Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
CPT4 code
Name of the Procedure:
Placement of Nephrostomy Catheter, Percutaneous (including Diagnostic Nephrostogram and/or Ureterogram when performed, with Imaging Guidance such as Ultrasound and/or Fluoroscopy, and all Associated Radiological Supervision and Interpretation)
Summary
A nephrostomy catheter placement is a procedure where a thin tube is inserted through the skin into the kidney to drain urine. This process uses imaging techniques like ultrasound or fluoroscopy for accurate placement and may involve diagnostic imaging.
Purpose
This procedure helps drain urine from a blocked kidney, preventing damage and infection while providing pain relief and preserving kidney function. It can also diagnose issues in the urinary tract.
Indications
- Kidney obstruction due to stones, tumors, or other conditions
- Persistent urinary tract infections
- Severe pain from kidney blockage
- Pre-surgical preparation for certain kidney and urinary tract surgeries
Preparation
- Patients are usually advised to fast for 6-8 hours before the procedure.
- Blood tests and imaging studies may be performed in advance.
- Adjustments or temporary stoppage of certain medications, such as blood thinners.
Procedure Description
- The patient is positioned to allow access to the kidney.
- Local anesthesia and possibly sedation are administered.
- Using ultrasound or fluoroscopy, a needle is inserted into the kidney through the back.
- A guide wire is placed through the needle into the kidney.
- Over the guide wire, a catheter is advanced into the kidney.
- The correct placement is confirmed through imaging.
- The catheter is then secured to prevent dislodgment.
- If necessary, a diagnostic nephrostogram or ureterogram is performed to assess kidney function and urinary tract anatomy.
Duration
Typically, the procedure lasts between 30 minutes to 1 hour.
Setting
Usually performed in a hospital's radiology or interventional radiology department.
Personnel
- Interventional radiologist or urologist
- Radiologic technologists
- Nurses
- Anesthesiologist or nurse anesthetist, if sedation is used
Risks and Complications
- Bleeding
- Infection
- Injury to surrounding organs
- Catheter dislodgment or blockage
- Pain at the insertion site
Benefits
- Immediate relief from kidney pain due to obstruction
- Prevention of kidney damage
- Accurate diagnosis of urinary tract issues
- Improved kidney function and quality of life
Recovery
- Post-procedure monitoring for a few hours to a day
- Instructions on how to care for the catheter
- Potential antibiotic prescriptions to prevent infection
- Avoid heavy lifting or strenuous activities for a few days
- Follow-up appointments to monitor kidney function and catheter position
Alternatives
- Ureteral stent placement: Less invasive but may not be suitable for all blockages.
- Open or laparoscopic surgery: More invasive with longer recovery.
- Conservative management: May be appropriate for minor obstructions but risks kidney damage.
Patient Experience
- Mild discomfort or pain during and shortly after the procedure, managed with pain medication.
- Sensation of the catheter in the back, which may cause minor inconvenience.
- Relief of pain and symptoms related to the kidney blockage usually within hours to a day.
Pain management and comfort measures include prescribed pain medications and instructions on catheter care to prevent discomfort.