A question for attendings and fellows about a case

[Reza Rajebi]

Hi everyone,

We had a case of PCN (nephrostomy tube placement) for a patient with non-dilated system. The patient was a young male with complex past medical history. He had a right renal stone measuring 2 cm. Getting access under ultrasound and confirmation with contrast injection under fluoro is the standard technique. But it seems that with non-dilated system this technique can be challenging. It usually takes longer to get access. Also, it is difficult to make sure the access was obtained through a calyx. In addition to increased radiation dose, there is also a chance of sepsis in these patients with possible underlying infection. I was wondering if there is an answer to make these cases easier and faster. Would you please let me know what you think?

Thanks,

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[phatfarm]

I think getting into a non dilated system is tricky. Thankfully most of the time we need to get in, there is usually hydronephrosis

 

[werewethere]

Hi everyone,

We had a case of PCN (nephrostomy tube placement) for a patient with non-dilated system. The patient was a young male with complex past medical history. He had a right renal stone measuring 2 cm. Getting access under ultrasound and confirmation with contrast injection under fluoro is the standard technique. But it seems that with non-dilated system this technique can be challenging. It usually takes longer to get access. Also, it is difficult to make sure the access was obtained through a calyx. In addition to increased radiation dose, there is also a chance of sepsis in these patients with possible underlying infection. I was wondering if there is an answer to make these cases easier and faster. Would you please let me know what you think?

Thanks,

Did you try single or double stick?

 

[Reza Rajebi]

Single stick. Do you think double might work better?

 

[werewethere]

Single stick. Do you think double might work better?

Just thinking that if you target was that difficult to get into, a double stick may have been appropriate.