Long-Term Percutaneous Nephrostomy Management of Malignant Urinary Obstruction: Estimation of Optimal Exchange Frequency and Estimation of the Financial Impact of Patient Compliance

McDevitt, Joseph; Acosta-Torres, Stefany; Zhang, Ning; Hu, Tom C.‐C.; Odu, Ayobami; Wang, Jijia; Xi, Yin; Lamus, Daniel; Miller, David S.; Pillai, Anil K.

doi:10.1016/j.jvir.2017.02.031

Cited by 24 publications

(26 citation statements)

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“…Literature suggests that regular nephrostomy exchanges reduces complications, admissions and therefore costs, although many statements are based on expert opinion, anecdotal opinions or local preferences rather than empirically derived evidence 3 . Consensus around the optimum exchange frequency suggest around 60-120 days.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Consensus around the optimum exchange frequency suggest around 60-120 days. Exchange is dependant on compliance as the preferred standard, but there is a poor evidential basis [2][3][4][6][7][8][9][10] . Results of this literature search has demonstrated a paucity of empirical evidence with the literature related to the management of long-term nephrostomy tubes 2 , a finding supported by the single available systematic review 10 .…”

Section: Literature Reviewmentioning

confidence: 99%

“…Indications for PCN include stone disease, external compression (i.e. malignancies), surgery, iatrogenic injury amongst others [3][4][5][6] . Traditionally, nephrostomies are inserted percutaneously under ultrasound/fluoroscopic guidance in the interventional radiology (IR) suite 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, nephrostomies are inserted percutaneously under ultrasound/fluoroscopic guidance in the interventional radiology (IR) suite 2 . Long-term nephrostomies have an associated morbidity and mortality, as well as an associated cost 3 ; over time crystal deposits can form on or within the tubes leading to mechanical or bacteriological complications [4][5][6][7][8] warranting exchange.…”

Section: Introductionmentioning

confidence: 99%

“…Nephrostomies, within our institution, have historically been exchanged by radiologists and have required an overnight hospital stay 2,3 . An Advanced Practitioner (AP) radiographer-led, day-case, nephrostomy exchange programme was introduced in our institution in (2017 as a means of reducing costs and improving patient experience.…”

Section: Introductionmentioning

confidence: 99%

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Initial single centre experiences of a radiographer advanced practitioner led nephrostomy exchange programme

2020

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PURPOSE: To evaluate the technical success, radiation dose, complications and costs from the introduction of a radiographer-led nephrostomy exchange service. METHODS: Postgraduate qualified interventional radiographers with several years' experience in performing other interventional procedures began performing nephrostomy exchanges. Training was provided by an interventional radiologist. Each radiographer performed ten procedures under direct supervision followed by independent practice with remote supervision. Each radiographer was then responsible for the radiological report, discharge, re-referral for further exchange and, where indicated, sending urine samples for culture and sensitivity. Data extraction included the time interval between exchanges, radiation dose/screening time and complications. RESULTS: Thirty-eight long-term nephrostomy patients had their histories interrogated back to the time of the initial insertion. The mean (range) age at nephrostomy insertion was 67 (35-93) years and 65% were male. Indications for nephrostomy were prostatic or gynaecological malignancy, ureteric injury, bulky lymphoma and post-transplant ureteric stricture. A total of 170 nephrostomy exchanges were performed with no statistically differences in the radiation dose, fluoroscopy time nor complication rates between consultants and radiographers. There was, however, a statistical reduction in the time interval between nephrostomy exchanges for the radiographer group (P=0.022). CONCLUSION: Interventional radiographers can provide a safe, technically successful nephrostomy exchange program with radiation doses equivalent to radiologists. This is a cost-effective solution to the capacity issues faced in many departments, whilst providing career progression, job satisfaction and possibly improved care. IMPLICATIONS FOR PRACTICE: Radiographer-led interventional services should be considered by other institutions as a means of providing effective nephrostomy exchanges.

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Section: Literature Reviewmentioning

confidence: 99%