Urinary drainage care. Urinary bladder drainage bladder drainage

With any unpleasant sensations in the area of \u200b\u200bthe drainaged organ, feel free to consult a doctor. Many urological operations end with temporary or constant drainage of the organ. For example, in some interventions on the kidney, the surgeon imposes a fistula on the kidney laughter, inserts a drainage tube or a catheter and displays it to the skin. Drainage tubes are introduced and with double-sided obstruction of the ureters, and in the case of an obstacle to urine outflow from the bladder, the drainage tube is installed in the urinary bubble cavity and remove the front abdominal wall above the pubic.

In all these cases, surgeons use rubber or polymer tubes of various diameters or special catheters, having a fixture at one end to hold them in a particular department of the urinary system: special heads or stretched liquid springs.

The system used for temporary and constant drainage of urinary tract includes urinary studies. Their patient or his relatives may pick up in a pharmacy. The main thing is that the diameter of the drainage tube corresponds to the diameter of the diametic adapter. Urochlorides with a capacity of 1500-2000 milliliters are usually attached to the bed, the tacht is the bedroom of the patient with the help of special fixtures, or bandage, or large English pins.

For constant wearing, these urinary studies are severe, uncomfortable, it is better to use smaller, with a capacity of 750 milliliters. They are fixed to the hip with a self-adhesive tape "Velcro", and best of all - linen ribbons.

The entire drainage system is a tube or catheter, connected to the sharbard adapter and its tank. Only a medical worker can correctly install this blue, only a medical worker: so that the urine does not leak, the tube or catheter stood tightly and did not pull out. First of all, it is provided by the heads of catheters and the canopy, which was mentioned at the beginning. However, such fixation is not enough, and the patient can bind the tube with a gauze ribbon (cut in half a bandage) around the body. Some fasten the tube to the skin of the leukoplasty, but over time it has to refuse due to skin irritation.

Where the tube or catheter comes out, the surgeon imposes a bandage. Periodically (once a week) it must be changed. And if urine leaks, change it daily. When discharge from the hospital, the doctor explains how to cope with it. But it is better if a doctor or nurse makes this procedure. When there is no such possibility, someone from relatives can master it as the patient is inconvenient.

Pipes and catheters made of polymeric materials, in contrast to rubber, clocked with mucus and salts. Every 2-3 months, the doctor changes them if, of course, no extraordinary circumstances will occur, for example, the blockage of the tube, then the doctor should be called immediately. But this does not mean that the urologist can not apply for so long. A patient with a shredded kidney jelly, for example, you think to come to consult a specialist at extreme measures every 7-10 days. Drainage tubes inserted into the kidney pelvis or ureter are usually not washed, but if such a need arises, it only does a doctor. But the drainage tube installed in the bladder can rinse the patient itself or its relatives.

For washing, a warm solution of furaciline is used. At home you can dilute 2 pills of furaciline in 400 millilita boiled water. Solution strain through the double layer of gauze. You can buy a ready solution in a pharmacy. Suitable 3 percent solution of boric acid.

The drainage tube is washed with a 50-100-millilitone syringe or rubber pear with a scripting with the same container. Pre-syringe must be boiled, rinse with boiling water, but between procedures to keep in a disinfectant solution: 3% chlorine or 2% chlorhexidine. They are sold in pharmacies. By disconnecting the tube from the vocarbon adapter, process its end outside the furaticiline solution or an alcoholic solution of iodine. Then type in the syringe prepared solution for washing, the cannula of the syringe insert into the hole of the tube or catheter and slowly glue the solution, starting with small portions (20-30 milliliters). After the introduction of portions of the syringe solution, remove from the catheter. The wash solution will freely flow into the substituted basin or tray.

How often repeat this procedure? If the therapeutic effect on the mucous membrane of the bladder, washing can be daily. And if there is a need to periodically die out of the bladder mucus and salts, these procedures are spent less often. What frequency - a doctor will say.

The urinary student is necessary, of course, contain clean. As it is filling it empty and wash. It is best to use a weak-pink solution of potassium mangartage. The adapter and the urinary can be washed with running water, substituting under the stream of water from the water tap adapter of the urochloride. When collecting salts, it is difficult to wash the raid on the bottom and walls, the urinary reading is advisable to replace the new one.

Sometimes stones are formed in drainaged cavities, which is manifested by pain in the field of kidneys or bladder, and when the stone leads to the activation of the inflammatory process, the body temperature increases. In this case, it is necessary to urgently consult a doctor, since the process of stone formation can break drainage, the catheter will be out of the drained organ, and the fistula, especially in young people, may even close the catheter. Then you have to resort to re-surgical intervention. Try to prevent this and with any unpleasant sensations in the area of \u200b\u200bthe drainaged organ, please contact the doctor.

Quite often, with pathological processes in the human body, more often a urological nature, there is a need for the drainage of the MP, that is, the creation of artificial outflow of urin from the urine-bubble tank cavity. In modern medical practice, this process is carried out with the help of a whole set of modified devices (catheters) made from various materials. Urinary bubble catheterization is used in both diagnostic and for therapeutic purposes.

Indication to the drainage procedure is individual and depend on the set of reasons. Usually, these are patients with urologicality problems. The drainage system is necessary:

When examining the urethral paths for obstruction in patients who have lost the ability of independent micakes, which led to their long delay (more than 12 hours) and the development of acute pain syndrome, which may be a consequence of the dysfunction of the innervation of MP, the strong inflammatory process in the urethra, the presence of concrections or Tumor formations in the organs of the urinary system and in the adjacent tissues.

For laboratory monitoring urin on the microflora - for greater reliability of the results, sterile urine is taken directly from the reservoir urine-bubble cavity.
If necessary, diagnosis with a contrast agent.
For washing the urine-bubble cavity from stagnant urine, pus, or bloody clots formed by infectious and inflammatory processes, or operational interventions.
Indications for catheterization have patients who have suffered surgical interventions on the organs of the urinary system, which contributes to the processes of complete regeneration and recovery.
Finally, patients in a state of coma have lost their ability to independent micakes.

Absolute contraindications to catheterization, due to:

the presence of infectious urethritis in the patient;
pathological disorders that prevent urin's intake in the urine-bubble cavity;
injury of the urine-bubble organ and urethral paths;
presence of blood in urethra and scrotum;
signs of the presence of urine-bubble reflux;
potential complications in the form of acute prostatitis or a member fracture;
real risk of infection of MP from outside.

Weather bladder drainage methods

Depending on the state of the patients and the purpose of drainage, the bladder catheterization in women and other patients of different ages can wear a one-time character, periodically (intermittent catheterization) is carried out or installed for a permanent period. For each specific case, its drainage system is selected.

The one-time catheterization procedure applies:

if necessary, the withdrawal of urin from the tank bubble cavity for the diagnostic assessment of the state of the MP and the collection of urins to laboratory monitoring;
y, to stabilize the state in front of the most sorts;
if necessary, the medicinal irrigation of MP tanks.

For such purposes, one-time catheters use. The duration procedure does not exceed 2 minutes, and the minimum presence of a drainage tube in the body minimizes the risks of additional infection and the development of other complications.

The constant catheterization procedure from the middle of the last century is used in chronic urination issues. Drainage is left in the urine-bubbling reservoir for a long time. It is installed in a urethral, \u200b\u200bor by cestricate (cut in the pubic zone of the abdomen). But, as studies show, long-term drainage contributes to the formation of concretions (stones) in the system of the urine of removal and increases the risk of malignant tumors in MP.

According to the testimony of international research and recommendations of the Association of Uromologists - a constant catheters should not be established for a period of more than 2 weeks.

The method of intermitting drainage from the end of the XX century is widely used instead of constant drainage. The method is based on 4, 6 of one-time catheterization during the day, which simulates the normal process of the urine of the removal of one-time drainage. This technique represents the smallest risk of developing functional disorders in the kidneys, infectious and other violations. It can be used for many months and years without bringing any harm to health.

