Approach to nephrostomy tubes in the emergency department
| Autor: | Michael J Yoo, Rachel E Bridwell, Brit Long, Jonathan Henderson, Brannon L. Inman |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment General surgery Urinary diversion Specialty Nephrostomy tube General Medicine Emergency department medicine.disease Catheter Postoperative Complications Hematoma Nephrostomy Emergency Medicine medicine Humans Emergency Service Hospital business Complication Nephrostomy Percutaneous |
| Zdroj: | The American Journal of Emergency Medicine. 50:592-596 |
| ISSN: | 0735-6757 |
| Popis: | Background Nephrostomy tubes are commonly placed for urinary obstruction, urinary diversion, or future endourologic procedures. While the technical success of nephrostomy tube placement is high, nephrostomy tube complications may occur. Objective of review Limited literature exists regarding the complication of nephrostomy tubes and their approach in the emergency department. This review summarizes the existing literature and provides a framework for emergency providers regarding the evaluation and management of nephrostomy tube complications. Discussion Nephrostomy tube failure, caused by kinking, dislodgment, or migration can manifest with obstructive signs and symptoms. In well appearing patients, asymptomatic bacteriuria is common and should not be treated. However, in the presence of infectious symptoms, patients should be treated similarly to complicated cystitis or pyelonephritis. While gross hematuria is common following catheter placement, prolonged hematuria, or the return of hematuria after previous resolution should trigger investigation for hematoma formation or a delayed presentation of an intraoperative vascular injury. Finally, clinicians should obtain laboratory testing, advanced imaging, and specialty consultation if serious complications are suspected. Conclusion This narrative review highlights general nephrostomy tube care, minor complications, and troubleshooting in the emergency department. The majority of these minor complications can be managed at the bedside without specialty consultation. However, in patients with more serious complications including dislodgement, obstruction, infection, bleeding, and pleural injury, laboratory assessment and advanced imaging to include ultrasound and computed tomography with specialty consultation are essential in the patient's evaluation and management, particularly in cases of immune compromise and worsening renal function. |
| Databáze: | OpenAIRE |
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