(17)(18)(19)(20). However, technical success rate decreases to about 80% in kidneys with nondilated collecting system (16). Moreover, performing PCN in patients with nondilated collecting system results in a sixfold increase in overall complication rates compared with patients with dilated collecting system (8).…”

Section: Discussionmentioning

confidence: 79%

“…There were no major complications and four minor complications. For patients undergoing PCN with both dilated and nondilated collecting system, the Society of Interventional Radiology reported that when minor and major complications are considered together, they occur in approximately 10% of patients (16,37) and in 4%-5% of patients for major complications only (37). For patients with nondilated collecting system, the overall complication rate of PCN increased sixfold when compared with those with dilated collecting system (8).…”

Section: Disclosures Of Conflicts Ofmentioning

confidence: 99%

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Contrast-enhanced US-assisted Percutaneous Nephrostomy: A Technique to Increase Success Rate for Patients with Nondilated Renal Collecting System

et al. 2017

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Purpose To perform a single-center study of contrast material-enhanced ultrasonography (US)-assisted percutaneous nephrostomy (PCN) for patients with nondilated renal collecting system. Materials and Methods An international review board approved this retrospective study with waiver of informed consent for participation, and the study was approved by the Ethical Committee. From November 2011 to September 2015, 47 patients (mean age, 51.9 years ± 16.2 [standard deviation]; range, 18-80 years) with clinical necessity of urinary drainage, urinary diversion, or provision of access to the collecting system and with nondilated renal collecting system who underwent contrast-enhanced US-assisted PCN for 48 kidneys were included. US contrast agent was injected through the puncture needle and the drainage catheter to confirm successful PCN. The technical success rate and complications were evaluated. Relative frequencies with 95% confidence intervals (CIs) were calculated. Results The technical success rate was 100% (47 of 47, 95% CI: 93.8%, 100%) per patient and 100% (48 of 48, 95% CI: 94.0%, 100%) per kidney. For each kidney, the mean number of needle passes was 1.4 ± 0.5 (range, 1-3). The mean duration of the complete procedure was 18.9 minutes ± 4.8 (range, 8-30 minutes). The mean dose of contrast agent was 12.9 mL ± 3.2 (range, 8-25 mL). No major complications were observed. After a follow-up of 1-30 days (mean, 18.4 days ± 10.3), only four patients (four of 47, 8.5%, 95% CI: 2.37%, 20.4%) had minor complications, including one perirenal hematoma seen at US 9 days after the procedure and three patients with transient macroscopic hematuria that lasted 1-2 days. Conclusion Contrast-enhanced US-assisted PCN in patients with nondilated renal collecting system is valuable with high technical success rate. RSNA, 2017.

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Section: Vascular and Interventional Radiology: Contrast-enhanced Us-mentioning

confidence: 55%

Section: Discussionmentioning

confidence: 79%

Section: Disclosures Of Conflicts Ofmentioning

confidence: 99%

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Contrast-enhanced US-assisted Percutaneous Nephrostomy: A Technique to Increase Success Rate for Patients with Nondilated Renal Collecting System

et al. 2017

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“…Percutaneous nephrostomy is a well-established procedure with a growing number of indications that can be grouped into three main categories: urinary drainage, urinary diversion and provision of access to the collecting system; the technical success rate of percutaneous nephrostomy catheter placement is high, ranging 84-99% (Pabon-Ramos et al 2016), with the lowest rates in nondilated collecting systems.…”

Section: Introductionmentioning

confidence: 99%

“…The rate of minor and major complications grouped together is 10%; considering major hemorrhages only, those requiring blood transfusions occur in up to 4% of the cases while those requiring arterial embolization occur in up to 1% (Pabon-Ramos et al 2016). Nephrectomy is reserved only for the cases in which the minimally invasive endovascular treatment fails (Summerton et al 2012); actually the technical success of transarterial embolization of iatrogenic renal hemorrhages occurring during nephrostomic procedures is high (Jinga et al 2013;Kervancioglu et al 2014;Wang et al 2015); multiple embolizing agents have been reported, mainly coils/microcoils, gelatin sponge and particles.…”

Section: Introductionmentioning

confidence: 99%

MVP (Micro Vascular Plug®) embolization of severe renal hemorrhages after nephrostomic tube placement

et al. 2019

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Background: We report our experience in managing iatrogenic renal bleedings after nephrostomic procedures by transarterial embolization using Micro Vascular Plug (MVP) (Medtronic, USA) as single or complementary embolization device with parenchimal sparing. Materials and methods: Five patients have been treated in a single center with transarterial embolization because of renal hemorrhages occurring after positioning of nephrostomic drainages. All patients presented with back pain, severe hematuria and/or bright red blood into the nephrostomic bag, with fall in hemoglobin value. After contrast enhanced CT scan confirming arterial active bleeding, rescue embolization was performed using MVP. The renal parenchimal loss was estimated on final postembolization DSA. Creatinine values were monitored before and after the procedure. Results: Technical and clinical successes were obtained in all patients. Two patients presented with extraluminal blush, one with multiple pseudoaneurysms, one with pseudoaneurysm with arterovenous fistula, one with extraluminal blush with arterovenous fistula. MVP models were choosen oversized because of vasospasm that would underestimate the effective caliber of target vessel; MVP 3Q and MVP 7Q were adopted in one patient each, while MVP 5Q was released in three cases. MVP was the sole embolizing agent in four patients; in one patient, MVP was employed after microcoils failed to obtain complete embolization. The percentage of renal parenchimal lost was lower than 20%; no increase in Creatinine values was detected at dismission. Conclusions: According to proposed data, MVP seems to be a safe, effective and fast embolizing device that interventionalists could consider when facing renal bleedings, even as sole agent.

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