Types of drainage urinary systems

There are various types of urinary bubble catheters, differing in manufacturing material, sizes and modifications, female, men's and children's, soft (rubber), solid or rigid (metal) and semi-chain (synthetic) equipped with additional internal channels (from 1 to 3) For permanent and temporary drainage. Consider some of them used in medical practice:

The drainage system of nonlaton (Robinson) is the simplest version of the rubber or polymer catheter. Designed for interviewing drainage in uncomplicated cases. Made from polyvinyl. Under the action of body temperature becomes soft. Equipped with two side openings and closed rounded end. Used both in men and women, differ only - women's length from 12 cm to 15, men's, up to 40 cm. Dimensions are marked with different color encoding. A special hydrophilic coating when interacting with moisture makes it slippery, which does not require additional lubricant, and minimizes the risks of additional infection.

The Merce (Timman) system is equipped with an elastic curved tip, two holes and one discharge channel. Used in case of complex infectious inflammatory processes against the background of adenomatous growths in the prostate, or the stenosis of the urethral paths.
The nonlaton system with the Timman tip - has the characteristics of the fundamental system, but the drip tip of the above-described device helps drainage patients with the presence of a prostate.
Long use catheter of the pezzhera system. It has the appearance of a conventional rubber tube, equipped with two output channels and a lock in the form of a thickening of the tube.
Foley's drainage catheter is the most popular kind of drainage in urology. It is an excellent option for long-term use. Equipped with a special cylinder, (filled with sterile liquid) holding the device inside MP. Through this catheter was washed with a bladder, drugs are introduced, or removed the urine attached to the end of the tube.

The drainage modification of this system (Foley catheter) may be different:

two-channel with a shared force for the outflow of urin and washing the MP and the channel through which the balloon fluid is introduced;
three-channel with an additional channel for the administration of drug-made drugs made of silicone coating (cheap option), which eliminates the deposition of salts inside the catheter, or from silver silicone (expensive version), which restrains bacterial replication and reduces the risk of infection;
two-channel with a beak-curved Timman tip, which is the most convenient version of catheterization against the background of prostate and its hyperplasia;
with options for women and children's modification (shorter length and with a smaller diameter).

Drainage registered (metal) systems today is carried out in rare cases. In ordinary practice, the catheterization is applied with a soft catheter, which minimizes the risk of injury.

In each case, the drainage system is selected by a doctor and is established by medical personnel. Independent drainage is fraught with serious consequences, additional infection and the development of hazardous complications, as the procedure requires special preparation and knowledge of certain installation algorithm rules.

Independent catheterization is carried out only in emergency cases, when there is no possibility to call the doctors, or medical care is too late.

Preparation for drainage manipulation

The preparatory period of patient's catheterization consists of several stages, including:

preliminary examination by the doctor to refine the absence of contraindications;
compliance with a certain nutritional diet (elimination of fried and sharp products, alcohol and sweet drinks with gas) a couple of days before the procedure;
careful patient preparation by a specialist (treatment of genital organs by antiseptic, familiarization with the technique of catheterization).

At the next stage, a special set for catheterization is selected, including:

A set of sterile girlfriend necessary for the procedure - gauze, cotton swabs and napkins.
Disposable medical gloves.
Package preparations and sterile solutions that make it easier to install the drainage tube of the catheter.
Sterile plastic tweezers and conical configuration Syringe Jean.
Antiseptic solution and means for processing genitalia.
Tray for taking urin.

Article on the topic:

Features of the drainage of MP in adults

The drainage of the urine-bubble organ in men is associated with the peculiarities of the anatomical configuration of the urethra (long and bending) and a different structure of its sections - prostatic, web-anding and cavernous, which makes it rather vulnerable and sensitive to various kinds of damage.

The algorithm for performing the carbuild catheterization in men is due to a certain, sequential technique of introducing a drainage device.

The introduction of drainage men can be in the standing position and lying. The classic method is lying on the couches with legs bent.
The procedure is starting with the processing of the penis head with an antiseptic, instillations in the urethral slit of sterile glycerol and processing it, the end of the catheter tube.
Vessel for the collection of urin is set between the patient's feet. If the installation of the constant system is performed, the patient parallels the recommendations for its care. Sometimes a patient who has suffered surgery is offered a stoma outline operation.
The next stage is the introduction of the system. The doctor's processed antiseptic tape, at a distance of 6 centimeters from the edge, captures the catheter tube and gradually immerses in the urethra. To prevent uncontrolled micakes, the cock head is slightly squeezed.

The achievement of the urinary reservoir cavity by the catheter is marked by the separation of urine.
After the exit of urins, the system tube is attached to the syringe with sterile furacilin, for the subsequent washing of the urine-bubble tank. If necessary, inapplicable drug therapy is carried out in parallel.
After intravenous washing, the system is output from the cavity of the urethra and is disinfected. To avoid complications, the output of the system from the bubble is performed after the exit of fluid or air from the balloon retainer.
The remains of the drops, the solution or urine are cleaned with a penis with a sterile napkin, and the patient is recommended to lie down after the procedure for an hour.

Features of the catheterization algorithm in women, little to fall from the technical characteristics of the installation of the drainage system in men.

The drainage procedure of MP in women is carried out lying on a couch with bent in the knees, divorced legs. A woman is washed, after which the ship is cleaned.
At the base of the legs install a tray for collecting urine.
Alternately handled the folds of the germ lips. Then they are moving along with the doctors' fingers and the processing of the urethral stroke of the antiseptic is carried out.
The base of the catheter is careful, by means of circular movements, immersed to a depth of 5 cm into the cavity of the urethra, the second end is placed in the urine receiving tray. The urine yield indicates the presence of the tube in the bubble tank.
Upon completion of the urination, the procedure of intrapaulic washing with a sterile solution is carried out by means of a zane's syringe to the complete purification of the bubble cavity.
A flushing solution is excreted in the tray, the system is carefully removed, and the urethra is processed by a stereptic.

Drainage of MP in children

The MP catheterization algorithm in children, in contrast to adults, requires special care of the doctor, or its assistant during the procedure, given all age features of the child. The technique of catheterization of the bladder in the kids is carried out in compliance with the strict rules of antiseptics, from which the life of a child may depend on the literal sense.

Careful selection of drainage device in order to avoid injuries - the size corresponding to age.
Strict adherence to all norms of antiseptics that help prevent infection.
Conducting manipulation on the filled MP (determined by the results of the ultrasound).
Ensuring good workplace lighting, to avoid errors.

MP catheterization in girls

During the drainage of the urine-bubble tank in girls, the minimum amount of antiseptic means is used to treat the crotch to reduce the risk of bacterial infection from the outside.

The doctor gently spreads the baby's small sex lips for a short distance to minimize the ability to disrupt the integrity of the bridle.
The system tube must be introduced without effort. If free administration is impossible, the manipulation is stopped before finding out the presence of obstacles of urine outflow.
In order to avoid twisting the tube into the spiral, the introduction of it is stopped with the first appearance of urine outflow.

After emptying the bubble, the system is fast, but carefully remove to prevent infection from the outside.
Extraction of the system with an application is unacceptable, since it is possible to twist the tube into the node. In this case, the presence of a urologist is necessary.

As you can see, this manipulation requires certain skills and knowledge, so it must be carried out by a qualified specialist so that everything goes painlessly and without complications, and the results helped in the appointment of an effective course of therapy.

MP catheterization in boys

The drainage of MP in boys provides for the introduction of the system in different positions - lying or standing.

The penis head is wiped with an antiseptic, the catheter is processed by a purified liquid vaseline.
The extreme flesh of the penis, if it is not circumcised, carefully shifted, exposing the urethral hole. It should be borne in mind that the newborn kids may have signs of physiological phimosis.
To avoid reflex micakes, the base of the member is slightly squeezed.
In order to prevent the inflection of the urethral channel, the penis is delayed up, as if planting a drainage tube.
With poor visibility of the urethral input, the drainage tube is inserted through the expanded prepared space of the penis.

In the presence of resistance in the outer sphincter of the urethra, is permissible to use light pressure. Manipulation continues after inside the urethral spasm. If the procedure is not possible due to the presence of an obstacle, it is postponed to clarify the causal factor.

Possible complications

The specificity of the catheterization procedure itself, even with all the compliance with the prescribed rules, does not guarantee the lack of development of possible complications. They are able to manifest:

additional infection of urine-bubble and urethral tissues;
damage to the mucous coating of the organs;
the development of pyelonephritis and catheterization fever;
breaking the urethral canal.

