Antikoagülan-Antiagrean Kullanan Hastalarda Perkutan Nefrostomi Takılması; Preop Hasta Hazırlığı ve Hasta Takip Süreci
Özet
Üriner sistem hastalıklarının tedavisinde, cerrahi tedavilere alternatif olarak minimal invaziv yöntemler gittikçe artan oranlarda uygulanmaktadır. Böbreğin toplayıcı sistemine görüntüleme yöntemleri kılavuzluğunda katater yerleştirilmesi işlemine perkütan kateter nefrostomi adı verilir (PKN).
İşlem öncesi hazırlık aşamasında; Girişimsel Radyoloji Derneği Uygulama Komitesinin güncellediği kılavuzlarda, girişimsel radyoloji prosedürleri antiplatelet ve antikoagülan ilaçların kesilmesine yönelik kanama risklerine göre seviye 1'den seviye 3'e kadar sınıflandırır. Kılavuzda PKN, seviye 3 prosedürü olarak yer alır ve işlem öncesi International Normalized Ratio (INR)’nin 1,5'ten büyük olmamasını, aktive parsiyel tromboplastin zamanının (aPTT) normal standardın 1,5 katından büyük olmamasını ve trombosit sayısının en az 50.000 hücre/mL olmasını önerir. Kılavuza göre, kanama risklerini azaltmak için işlem öncesi kesilmesi gereken antikoagülan ve antiagreganlar da belirtmiştir.
Perkütan nefrostomi tüpü takarken temel anatomik prensiplere uyulması kanama komplikasyonu oranını azaltmak açısından son derece önemlidir. İğnenin veya yerleştirilen kateterin boyutu kanama oranıyla ilişkili görünmemektedir.
PKN, işlem öncesinde hastanın koagülopati durumuyla beraber böbrek ve bölge organ anatomisi birlikte değerlendirildiğinde hastanın kliniğinin düzelmesine katkısı olabilen başarı oranı yüksek ve güvenli bir yöntemdir.
In the treatment of urinary system diseases, minimally invasive methods are increasingly being used as an alternative to major surgical approaches. The process of inserting a catheter into the collecting system of the kidney under the guidance of imaging methods is called percutaneous catheter nephrostomy (PCN).
In the preparation phase before the procedure; In the guidelines updated by the Standards of Practice Committee of the Society of Interventional Radiology (SIR), interventional radiology procedures are classified from level 1 to level 3 according to bleeding risks for discontinuation of antiplatelet and anticoagulant drugs.
In the guideline, PCN is included as a level 3 procedure and requires that the International Normalized Ratio (INR) before the procedure is not greater than 1.5, the activated partial thromboplastin time (aPTT) is not more than 1.5 times the normal standard, and the platelet count is at least 50,000 cells. It recommends /mL. According to the guide, it also states that anticoagulants and antiplatelets should be discontinued before the procedure to reduce bleeding risks.
Compliance with basic anatomical principles when inserting a percutaneous nephrostomy tube is extremely important to reduce the rate of bleeding complications. The size of the needle or catheter inserted does not appear to be related to the bleeding rate.
PCN is a very practical, safe and high-success option that can dramatically improve the patient's clinical condition when the patient's coagulopathy status, kidney and adjacent organ anatomy are carefully evaluated before the procedure.
Referanslar
Percutaneous Urinary System Interventions. Karaköse S. Turkiye Klinikleri J Radiol-Special Topics. 2012;5(1):56-64.
Dagli M, Ramchandani P. Percutaneous nephrostomy: technical aspects and indications. Semin Intervent Radiol. 2011 Dec;28(4):424-37.
Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, Knoll T, Lingeman JE, Nakada SY, Pearle MS, Sarica K, Türk C, Wolf JS., EAU/AUA Nephrolithiasis Guideline Panel. 2007 guideline for the management of ureteral calculi. J Urol. 2007 Dec;178(6):2418-34.
Goodwin, W. E., W. C. Casey, and W. Woolf. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc 1955 157(11): p.891–4.
Seldinger, S. I., Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta radiol 1953 39(5): p.368–76.
Hogan, M. J., B. D. Coley, V. R. Jayanthi, et al. Percutaneous Nephrostomy in Children and Adolescents: Outpatient Management 1. Radiology 2001 218(1): p.207–210.
