Operative note 18 Core CORE when supervised
Nephrostomy / kidney access
What it does: drain the kidney through the back, over a wire.
- Prone. (Or supine for ECIRS; see the PCNL operative note.)
- Posterior axillary line. Midway, crest to 12th rib.
- Through parenchyma into a POSTERIOR calyx. (Calyx = a cup of the kidney's collecting system.) Fewer vessels. Stable track.
- 16-18G needle under ultrasound. Urine back into a syringe: send it for culture. No urine: re-image, do not push.
- Wire in, coiled in the pelvis on screening. Needle out. Dilate over the wire.
- Pigtail 8-10 Fr over the wire. Curl in the pelvis. Wire out. Aspirate to check. Stitch to skin.
- Watch: Bleeding (rarely embolisation).
- Watch: Pneumothorax above the 12th rib.
- Watch: Colon, spleen, liver injury. Sepsis.
From the UroRef Operative Quick Guide.