How to recover after catheterization

Depending on the diagnosis and overall health of the patient, the drainage system of the bladder can be installed for a long time, after which, the patient is very difficult to restore the process of independent micakes. To do this, there is a special program that is through training classes helps to quickly cope with the problem. Prerequisite - classes must be systematic. Classes consist of not many and not at all sophisticated exercises:

To lie on the back and for 2, 3 minutes alternately together and bring to raise legs up.
Install the fists in the urine zone of the bubble organ, sit down, stopping on the heels, breathe deeply, and in exhale, as far as possible to lean forward. Top up to 8 times.
Become on your knees and thread the hands of your hands behind your back. Deep breathe. On the exhalation slowly leaning forward, as low as possible. We perform up to 6 times.
Lying on the back we have arms along the body, legs straightened. We begin to gradually relax from the fingers of the stop.

Getting Starting Restoration Do not forget to match the exercises with your attending physician, maybe what exactly for you, they will be contraindicated. Do not deal with self-medication, trust a specialist. Because, each such patient should be under the permanent control of the doctor.

Currently, there is a large number of modifications of stent catheters, which are used in various clinical situations.

Picture 1

Standard set for stenting consists of (Fig.2):
1. Catheter - stent
2. Pusher
3. Explorer with a movable core

In addition, since 1999, we use an antirefluxus stent (Fig. 3), developed in our (patent N 2113245,1997g.-Gazimiyev MA, destroying Yu.A. et al.).

We believe that before installing the stent in patients with nephrolithiasis, it is necessary to perform an excretory urography or retrograde ureteropelography (with the intolerance of the x-ray contrasting agent - magnetic-resonant urography) in order to determine the anatomy-functional state of the ureter, the zones of the pyro and ureteral segment and a cup-making system.

In addition, the usual and mixing cystography make it possible to identify bubble-ureter reflux and, in the case of its detection, determine the peculiarities of the internal (using an antirefluxic stent, the need to drain the bladder, etc.).
The main steps of retrograde stenting (Fig. 4 - 5):
Overview X-ray (detailing of stone localization at the time of stenting)
Cistoscopy, Visualization of the mouth of the ureter
Conducting a stent with a conductor using a pusher under X-ray control to a cup-glass system (Fig.4)
Removing the conductor with the formation of proximal and distal curls of the stent (Fig. 5)
Control X-ray

With the retrograde set of the stent, it is also possible to pre-hold the conductor in a cup-butter-loop system, and on it setting the stent.
Install the stent may also be antegradable during an open or nephrostomical fiscule.

Forced conducting conductor with a wall through the mouth of a ureter can lead to several complications. With the wrong direction it is possible to break the mouth of the ureter, the ureter's rupture in the region of pronounced bending or inflammatory infiltration. Another complication in the establishment of the stent is the impossibility of its holding at the mouth of the ureter and further on the ureter, which may be associated with the presence of a stone in the intramural department of the ureter, inflammatory infiltration of the ureter's mouth, etc.

All this requires careful execution of manipulation, using conductors with a flexible end and mandatory radioscopic control. The presence of stricture or stenosis in the proximal part of the ureter leads to the bending of the conductor and the stent. If in such a situation, it is possible to steant the ureter (due to physiological mobility, the ureter in the zone of the existing narrowing can be deformed when the stent is promoted), then the incorrect installation of the stent is also possible (the proximal area does not reach the lochank). However, this problem can be solved by the use of various conductors or the introduction of stents with a narrowing tip. Sometimes only easy tightening of the conductor back helps "find a pass" in the zone of narrowing or deviation.

If you doubt the proper setting of the stent, it is necessary to perform control x-ray or an excretory urography (according to indications) (Fig. 6 - 10).

Normal Stant position

Normal position of the proximal curl of the stent
In the laughter of the left kidney.

Incorrect position of the proximal curl of the stent (indicated by the arrow).

In the postoperative period, it is necessary to drain the bladder urethral catheter during the first night (12-24 hours). This tactic of the patient is related to the fact that during the first day after the operation, independent urination is often difficult, which leads to an increase in intravenous pressure and the occurrence of bubble-ureteral reflux (in a horizontal position, the availability of a message between a loch and the bladder that provides a stent, equalizes intravenous pressure with intra-catering).

Enhanced back of the larger volume of urine in a pelvis with an increased intravenous pressure can lead to the development of a purulent inflammatory process in the kidney. On the need to drain the bladder in the postoperative period on the background of the installed stent, when performing reconstructive operations on the upper urinary tract, G. Pained Grigoryan V.A. (1998).

With intravenous lochank, the most optimal is the establishment of an antirefluxus stent. Given the limited mobility of the wall of intravenous pellets, even a short-term increase in intra-catering pressure with bubble-urine reflux can create a threat to the development of acute pyelonephritis, despite the adequate urinary outflow on the wall and drainage of the bladder.

Thus, when determining the indications for internal drainage, it is necessary to take into account the anato-functional state of the kidneys, urinary tract, as well as the modification of the stent.

Complications of internal drainage and their prevention.

When analyzing the results of internal drainage in 81 nephrolity patients, complications were noted in 15 patients, which amounted to 18.5% of the total number of patients (the nature of the complications is presented in Table 1).

Stanta inlay (7.4%). We believe that the main point of the prevention of the inlay of the lumen of the stent the salts is the elimination of alkaline bacteriuria. The acidic urine reaction is the optimal medium in which the stent is not exposed to inlaid and ensures the reliability and duration of the adequate passage of urine.

With an alkaline urine reaction, it is necessary to constant pH urine, its "acidification" and ultrasonic monitoring, since the developing inlay leads to a violation of the passage of urine on the lumen of the stent, which is manifested by the gradually developing dilatation of the cup-laughter system (Fig. 11).

Ultrasonogram of the patient H., 38 years, and / b 3850.
Dilatation of the Local System (1)
and upper third of the ureter
Against the background of the inlaid stent (2).

After remote shock-wave lithotripsy, if there is a stent, urine outflows can be impaired and besides the stent. As a result of the impact of shock-wave pulses, there are disorders of the integrity of the endothelium of the locher and the ureter. These violations may also be due to the migration of calculation fragments, both during crushing and after DLT. At the same time, hematuria is observed, as a result of damage to the endothelium, blood clots are formed. Adhesive processes lead to the fact that the damaged surfaces of the endothelium adhere to the stand.

The stent in turn "turns" the mucous blood clots, in which small fragments of stone or salt crystals are also delayed. The accumulation of fragments of the destroyed concrete or salt crystals outside and inside the stent also contribute to the damage to the stent itself during the shock-wave lithotripsy under the influence of shock-wave pulses. The degree of damage to the stent during the pressure depends primarily on the material from which it is manufactured. All this is represented on electronic micrograms (Fig. 12 - 15).

Electronic stem surface microgram. Inboard surface of the stent uneven (increase x50).

Electronic stem surface microgram. More clearly, due to the greater increase, it is observed unevenness (roughness) of the inner surface of the stent (increase in x1000).

Electronic microgram of the stent surface after DUVL. On the inner surface of the stent, the accumulation of small fragments of stone and salts crystals is observed (increase in x50).

Electronic microgram of the stent surface after DUVL. Due to larger increase, on the inner surface of the stent, the accumulation of small fragments of the destroyed stone and
Salts crystals. (increase x1000)

A prerequisite for the maintenance of patients under hypersaturized urine is the increase in daily diurere due to an increase in the fluid consumed (up to 2.500 - 3.000 ml / day), in small doses of saluretics, since the elevated domez and the low urine density observed significantly reduces the probability of stanta inlay and His obstruction.

Dizuriy (4.9%). This complication is primarily due to irritation by the distal curl of the mystery of the urohy triangle mucosa and the bladder cervix, the exacerbation of chronic cystitis, and is also observed in the excessive length of the distal (intravenous) section of the stent and the low water bubble tank. In addition, the overpressure of the intravenous part of the stent can lead to the development of bubble-ureteral reflux not only in a pentated, but also in the counterclature kidney. Therefore, the individual selection of the stent is necessary.

