BackTable / VI / Podcast / Episode #97
Nephrostomy Tube Placement: Basic to Advanced
with Dr. David Field
Dr. David Field from MedStar Georgetown University Hospital walks us through indications and technique for placement of Nephrostomy tubes, as well as some advanced tricks for the non-distended collecting system.
BackTable, LLC (Producer). (2020, November 30). Ep. 97 – Nephrostomy Tube Placement: Basic to Advanced [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. David Field
Dr. David Field is a practicing Interventional Radiologist at MedStar Georgetown University Hospital in Washington DC.
Dr. Aaron Fritts
Dr. Aaron Fritts is a Co-Founder of BackTable and a practicing interventional radiologist in Dallas, Texas.
In this episode, Dr. David Field joins Dr. Aaron Fritts to discuss nephrostomy tube placement. We talk about the most common indications for this procedure, and Dr. Field explains why he prefers the single stick technique over the double stick technique. We discuss why it is important to scan the patient with ultrasound before preparing them for the nephrostomy tube placement.
We give some tips for trainees on the process of inserting the needle, and we review the dangers of over-pressurizing. We discuss how much blood in the urine is worrisome, managing anticoagulation meds, and which labs to run prior to the nephrostomy tube placement. Dr. Field tells us about using guidance software and how to properly direct the needle, once inside the patient.
We discuss why you might inject air rather than contrast. We emphasize the importance of working with urology ahead of time and what post-op care looks like for different types of patients. Dr. Field gives some advice when dealing with the challenges of nephrostomy tube placement, and we give trainees some general advice on this procedure.
Nephrostomy Tube Placement Procedure
The way to get in them more easily is to make them a: easier to see, and b: bigger. At Georgetown, we have a Phillips system that has a guidance software package attached to it, like XperGuide CT, and we basically can do an on-table DynaCT and then the cone beam CT image that is generated allows you to pick a target calyx and the entry point on the skin, and you thereby know that there's nothing in between the skin and the calyx, and it will create the exact fluoroscopic angle under which to stick the system. Once you've selected your target, and your skin entry, the C-arm goes to a specific position and then on the fluoro screen, there is a target where you start your needle and then under fluoro, you just advance it straight down along the beam. About halfway through, the machine will rotate to the other 90-degree angle and then you can follow your needle to the target.
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