CPT® Code 50398

Deleted

1. Indications

Change of nephrostomy or pyelostomy tube is indicated for patients who have a nephrostomy or pyelostomy tube that requires replacement due to various reasons, including:

• Obstruction The tube may become obstructed, preventing proper drainage of urine from the kidney.
• Infection The presence of infection may necessitate the replacement of the tube to reduce the risk of complications.
• Tube Malfunction If the tube is not functioning correctly, it may need to be changed to restore proper urinary drainage.
• Scheduled Maintenance Regular changes may be required as part of ongoing management for patients with chronic conditions affecting urinary flow.

2. Procedure

The procedure for changing a nephrostomy or pyelostomy tube involves several key steps to ensure successful replacement and proper positioning of the new tube.

• Step 1: Preparation The patient is positioned appropriately, and the area around the nephrostomy or pyelostomy tube is cleaned and sterilized to minimize the risk of infection.
• Step 2: Contrast Injection Contrast material is injected into the nephrostomy tube as needed. This step is crucial for visualizing the tube's position and ensuring that the renal pelvis is adequately filled for imaging purposes.
• Step 3: Fluoroscopic Visualization Using fluoroscopic imaging, the physician can visualize the tube and surrounding anatomy in real-time. This guidance is essential for the safe removal and replacement of the tube.
• Step 4: Cutting the Suture The suture that fixes the nephrostomy tube to the kidney is carefully cut, allowing for the removal of the existing tube.
• Step 5: Insertion of Guidewire A guidewire is inserted through the existing nephrostomy tube. This guidewire will facilitate the removal of the old tube and the insertion of the new one.
• Step 6: Removal of the Old Tube The nephrostomy tube is removed over the guidewire, ensuring that the guidewire remains in place for the next step.
• Step 7: Insertion of New Tube A new nephrostomy or pyelostomy tube is advanced over the guidewire into the renal pelvis. This step is critical to ensure that the new tube is correctly positioned for optimal drainage.
• Step 8: Securing the New Tube The new tube is secured in place, often with sutures, to prevent displacement and ensure proper function.
• Step 9: Radiographic Confirmation Finally, radiographic images are obtained to confirm that the new tube is properly positioned within the renal pelvis, ensuring that it will function effectively for urine drainage.

3. Post-Procedure

After the procedure, the patient may be monitored for any immediate complications, such as bleeding or infection. It is essential to ensure that the new nephrostomy or pyelostomy tube is functioning correctly and that urine is draining appropriately. Patients may receive instructions on how to care for the tube site and recognize signs of potential complications, such as increased pain, fever, or changes in urine output. Follow-up appointments may be scheduled to assess the tube's function and the patient's overall condition.