Dizuriuri may also be a manifestation of individual intolerance caused by the physicochemical properties of a stent as a foreign body located in urinary tract. Short-term dizuriy was noted in all patients, but only 4 (4.9%) patients due to the persistent clinical manifestation, it required the replacement of the stent.

A feature of the drainage of the urinary tract in patients with severe terminal disurium, which is a manifestation of an individual reaction to irritation by the distal curl of the mystery of the urinary triangle and the bladder cervix (destroyer Yu. A. et al., 1997; Vinarov A.Z. et al., 1998) As well as in chronic cystitis, is to use a shortened stent.

In this case, a closure apparatus of the ureter's mouth is used as an antirefluxic protection (in the absence of bubble-ureteral reflux to stenting), and the distal (shortened) section of the stent is installed above the ureteral mouth, in the Linea Terminalis projection (a longer pusher is used when installed). The removal of the stent is carried out during cystoscopy by capturing the thread fixed to the distal end of the stent and remaining in the process of drainage in the bladder. At the same time, the establishment of such a stent is possible only retrograde.

Acute pyelonephritis on the background of internal drainage can be due to:
bubble-ureter reflux;
stent inlay;
Incorrect stent position (incorrect installation or its migration).
We observed acute pyelonephritis due to a bubble-ureteral reflux in 1 (1.2%) patient.
Considering the possibility of bubble-ureter reflux on the background of stenting, it is necessary to eliminate the bubble-ureteral reflux before setting the stent, since it determines the characteristics of the inner drainage (the establishment of an antirefluxus stent, the drainage of the bladder of the urethral catheter or the choice of another type of drainage).

Migration (proximal-2.5% and distal-2.5%) can be observed at various times after the installation of the stent and more often occurs when using smooth and soft silicone catheters (Fig. 16). An important is the individual selection of the stent in length. Migration leads to the obstruction of the upper urinary tract and is manifested by the dilatation of the cup-making system. Proximal migration may require emergency ureteroscopy.

The distal migration of the stent (indicated by the arrow).

Analyzing complications against the background of internal drainage, we allocated the following readings to emergency removal of the stent:
Attack of acute pyelonephritis due to inadequate drainage or bubble-ureteral reflux;
violation of the outflow of urine from a cup-making system (obstruction of the upper urinary tract) as a result of the inlay stent, incorrect position or migration;
Macro Hematuria;
pronounced dysuria.

Thus, the prevention of complications of internal drainage in patients with nephrolity and chronic pyelonephritis is reduced to the following:
Individual selection of the stent, taking into account the anato-functional state of the upper urinary tract;
Exclusion of bubble-ureter reflux to stenting;
Conducting a stent to the upper urinary ways under X-ray control;
Complex antibacterial and anti-inflammatory therapy;
Dynamic ultrasound and radiological monitoring.

The article has prepared and edited: a surgeon doctor

Under cystostomy, the drainage of the urinary bubble cavity is understood through the front of the abdomen with the installation of a suplocked catheter. There is a wide list of pathologies requiring the production of grazing cystostomomas.

The most often cystostomtoma is established when the patient cannot empty the bladder independently, and the introduction of the urinary catheter through the urethra is undesirable or impossible.

Cystostomy with the installation of a suplocked catheter can be performed in two ways:

Through an open operation at which a small skin incision is made above the Lonatic Jim.
A minimally invasive method: the formulation of gradation of the cestomomas according to the Method of the Seldger, Trokarny Cystostomy. Cystostomomy can be performed both under the control of ultrasound, cystoscope, and without them, blindly.

Show all

1. Anatomy of the bladder

In an adult, a bladder is in the forefront of a small pelvis and is surrounded by a fatty tissue, covered with peritoneum on one side. The bubble is separated from the Lonatic articulation of the front pre-extension space (Retzievo Space).

The bottom of the bladder is covered with peritoneum, the cervix cervix is \u200b\u200bfixed to the surrounding tissues of the branches of the pelvic fascia and ligaments of the pelvis. The filled bladder rises up and adjacent to the inner surface of the lower part of the front of the abdomen, moving the intestines from it (in the absence of adhesions in the abdominal cavity).

In the absence of adhesions, sufficient urinary bubble filling frequency of custostomy complications is minimal.

2. Indications for the production of cystostomas

1 Acute urine delay when it is impossible to put a urethral catheter due to the obstruction of the surveillance of the urethra (benign hyperplasia of the prostate, strictures of the urethra, the false stroke of the urethra, contracture of the bubble cervical as a result of previous interventions).
The patient will have massive and long-term operational interference with the impossibility of catheterize the bladder through the urethra.
3 Urethra injuries. Injuries of urethra can be the result of mechanical damage to the pelvis, manipulations on the urethra (therapeutic, diagnostic). Sometimes, the injuries of urethra arise during sex, with coarse manipulations with a gender member. Inheritance of urethra always requires a urologist, however, with an acute urine delay, the urinary bubble is required by the urgent formulation of custostomas. The cystostomtoma leads to unloading of the affected slide of the mucous membrane, which contributes to its recovery.
4 injuries of the bladder.
5 Treatment of complicated urinary system infections. With a combination of an infectious process with a chronic obstruction syndrome of the weekend of the bladder, a solution is made about cystostomy.
6 The need for a long-term urine duty (neurogenic bladder as a result of spinal cord injuries, acute violations of the blood supply of brain, multiple sclerosis, neuropathy; patients after phallaloplasty, closing operations fistula).
7 Monitoring the daily diurea with the impossibility of catheterization through the urethra.

The impossibility of setting the blade of the blade can be associated with the formed false move at repeated unsuccessful attempts of transurethral catheterization, strictures of the urethra.

In the absence of a result from several attempts to set up the blade of the Folee, a metal conductor is introduced into the lumen of the soft catheter.

If the attempt did not give results, then the decision on cystoscopy with the formulation of the catheter is made. In the absence of a urologist and the necessary equipment, a solution is made in favor of installing a suplocked cystostoma.

3. Contraindications

The absolute contraindications of minimally invasive cystostomy include:

1 states when the bladder is not filled, it is severely palpable or cannot be visualized with ultrasound diagnostics.
2 In the patient a history of the bladder cancer tumor.

Relative contraindications of percutaneous (minimally invasive) cystostomy:

1 coagulopathy.
2 The history has an operation on the lower body of the abdominal cavity or cavity of the pelvis (the formation of adhesions between the bladder and intestines is possible).
3 oncological process in a small pelvis +/- radiation therapy (possibly formation of adhesions).

In the presence of contraindications to percutaneous cystostomy, it is necessary to resort to an open operation with the aim of good visualization of the wall bladder, selection of adhesions, reliable hemostasis at the end of the operation.

4. Prevention of complications

1 Accurate visualization of the filled bladder, the definition of its borders and the place of operation make it possible to avoid intestinal damage. Sometimes in the bladder specially injected by saline for its best visualization.
2 In order to prevent grams-negative bacteremia, antibacterial therapy is prescribed before the operation.

5. Expressive (minimally invasive) cystostomy

At the moment there are a huge number of diverse disposable sets for grazing cystostomy. Almost all sets of tools work according to one principle.

In the absence of such a set (in an emergency), the use of anesthesiological set for the production of the central venous catheter is possible (the statement of the catheter on the technique of the celebringer).

Depending on the variant of the operation and psychological characteristics of the patient, a choice of anesthesia is selected.

In most cases, there is enough local anesthesia for a tropartic cystostomy. With emotional lability, local anesthesia is complemented by intravenous administration of anesthetics. Can apply spinal anesthesia.

Position of the patient - on the back with the head end of the operating table: In this position, the intestine is shifted, the front surface of the bladder is exposed, arrives at the front wall of the abdomen and is available for safe puncture.

There are several varieties of percutaneous epicistostomy (see Table 1).

Fig. 1 - a set for performing a grazing cystostomoma (syringe for feeding anesthetic and inflating cake cable, trocar with mandren, two-piece catheter, scalpel, antiseptic, napkin for restricting the operating field, bactericidal plaster)

The drainage of the bubble under the control of ultrasound / cystoscopy is modifications of cystostomy.

