Percutaneous Access Lab Report
Percutaneous Access
TECHNIQUE FOR CREATING ACCESS TRACTS
Prior to percutaneous needle insertion, the patient must be placed into the appropriate position. For most patients, this is either prone or proneoblique with the body side of the targeted kidney slightly elevated. These patient positions provide access to the posterolateral flank where the access tract originates. For practitioners using primarily fluoroscopic guidance, the operator’s hands are out of the vertical x-ray beam with the patient prone. In those patients who cannot be turned prone, the supine oblique position can be used, with the body side of the targeted kidney elevated off the table top.14
If fluoroscopic guidance is used, the collecting system can be opacified either …show more content…
The access needle is advanced through the skin, the flank, and the renal parenchyma into the appropriate caliceal tip. The use of C-arm fluoroscopy assists in defining the three-dimensional tract. After the access needle tip enters the calix, the needle stylet is removed and a small amount of urine is aspirated to confirm the needle tip’s intraluminal position. Small amounts of contrast material may be injected to confirm the intra-caliceal position of the needle tip if fluoroscopic guidance is used. A soft-tipped guidewire is then inserted into the needle and gently advanced beyond its tip. The wire is …show more content…
Techniques of access tract maintenance during surgical procedures, as well as in the postoperative period for follow-up examinations, are important determinants of overall endourologic procedure success rates. All percutaneous access tracts can be slowly dilated with serial nephrostomy tube changes.24
Acute dilation of nephrostomy tracts at the time of initial creation to sizes of 24to 30F is now widely practiced and has proven to be safe and beneficial. Acute dilation of nephrostomy tracts can be performed with a variety of instruments. The most widely used are serially introduced progressive fascial dilators, Amplatz renal dilator sets, metal coaxial dilators, and high-pressure balloon systems. These are all designed to be inserted over a working guidewire in the tract. Because of the risk of perinephric guidewire kinking with loss of the nephrostomy tract and laceration of the renal parenchyma, the utilization of all these dilator systems require fluoroscopic
TECHNIQUE FOR CREATING ACCESS TRACTS
Prior to percutaneous needle insertion, the patient must be placed into the appropriate position. For most patients, this is either prone or proneoblique with the body side of the targeted kidney slightly elevated. These patient positions provide access to the posterolateral flank where the access tract originates. For practitioners using primarily fluoroscopic guidance, the operator’s hands are out of the vertical x-ray beam with the patient prone. In those patients who cannot be turned prone, the supine oblique position can be used, with the body side of the targeted kidney elevated off the table top.14
If fluoroscopic guidance is used, the collecting system can be opacified either …show more content…
The access needle is advanced through the skin, the flank, and the renal parenchyma into the appropriate caliceal tip. The use of C-arm fluoroscopy assists in defining the three-dimensional tract. After the access needle tip enters the calix, the needle stylet is removed and a small amount of urine is aspirated to confirm the needle tip’s intraluminal position. Small amounts of contrast material may be injected to confirm the intra-caliceal position of the needle tip if fluoroscopic guidance is used. A soft-tipped guidewire is then inserted into the needle and gently advanced beyond its tip. The wire is …show more content…
Techniques of access tract maintenance during surgical procedures, as well as in the postoperative period for follow-up examinations, are important determinants of overall endourologic procedure success rates. All percutaneous access tracts can be slowly dilated with serial nephrostomy tube changes.24
Acute dilation of nephrostomy tracts at the time of initial creation to sizes of 24to 30F is now widely practiced and has proven to be safe and beneficial. Acute dilation of nephrostomy tracts can be performed with a variety of instruments. The most widely used are serially introduced progressive fascial dilators, Amplatz renal dilator sets, metal coaxial dilators, and high-pressure balloon systems. These are all designed to be inserted over a working guidewire in the tract. Because of the risk of perinephric guidewire kinking with loss of the nephrostomy tract and laceration of the renal parenchyma, the utilization of all these dilator systems require fluoroscopic