Thread by @socpedsir

#Wednesdaywisdom
#pedsIR #PaediatricIR

Paediatric nephrostomy
(a short tweetorial)

Common indications

-Congenital obstruction – PUJ, VUJ
-Sepsis
-Post operative obstruction
-Stone disease / PCNL
-Fungal obstruction
-Tumoural obstruction
-Urinary diversion

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Technique
•GA
•US guidance for access to PCS
• I I  for drain catheter placement

•Seldinger technique with Micropuncture access
–Modified or single exchange
•Trocar (‘single-stick’) technique

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What can go wrong:

xSeptic shock- pyonephrosis

xDistorted anatomy – calyx puncture vs pelvic puncture

xRupture
– very dilated PCS,
- guidewire exchange,
- infection

xNon dilated PCS: challenging to get in

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Tips

•Use US for access

•Minimise steps – wire exchange and    dilatation (Single exchange or single-stick)

•Use floppy tip guidewire

•Small bore catheters (6f Neonatal nephrostomy catheters or 8 f pigtail)

**please feel free to add your tricks and tips**

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