Table 1 - Expressive Cystostomy Options

Procedure surgery:

1 Triple processing of the operational field with a solution of antiseptic.
2 Operational field separation with sterile operating linen.
3 Palpation of the bladder over pubic symphysis. It is necessary to ensure that the bottom of the bubble is sufficiently extending the bottom joint.
4 Marking of the place of puncture and further skin section: two finger diameters are above the pubic symphiz in the midline.
5 It is necessary to avoid setting the catheter in the field of natural skin folds.
6 The syringe is filled with a solution of local anesthetic (1% Lidocaine solution is suitable for anesthesia, 0.25% bupivacain solution) - 10 ml. Layered fabric infiltration in a marked place with a gradual immersion of a deep needle. It is necessary to slightly tilt the needle (by 10-20 degrees) towards the pelvis. As needle immersion, test aspirations are performed in the fabric: when you hit the urinary bubble cavity in the syringe, urine appears. The surgeon remembers at what depth of the needle fell into the bubble cavity.
7 Further, two options for the implementation of cystostomy are possible: according to the method of the celebringer and using a trochar. Consider them in more detail.

5.1. Methods of Selfie

To discharge local anesthetic, a needle is used for spinal puncture.
After anesthesia and puncture of the lumen of the bubble, the syringe is disconnected.
A metallic conductor is introduced into the bubble cavity through the magnitude of the needle, the needle is removed.
Through the place of production of the metal conductor, a small skin incision 1 cm is done in length.
On the conductor in the bubble cavity introduced the peel-away, together with the catheter for cystostomy.
Metal conductor is extracted.
The introducer is divided into two petals and removed from the surface of the catheter.
The locking cylinder is inflated at the end of the catheter.
The catheter is fixed outside to the skin with several seams.
The aseptic bandage is superimposed on top of the installed cystostoma.

Fig. 2 - setting custostomas using Peel Away inverter. To view click on illustration

5.2. Trokarny cystostomy

Fig. 3 - Troopar Cystostomy (Scheme)

As soon as the stilette falls into the bubble cavity, it begins to strengthen the urine from the trocar. Stileta is removed, the bladder in the bubble cavity is introduced into the bladder cavity.
Trocar is removed.
At the end of the catheter, the cylinder fits the catheter from the outdoor displacement.
Outside, the catheter is fixed by one - two skin seams.

6. Open cystostomy

The open operation is used in the case when there is an indication for cystostomy in combination with absolute contraindications to minimally invasive intervention (the presence of adhesions in a small basin, urinary bubble neoplasms, the pathology of the blood coagulation system).

Only with wide access is enough visualization and reliable hemostasis.

Procedure surgery:

Vertical skin cut below navel (4-5 cm).
During access to the Bublar, the peritonean remains intact and moves away from the rear wall of the blister bubble.
The front wall of the bubble rises using tweezers.
A small cut is made between the tweezers, a bladder cavity is introduced into the bubble cavity.
The cut of the wall around the catheter is invented by one - two seams, thereby fixing the catheter tube.
The catheter cuff is swelling.
The wound layer is produced.
Fixing the catheter is performed by skin seams.

Fig. 4 - open custostomy. The catheter is introduced into the urinary bubble cavity, the wall of the bubble is stitched by separate knotted seams

Possible complications:

1 Intraish urine expiration.
2 urine expiration in extra-bustitoneal fiber.
3 Excess granulation of the skin around the cystostomomic tube.
4 blockage tubes (blood clots, mucus).
5 Distribution of the tube with stoma hole overgrow.
6 hematuria after the production of custostomas.
7 Damage to the rear wall of the bladder.
8 Perforation of the intestinal wall.
9 Bulk tissue around cystostomy. The appearance of the mucous membrane, the mucous-purulent wound discharge speaks of its infection. In the absence of signs of systemic inflammation, the problem is eliminated with due departure (skin treatment around the cystostomoma with antiseptic solution).

7. What do you need to know the patient?

1 It is necessary to prevent the patient that after the end of the procedure, watering from the lumen of the bubble will be discharged through the tube derived from the front surface of the abdomen.
Two patients talk about the rules for the care of the tube and the wound around it, they are instructed to change the replacement of urinary.
3 After wound healing, the place around the cystostoma is washed with soap solution, then with conventional boiled water and covers sterile gauze.
4 In the absence of contraindications, the patient recommends abundant drinking mode.
5 When the catheter shifts the patient, it is necessary to urgently turn to the urologist / surgeon to restore cystostomas. The formed move between the skin and the bladder, when removing cystostomomas, is very quickly closed, which may require a re-operation to drain the bubble. Therefore, it is important when the catheter is shifted not to postpone consultation with a qualified physician.
6 The first catheter changes after 4-6 weeks from the date of production, further replacing the catheter to the new one is produced every month.
7 The diameter of the catheter 22 - 24 FRENCH, when setting a catheter with a diameter of less than 16 FRENCH there is a high probability of its obstruction.

7.1. Before the operation

1 The patient consent comes to medical intervention, provides information on the operation, its main points, possible complications.
2 Setting the intravenous catheter for the introduction of drugs during the operation and after it.
3 Selection of anesthesia option (local anesthesia, spinal, epidural anesthesia, endotracheal anesthesia).

7.2. During the operation

1 Depending on the method of the operation, a cut of the skin of a certain length will be performed, a tube for the urine leads will be introduced into the lumen of the bladder. The tube is fixed inside the bubble inflating the cylinder at the end of the catheter, to the skin - separate skin seams.
2 The catheter is connected to the urinary (plastic package for urine collection).

7.3. After operation

1 Patient after a complete awakening from anesthesia is translated into the ward.
2 The urinary student must always keep below the waist level, which will prevent the reverse urine current from the package in the bubble cavity and will prevent ascending infection.
3 a day after the operation, it is permissible to start drinking. Water drink in small sips. In the absence of nausea and vomiting for 2 hours of the beginning of water consumption, the volume of the liquid can be increased. At the same time you can start a liquid nutrition (skimmed yogurt, kefir).
4 The next day you can take hard food.
5 For the removal of pain and prevention of infectious complications after the operation, analgesics are assigned (ketorol, analgin), a wide spectrum antibiotics (cephalosporins of the 3rd generation - cefotaxim, ceftriaxone).

7.4. Emptying of the urinary

Fig. 5 - urination

1 The urinary needs to be emptied when it is filled with more than half.
2 Big capacity urochildren empty on average every 8 hours.
3 Small vocarieties empty at least every 4 hours.
4 The urinary is placed above the toilet, the valve opens at the bottom of the bag.
5 Water poured into the toilet. It is necessary not to touch the drainage tube of any surfaces.
6 After a complete emptying of the blasting hole bag at the bottom of the urinary treatment is processed by a solution of alcohol (40% solution).
7 Valve on the neck drainage closes.

8. Care for Custe

1 Daily cleaned leather around the cystthomy hole.
2 Before handling the skin of the hand is clean with the use of soap, sterile gloves are put on.
3 In the first 7-10 days, the skin is processed with an antiseptic solution (iodine, iodiskin, septicide, 70% alcohol solution).
4 After 10 days, the skin can be processed by soap solution, the soap is then washed off with water. The skin is dried. It is permissible at the end to handle the skin with a solution of antiseptics (40% alcohol solution).
5 around the tube plaster fixes sterile march (napkin).
6 Important timely shift and emptying of the sonar.
7 Changing the urinary package to the new should be made at least once a week.
8 Replacing the first catheter is carried out in 4-6 weeks. Next, the replacement of the blade of the blade on the new one is performed every month.
9 It is necessary to maintain the urinary at the level below the waist.
10 Abundant Drink in the absence of contraindications (in the absence of contraindications, the volume of fluid drunk per day increases to 2.5 - 3 liters).

9. In which case to seek medical care?

1 Increases temperature, chills.
2 burning pain around custostomas.
3 Around the cystostomy - swelling and redness of the fabrics, the department of the pus.
4 The appearance of blood in the urine.
5 The emergence of questions for its state, care of the cystostomy.
6 With strong pains in the field of cystostomomas, the absence of urine on it needs to cause ambulance aid.

10. Types of urination

Depending on the volume of urinal, divided into bags with a large capacity (up to 1.5 - 2 liters) and low capacity (500 ml).

