Exchange 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:
Exchange Nephrostomy Catheter, Percutaneous, including Diagnostic Nephrostogram and/or Ureterogram, Imaging Guidance (e.g., Ultrasound and/or Fluoroscopy), and all Associated Radiological Supervision and Interpretation.
Summary
In this procedure, a nephrostomy catheter—a tube that drains urine from the kidney—is removed and replaced with a new one. The process includes imaging tests like a nephrostogram or ureterogram to visualize the urinary tract, using imaging guidance such as ultrasound or fluoroscopy. Radiologists supervise and interpret the images throughout the procedure.
Purpose
This procedure addresses urinary obstructions or complications such as blockages, infections, or damage to the urinary system. The goals are to ensure proper drainage of urine from the kidneys, identify any issues through imaging, and replace the nephrostomy catheter to maintain its function.
Indications
- Urinary tract obstructions
- Kidney infections
- Damage or blockage in the urinary system
- Need for ongoing drainage to prevent urine buildup
- Recurrent urinary tract infections
Preparation
- Fasting for a few hours before the procedure
- Adjustments to medications as advised by the healthcare provider
- Pre-procedural imaging tests like an ultrasound or CT scan to assess the condition
Procedure Description
- The patient is positioned, usually lying on their stomach.
- Local anesthesia is administered to numb the area, and sedation may be given if necessary.
- Using imaging guidance (ultrasound or fluoroscopy), the existing nephrostomy catheter is carefully removed.
- A diagnostic nephrostogram and/or ureterogram is performed to visualize the urinary tract.
- A new catheter is inserted into the kidney using a guidewire.
- The position of the new catheter is confirmed with imaging.
- The catheter is secured in place, and the site is dressed.
Duration
The procedure typically takes 30 minutes to 1 hour.
Setting
This procedure is usually performed in a hospital's radiology or interventional radiology department.
Personnel
- Interventional Radiologist
- Radiology Technician
- Nursing staff
- Anesthesiologist or nurse anesthetist (if sedation is used)
Risks and Complications
- Infection at the catheter insertion site
- Bleeding
- Displacement of the catheter
- Injury to surrounding organs or tissues
- Allergic reaction to contrast material used in imaging (rare)
Benefits
- Improved urine drainage from the kidneys
- Relief from symptoms like pain or infection associated with urinary obstructions
- Accurate assessment of the urinary system via imaging
- Maintaining the function and longevity of the nephrostomy
Recovery
- Patients are typically observed for a short period after the procedure.
- Pain management includes over-the-counter pain relief or prescribed medication.
- Patients should avoid strenuous activities for a few days.
- Follow-up appointments may be necessary to monitor the catheter and overall kidney function.
Alternatives
- Surgical intervention for urinary obstructions
- Ureteral stent placement
- Conservative management with medication and observation
Each alternative has its pros and cons. Surgical options may offer a more permanent solution but come with greater risks, while conservative management may not be effective for all patients.
Patient Experience
Patients might feel some pressure or mild discomfort during the procedure. Afterward, there could be slight soreness at the insertion site. Pain is generally manageable with prescribed or over-the-counter medications. The healthcare team will ensure comfort and address any concerns throughout the process.