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Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent)
CPT4 code
Name of the Procedure:
Removal of Nephrostomy Tube with Fluoroscopic Guidance
Summary
The nephrostomy tube, a tube that drains urine from a kidney, is removed with the help of fluoroscopic imaging. This procedure often involves an indwelling ureteral stent which is left in place to ensure proper urine drainage from the kidney to the bladder.
Purpose
This procedure addresses conditions where the nephrostomy tube is no longer required for kidney drainage. The goals are to remove the external tube to improve patient comfort and reduce the risk of infections.
Indications
- Successfully treated urinary obstructions
- Adequate urine drainage demonstrated through prior imaging tests
- Patient stability without signs of active infection
Preparation
- Patients may need to fast for several hours before the procedure.
- Blood tests and imaging studies ensure the kidney and urinary tracts are prepared for tube removal.
- Adjustments in medications, especially blood thinners, may be required.
Procedure Description
- The patient is positioned and local anesthesia is administered to minimize discomfort.
- A fluoroscopic X-ray machine guides the medical team while they gently remove the nephrostomy tube.
- If an indwelling ureteral stent is present, it is inspected to ensure it remains in the proper position.
- The access site on the skin is dressed to prevent infection.
Duration
The procedure typically takes 30 to 60 minutes.
Setting
The procedure is performed in a hospital's radiology department or an outpatient clinic equipped with fluoroscopic imaging.
Personnel
- Radiologist or urologist
- Nursing staff
- Radiologic technologist
Risks and Complications
- Infection at the site of tube removal
- Bleeding
- Incomplete removal requiring additional intervention
- Rare risk of injury to the kidney or surrounding tissues
Benefits
- Removal of the external tube improves comfort and quality of life.
- Decreases risks associated with long-term nephrostomy tube presence, such as infections.
Recovery
- Patients are monitored for a short period post-procedure.
- They may experience mild discomfort that can be managed with medication.
- Normal activities can usually be resumed within a day or two.
- Follow-up appointments ensure proper kidney function and the integrity of any remaining internal stent.
Alternatives
- Continued use of the nephrostomy tube if conditions warrant
- Surgical options for patients who may not be suitable candidates for tube removal
- Pros and cons involve balancing the risks of prolonged nephrostomy tube use versus procedural risks
Patient Experience
- The patient will experience mild pressure and discomfort during the procedure, which is minimized by local anesthesia.
- Post-procedure discomfort is usually minor and temporary.
- Pain management strategies, including over-the-counter pain relief and prescribed medications, are available to enhance comfort.