Low capacity bags can be equipped with special fasteners for foot fixing. Foot fixing of urinal increases mobility and social adaptation of the patient with a cystostomy.

Nephostomy is an operational intervention carried out under X-ray or ultrasound control.

The operation is aimed at removal of urine kidney through a special tube (nephrosty or drainage).

As a rule, the procedure is carried out when blocking ureters when urine accumulates in a cup-laughter system.

The nephrosta is carried out through the skin and muscles in the area of \u200b\u200bthe lower back, renal fabric, ending in the curious kidney system.

By drainage, the liquid goes into a sterile urinary. The operation is carried out in an operating room under intravenous anesthesia.

Purpose of manipulation

The main goal of the installation of nephrastomas is the restoration and normalization of urine outflow from one or both kidneys, which is most often necessary to patients with oncology.

The lack of a normal removal of urine is dangerous, rushes a threat to the emergence of non-stop damage to the renal tissues, which are completely destroyed. That is, kidney dysfunction can become irreversible.

In some cases, patients drainage is set temporarily and is used to approach the upper paths of the urinary system (ureter and kidney).

After the kidney functions are restored, it is descended. But in serious cases (with irreversible and large fabric damage), the catheter may remain forever.

Also, nephrastoma is placed for lithotripsy (intravenous crushing stones), to perform chemotherapy, setting stents or to prepare for the subsequent operation.

Also, the operation can be performed for the implementation of special surveys. A person requires an artificial outflow of urine in the violated natural allocation.

The operation can be carried out in some diseases and pathological processes:

urolithiasis;
tumors in a small pelvis (cysts in the kidneys, tumor education in the vagina, a prostate, urinary bubble);
with acute hydronephrosis;
with an excretory Anuria;
when removing coral stones;
with strictures of urethra and ureter;
with metastatic damage to the abdominal organs, and if there is a squeezing of organ with tumor clusters.

Restoration of urinary outflow prevents the development of hydronephrosis (expansion in the body system), acute form of renal failure, pyelonephritis (renal tissue inflammation).

In emergency cases, it is important to bring the accumulated liquid first, after which it is about restoring the natural outflow of urine.

Contraindications to the operation

All contraindications for surgery are established by the attending physician or consilium.

Major restrictions for the installation of nephrostomas:

arterial hypertensionthat fails to be adjusted;
diseases concerning blood clotting disorders, a history of thrombocytopenia or hemophilia;
the use of anticoagulants or drugs drank bloodThey include heparin, aspirin, etc.: You should stop their consumption no later than a week before operating.

Preparatory activities

Preparation before nephthromy is also carried out, as before other operations.

First, the patient must pass a standard set of analyzes (urine, blood). Different surveys are carried out (biochemical analysis, sowing on the microflora, checking the time of coagulation and blood sugar levels).

In the absence of contraindications to the operation after analyzes, an ultrasound study of the kidneys and a radiograph is made.

After determining the disease and the volume of the accumulated fluid in the kidneys, additional surveys may be assigned:

computer tomography kidney;
urography;
computer tomography for peritoneum space.

The patient is inspected at the anesthesiologist, its reaction to the anesthesia and other drugs is determined.

Special antibacterial therapy before the planned operation is not appointed.

When inflammation in the urinary bubble and the spread of infection, the reception of antibacterial drugs is aimed at eliminating the inflammatory process. They are appointed by a doctor in the necessary dosage and volume.

Course of operation

There are two types of surgery to overtake nephrostomas into renal cavity:

open (intraoperative);
expressive puncture nephrostomy.

In the old manner - hurt and unpredictable

Open type of operation is characterized by the installation of a stoma (drainage) when the kidney is expensive.

To do this, in the region of the lumbar section, tissues are cut to the damaged organ. Upon reaching the renal adhesive capsule, it is sewn to the skin and impose several seams.

Then at the same level the kidney and the pelvis are cut, where the rubber tube is introduced. It is fixed, sewing to the skin one seam. The rest of the skin is sewn.

Modern way with minimal consequences

The puncture operation is characterized by a skin bunch in the area of \u200b\u200bplacement of the affected organ. To penetrate the necessary zone, the doctor operates with an ultrasound or x-ray study.

A rubber tube joins a special accumulative container with a valve, to which urine will accumulate for the period of finding a stoma in the kidney.

Specialists advise frequently changing the tube, as salt sediments accumulate on it. The duration of the operation is about half an hour.

After the recovery period is completed, the drainage is removed, and the fistula is delayed on their own for several weeks.

Care for drainage

Basically, after the patient's operation, the same day sends home with the provision of detailed instructions from the attending physician. The patient should not play sports and physical exertion.

It is also important to maintain the proper care for nephrosty and conducting preventive measures to protect against possible inflammation in the kidney. An observance of a volatile diet is required, so that the outflow of urine does not delay.

After a long-term operation requires standard care. The tube is removed after the appearance of a fistula for rejection of the fluid.

Regardless of the timing of the catheter installation, it requires careful care:

So that there is no urinary infection, preferably regularly wash drainage with saline.
Also the area of \u200b\u200bthe puncture wound should be clean, It is necessary to rinse it with antiseptic solutions (furacillin or chlorhexidine), overlapping a sterile bandage.
Periodic purification of urinary. There is a hermetic clasp and a special label, indicating the level of fluid at which the device needs to be changed. In case of untimely change of the package, the return emission of urine into the renal pelvis is possible. Because of this, it is possible to infect the kidney, the discrepancy between the seams and increase the pressure.
Constant flushing kidney. You should use active drainage. For this, 2 stomas are put in the lochank. Feeding an antiseptic to one thing, with the second, flushing fluid with stagnant urine and sand residues.

Possible complications

Primary complications belong to the process of operation and installation of stoma.

For example, when transactions with a cut, you can damage the artery near the kidney. Because of this, strong hemorrhage into the retroperitoneal tissue with the advent of retroperitoneal hematoma appears.

The hazard of the hematoma is to infect it, which is why the operation in this area will be required. Blood may also appear in the urine, which is why the doctor puts the wrong diagnosis and prescribes incorrect treatment.

Secondary complications are associated with the infection of the body. The postoperative pyelonephritis of the secondary type is characterized by aggressive development and is poorly eliminated with antibacterial therapy.

Adjust the pathological process can be modern antibiotics.

Patient's opinion

The feedback of the man who was installed in the kidney in connection with the disease.

The nephrosta is removed after the normalization of urine outflow across urethra. Before that, the passability of the channels in the dye into the tube is checked.

It should be referred to professionals that comply with European security standards and have proper certificates.

1Pochki.ru.

Nephostomy: General Information

What is nephrostom? The procedure is an operation to carry out a special stoma-drainage, stent or catheter (which is determined by the characteristics of disorders) through the skin in the lumbar zone until the renal structure and with the output. Manipulation is carried out under the control of X-ray or ultrasound. Less frequently applied device installation operation. The problem is the removal of biohydration, which, with certain disorders (more often, the blockade of the ureter) accumulates in the cavity of the kidney connoisseur. On the tube, Urina flows into a sterile uginal. Operation, called nephrostomy, is carried out under full anesthesia (intravenous) in the manipulation office.

They put one for the adjustment and stabilization of the regular leading of urine from the kidneys, the restoration of the performance of one or both kidneys. More often nephostomy is carried out onkopacients. The importance of the operation is that when ensuring urine's removal is presented with irreversible destruction of the kidney tissues against the background of urine accumulation. Often, the operation is used as a temporary measure when the device is deleted after its destination. In particularly difficult cases, you need to put for life.

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Indications for the holding of the kidney nephrostomy

When crushing stones in the kidneys are installed nephretic.

Nephostt is set to execute:

crushing stones in the kidneys;
chemotherapy;
mounting stents;
preparation for the further operation;
special surgery.

The catheter in the kidney is set when urine outflow is difficult with such pathologies and states:

neoplasms in the kidney or other zone of small pelvis;
narrowing narrowing;
stones in the kidneys, ureter, urea;
expansion of a cup and glass complex (hydronephrosis).

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Contraindications

The decision on the catheterization of the kidneys is taken by a doctor or a consultation of specialists. Prohibit operations can be prohibited in the following cases:

sustainable increase in blood pressure, non-drugic correction;
blood coagulation disorders and pathology accompanied by plasma liquefaction;
treatment with drugs that dilute blood that cannot be canceled;
condition for hydronephrosis.

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Preparation for manipulation

Ultrasound kidneys are carried out to diagnose the state of the kidneys.

Kidney catheterization requires the same preparatory measures as another type of operation. The first sets of urine tests, blood are surrendered: a common and biochemical test, bakposev, assessment of the coagulation rate and glucose in the blood plasma are performed. To check the state of the kidneys, the determination of the amount of accumulated biohydsis is used a set of diagnostic procedures: ultrasound, CT, urography. The patient consults and examines anesthesiologist to determine the reaction to anesthesia. Reception of antibiotics before manipulation is not required if there is no infection or other inflammation in the urinary system. 8 hours before the patient's procedure should not eat milk and dairy products, eat liquid dishes. Only nonconcentrated brows and water are allowed, from which you need to give up 3 hours before manipulation.

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Course of operation

Nephostomy is carried out in two ways:

open or intraoperative;
percutaneous punitive.

With an open operation, a kidney drainage is installed with an opening of the organ. To do this, in the lumbar zone there is an incision to the fat capsules of the damaged organ. The kidney is cut together with a locher, a flexible tube is introduced with one seam. With an installed nephrosty, the overlay stitches is carried out to the inlet. The procedure is carried out under general anesthesia. Technique is extremely rare due to a long period of rehabilitation and more consequences.

Penal nephrostomy is a modern minimally invasive way to introduce a catheter. Uzi or X-ray equipment is used to control the introduction. Before the introduction of the puncture needle, local anesthesia is made. After the needle is administered, a contrast agent is launched to highlight the route of the drainage tube. The total duration of the operation varies from 30 minutes to an hour. The risk of developing the adaptive effects at percutaneous nephrostomy is minimized in many respects due to the possibility of the patient to delay the breath, which will ensure the immobility of the kidney, therefore, will ensure the safe input of the catheter. The abandoning channel during punctuation is recorded in three ways:

through a loching loop;
by the inflating balloon;
sewing to the skin (more often).

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Operating special groups of patients

The kit includes all the necessary means for carrying out nephrostia.

The nephrostomic drainage channel is raised not only to adults, but also for children of different ages (there are cases when they put a newborn), pregnant women in testimony. Such a need is associated with congenital anomalies for the development of the urinary system (in a child), pyelonephritis or hydronephrosis, with stones during pregnancy, which occur in severe and are dangerous to wear the fetus. Such a group of patients is in the hospital, the entire period of treatment is up to the removal of the stent. For the installation of nephrostomic drainage, exclusively puncture nephrostomy is used.

List of testimony to nephrostomy in pregnant women:

all forms of nephritis;
inflamed tumor (carbuncoon) in the cortical part of the kidney;
abscess without a purulent-septic reaction;
purulent destructive pyelonephritis.

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How to care and wash drainage at home?

After the nephrostomy, the patient goes home with a detailed instruction from the doctor to care for drainage and the prevention of inflammation. The entire period of wearing the catheter is prohibited by physical exertion, otherwise nephrosty is possible, an insensible diet is observed. To prevent the urinary infection, a regular washing of wounds and drainage sterile salvory is performed. If the catheter is installed on a long or lifelong period (for life), it is periodically replaced by nephrosty. In particular, renephrostomy is required when the drainage tube is blocked by the salts contained in Urine. The same manipulation is required when the catheter is falling, which cannot be allowed to form a natural fistula for urine outflow due to the risk of infection and the emergence of problems. Replacement is made during the day.

The norm is considered to be the detection of blood in Urin the first 2-3 days after the stoma is administered. In the future, Urin contains traces of red blood cells.

Care for nephrosty should always be as thorough as possible.

It is necessary to care for the stoma through such procedures:

Flushing by nephrostomy by saline (20 ml of 0.9% sodium chloride). It is possible to rinse at home while complying with the recommendations of the doctor. If the device is required. For this, special kits that contain a removable adapter and the tubular catheter itself are sold.
Care for wake-up with antiseptic. It is necessary to rinse the inlet with an antiseptic ("furacillin", "chlorhexidine") followed by imposing a sterile, dry dressing. If a gauze bandage is done, it changes daily. When using a sterile transparent bandage, the replacement is produced once every 3 days.
Emptying urinal to achieve a level marked on the device. If the replacement is untimely, the risk of preproduction of biohydration is increased back to drainage and kidney, excess of pressure in renal loosening with discrepancies of seams and drainage drops.
Active renal washing. The technique is used in the infection of the pair organ. For this, two stoma is introduced: a washing solution is supplied through one, a stagnant urine with sand trails is derived.
Maintain dryness. Water treatments (bath, swimming are prohibited) The patient is necessary, but the place around the wound is important to maintain in dryness at least 14 days.
Protection. If the patient is carried out chemotherapy through one, it is important to provide protection in the form of sterile gloves during the empty of the urine collection container.
Providing assistance. A patient with nephrostoy needs help at least two people for changing the dressings and emptying of the urinary researcher, especially with double drainage.

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Possible risks

There are primary (operational) and secondary (postoperative) complications of renal nephrostomy. During the manipulation, there is a risk of damage to the ammunition artery with the development of bleeding into the retroperitoneal space with the formation of hematoma, which can be infected, which will require a long-distance operation. It is less likely to be treated against the background of blood detection in the urine during the first day, as the consequences of the breakthrough of the resulting adoperative hematoma.

Risks at a curvy operation more, more often - blade, bleeding, kidney infection. Secondary disorders are developing in the form of postoperative pyelonephritis, which is distinguished by the aggressive nature and resistance of infection to antibiotics. To eliminate the illness, more expensive drugs and elongation of the recovery period will be required. Therefore, if the temperature unexpectedly increased to 38 ° C and above, it is necessary to urgently cause a doctor.

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Delete Stoma

Indicators of well-carried out treatment, after which you can remove the nephrostat, are:

the formation of a fistula to ensure the natural outflow of urine (in patients with severe pathologies);
restoration of a normal dilution of urin in natural urine channels.

Usually drainage is carried out for 10-15 days. Pregnant women are not recommended to use nephrostomy over 4 days due to the high risk of developing disorders. In any case, the removal of nephrosty is prescribed the attending physician based on the results of control analyzes, evaluating the degree of restoration of the urinary function. An equally important indicator is the absence of irreversible diffuse damage to the renal parenchyma (fiber).

etopochki.ru.

Purpose of nephrosty

The drainage tube placed in the kidney serves as a peculiar adapter for urin. The resulting urine is freely excreted into a special capacity, externally similar to the container, which is a urinary.

This surgical manipulation is usually carried out for people with the presence of oncological diseases, to stabilize the process of removing urin from the body.

How much do you live with nephrosty? With proper care, with a drainage tube you can live from 10 to 20 years.

When installing nephrostomas, most pathological deviations are excluded, as well as the kidney amputation.

How to care for nephrosty

After the operation, nephrostomic drainage must be carefully protected, as well as to care for it. After completion of surgical manipulation, the patient leaves the medical institution and all mandatory preventive measures appointed by the surgeon, it exercises at home.

Before sending home, the patient carefully advise on how to care for the nephrostoy after surgery. For example, any physical exertion is strictly prohibited, since the device can fall out of the percutaneous hole. Next - support for a special diet (usually recommended table No. 7), as well as respiratory gymnastics.

Care for implanted nephrosty consists of the following items that are required to be fulfilled:

Daily needed drainage tube with a special sterile solution.
The puncture is necessary to process the antiseptic daily. To cut off not bleed, it is recommended to apply gauze bandages to it that you need to change once a few days.
It is necessary to monitor the amount of urine in the container. As soon as it is filled, there is a threat of the reverse outflow of urine in the kidney, which is fraught with serious complications, including the formation of serious inflammation, as well as the development of an infectious disease or ICD.
If there is an infection in the affected organ, you need to wash the kidneys. For these purposes, two nephrostomy is implanted to the patient. Urin is displayed through one tube, and the second is coming to physical.
It is important to remember that all the manipulations associated with the nephrosty and the attached set must be carried out in special gloves. The equipment must be sterile, as well as maintain tightness.
It is strictly forbidden to take a bath, visit the bath and other similar places in the first few weeks after the operation.
If a person is in serious condition, he needs the help of an outsider. The urinary container must empty on time.
Care for pregnant at home should be carried out exclusively under the supervision of the doctor. With the slightest deviations, the tone of the uterus is disturbed and the danger will hang over the life of the future child. Therefore, it is recommended to call a district doctor to the house or, if there is an opportunity, to attend the doctors yourself.

With implanted nephrostoy, you can live for a long time, while not to feel discomfort. If you comply with all the recommendations of the doctor, the chance of recurrence of the disease, as well as the development of viral diseases comes down to zero.

Rehabilitation

After the operation, the patient is transferred to the stationary compartment, where rehabilitation activities are carried out. To begin with, the patient is completely excluded from the diet, even in the smallest proportions. Every day the patient is treated with a wound and change the gauze bandage. Initially, medical staff take care of the postoperative period for a person, but after a few days he is released home, where he continues independent rehabilitation.

Special conditions for rehabilitation in women in position. With a drainage tube, some wonderful sex representatives move very difficult, but thanks to an implanted device, the risk for the mother and the child decreases significantly. As for labor activities, in 85% of cases, a cesarean cross section is produced, although at the request of the women in labor they can go naturally. If the need for nephrostomy occurs on 6-7 months of pregnancy, then after the operation carried out, the woman remains on preserving in a medical institution.

Patients often worry about how much you can live with an implanted device. The duration of life with nephrostoy is 10-20 years, but you can live much longer if you adhere to all the recommendations of the specialist, and in the first of all - to control your diet. For long years, the healing table number 7 is actively practiced. Its feature is that all products are prepared absolutely without salt, as well as food that the patient consumes, should be enriched with calories.

Thus, for the damaged organ, optimal conditions are created that allow you to regenerate the damaged organ much faster. Another condition of successful rehabilitation is thorough wound processing. To eliminate the possibility of enhancing a dangerous infection, as well as the development of inflammatory processes.

Physical exertion is excluded, otherwise, the tube can fall. Despite all the inconsistency and the deplorable situation, it is necessary to adhere to the established recommendations for the successful regeneration of the kidney.

But what if the drainage suddenly fell? It is strictly forbidden to independently install the dropping tube. Only a specialist in this area, guided by its knowledge and special technique, can be restored.

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Nefost - what is it? Functions

As is known, in the case of cancer, to carry out a radical operation and at the same time maintain the organ functions is not always. Sometimes the cloth affected at a large exterior has to be removed completely to avoid the spread of cancer. In other cases, on the contrary, the radical operation is impossible due to pronounced violations of the body's work. For this purpose, palliative surgical interventions were invented. They do not lead to curable, but contribute to the restoration of the physiological possibilities of the body. Palliative operations are performed in all spheres of oncology, no exception and urological assistance.

So, to establish the excretory function of the body and save a person from endogenous intoxication, carry out nephrostomy. It lies in the formulation of a drainage tube into a cup of kidney cup. The free end of nephrostomas is displayed outside, that is, on the surface of the skin. A special container is connected to it, and the outflow of the final exchange products is carried out, bypassing the bladder, ducts and urethra.

This operation relates to palliative types of assistance, so the doctor must think well, whether the nephrostom needs a particular patient. What it is and how to care for her, he will explain the patient before surgical intervention. And the kidney drainage installation is performed only with the written consent of the patient or its loved ones. At the same time, it is necessary to assess the overall condition of the patient and find out whether such an operation is possible.

Indications for the supply of nephrostomy

Like any artificially created drainage, nephrostom in the kidney performs a vital function. It is most often installed in cancer diseases of the urogenital system. Less often - with other serious urological pathologies. There are special indications according to which nephrosta is established. The operation is carried out if the following readings are available for nephtomy:

Kidney cancer or other urinary system organs.
Hydronephrosis.
Urolithiasis with the predominance of large concrections.
Metastases of the tumor of any localization, squeezing the organs of the small pelvis.
The obstruction of the ureter due to the compression of it from outside or stricture.

Nephostomy helps not only restore the outflow of fluid from the body, but also prevent the occurrence of the inflammatory process. As a result, it is possible to avoid chronic and acute kidney insufficiency.

Such an operation does not always mean that artificial drainage will be in the body constantly. In some cases, after conducting a special treatment (surgical intervention, chemotherapy), the nephrosty is removed. Sometimes the recovery of urine outflow is required at the time of the diagnostic manipulation (stenting).

Contraindications for nephrostomy

Despite the sharp need for operation, nephrostomy can not always be performed. Contraindications include such states:

blood coagulation disorders;
uncontrolled arterial hypertension;
reception of anticoagulants.

Diseases in which blood clotting is disturbed include hemophilia, hemorrhagic vasculitis, thrombocytopenic purpura, etc. With these pathologies, any operational interventions are life-threatening. The same applies to the reception of anticoagulants - medicines that dilute blood. Nephosts are not installed at high arterial pressure, which is not amenable to drug correction. Conduct surgical intervention in a similar condition contraindicated, due to the risk of developing stroke and cardiogenic shock.

Preparation for nephrosty

In cases of violation of urine outflow, which is impossible to eliminate with medicines, need nephrostom in the kidney. The operation for its installation, as a rule, does not occupy a long time, however, it requires a patient's stay in the hospital.

Before proceeding with the surgical procedure, diagnostic studies should be performed. Among them is a common and biochemical analysis of blood, urine, coagulogram. If the cause of Anuururia (violation of the outflow of urine) is not clarified, instrumental examinations are required. These include an excretory urography, ultrasound kidneys, computed tomography.

Technique of nephrostomy

Patients naturally want to know what nephrost is needed for what it is and how it is installed. It should be noted that the withdrawal of the drain tube from the kidney to the surface of the skin for experienced surgeons is considered an easy operation. It is performed both under general anesthesia, and with local anesthesia. Nephostomy is carried out quickly, for 15-20 minutes. However, after performing the operation, the patient must be observed. It is necessary to assess the recovery of urine outflow. There are 3 options for nephrostomy. Among them:

Perform an open surgical operation.
Laparoscopic drainage installation.
Cracked nephrostomy.

Most often the last option is performed. Installation of nephrostomas by puncture of the skin and tissues are better transferred to patients. In addition, the percutaneous operation is considered less traumatic, compared with open surgical intervention. It is performed under the control of ultrasound or radiography.

The technique of operation includes puncture of the skin, fatty fiber, muscles and renal parenchyma with the help of a puncture needle. During the fulfillment of nephrostomy, the doctor watches the monitor. This is very important, since it is necessary to get into a cup of a bowl, without damaging the surrounding tissues. After the introduction of the needle, the drainage tube is installed, the free side of which is joined to the uniform.

When do nephrosty remove?

If the operation was carried out in order to fulfill therapeutic procedures (chemotherapy, the kidney vessels), the nephrostite is removed after the restoration of the physiological outflow of urine.

Sometimes the drainage tube is established for an indefinite period. Most often in cancer diseases of severe. At the same time, the replacement of nephrostomas is periodically required. It must be performed under operating conditions. In contrast to the initial surgical intervention, the puncture of the fabric is not required, as a fiscased hole is formed.

Recovery after surgery

Restoration after nephrostomy occurs quickly. Already in the first day, the patient can move around the ward with a drainage tube. Taking antibiotics after the operation follows 5-7 days to prevent the infectious process. For 2-3 days, blood can fall into the urinary researcher. This is due to the trauma of the kidney vessels. After 3 days, bleeding stops. To control the outflow of urine, an ultrasound is made.

Nephostom: Home Care yourself

Since drainage is a foreign body for the body, it is possible to infect it at any time. This is warned by each patient who has nephrostom. Care for catheter should be carried out constantly. The methods of prevention of the infectious process include:

Washing a drainage tube with saline and antiseptics. For this purpose, the drug "Chlorhexidine" or "Furacilin" is used.
Overlay sterile bandage to the postoperative wound area.
Timely emptying of the urinary.
Doctor control every 2 weeks.

Patients who have nephrostas are impossible to do physical exercises, lift gravity. The drinage tube inflection can lead to complications, so the catheter must be in the same position.

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