Egilmez, H., I. Oztoprak, M. Atalar, et al. The place of computed tomography as a guidance modality in percutaneous nephrostomy: analysis of a 10-year single-center experience. Acta Radiol 2007 48(7): p.806–813.
Grabe M, B. -J. T., Botto H, Wullt B, Çek M, Naber KG. Guidelines on urological infections. Eur Ass Urol (EAU), 2011: p.33–39.
Hopper KD, Sherman JL, Luethke JM, Ghaed N. The retrorenal colon in the supine and prone patient. Radiology. 1987 Feb;162(2):443-6.
Zegel, H., H. Pollack, M. Banner, et al. Percutaneous nephrostomy: comparison of sonographic and fluoroscopic guidance. Am J of Roentgen 1981 137(5): p.925–927.
Nielsen, O. S. and E. Grossmann. Ultrasonically guided percutaneous nephrostomy. Scand J Urol Nephrol 1990 24(3): p.219–21.
Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, Saad WE., Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Standards of Practice Committee of the Society of Interventional Radiology. Addendum of newer anticoagulants to the SIR consensus guideline. J Vasc Interv Radiol. 2013 May;24(5):641-5.
Cohn S, ed. Perioperative Medicine. Londra: Springer-Verlag; 2011.
Venkatesan AM, Kundu S, Sacks D, Wallace MJ, Wojak JC, Rose SC, Clark TW, d'Othee BJ, Itkin M, Jones RS, Miller DL, Owens CA, Rajan DK, Stokes LS, Swan TL, Towbin RB, Cardella JF., Society of Interventional Radiology Standards of Practice Committee. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and Canadian Interventional Radiology Association [corrected]. J Vasc Interv Radiol. 2010 Nov;21(11):1611-30; quiz 1631.
Wolf JS, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ., Urologic Surgery Antimicrobial Prophylaxis Best Practice Policy Panel. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008 Apr;179(4):1379-90
Young M, Leslie SW. Percutaneous Nephrostomy. 2023 Jun 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29630257.
Ko R, Soucy F, Denstedt JD, Razvi H. Percutaneous nephrolithotomy made easier: a practical guide, tips and tricks. BJU Int. 2008;101(5):535–9.
Miller NL, Matlaga BR, Lingeman JE. Techniques for fluoroscopic percutaneous renal access. J Urol. 2007;178(1):15–23.
Sampaio FJ, Zanier JF, Aragao AH, Favorito LA. Intrarenal access: 3- dimensional anatomical study. J Urol. 1992;148(6):1769–73.
Kim et al. BMC Urology (2020) 20:22 https://doi.org/10.1186/s12894-020-00594-6.
Clark TW, Abraham RJ, Flemming BK. Is routine micropuncture access necessary for percutaneous nephrostomy? A randomized trial. Can Assoc Radiol J. 2002 Apr;53(2):87-91.
Ramchandani P, Cardella JF, Grassi CJ, Roberts AC, Sacks D, Schwartzberg MS, Lewis CA., Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol. 2003 Sep;14(9 Pt 2):S277-81.
Farrell TA, Hicks ME. A review of radiologically guided percutaneous nephrostomies in 303 patients. J Vasc Interv Radiol. 1997 Sep-Oct;8(5):769-74.
Radecka E, Magnusson A. Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiol. 2004 Apr;45(2):184-8.
Degirmenci T, Gunlusoy B, Kozacioglu Z, Arslan M, Ceylan Y, Ors B, Minareci S. Utilization of a modified Clavien Classification System in reporting complications after ultrasound-guided percutaneous nephrostomy tube placement: comparison to standard Society of Interventional Radiology practice guidelines. Urology. 2013 Jun;81(6):1161-7.
Wah TM, Weston MJ, Irving HC. Percutaneous nephrostomy insertion: outcome data from a prospective multi-operator study at a UK training centre. Clin Radiol. 2004 Mar;59(3):255-61.
Lewis S, Patel U. Major complications after percutaneous nephrostomy-lessons from a department audit. Clin Radiol 2004;59:171-9.
Gupta, S., M. Gulati, K. U. Shankar, et al. Percutaneous nephrostomy with real-time sonographic guidance. Acta Radiol 1997 38(3): p.454–457.
Pabon-Ramos WM, Dariushnia SR, Walker TG, d'Othée BJ, Ganguli S, Midia M, Siddiqi N, Kalva SP, Nikolic B., Society of Interventional Radiology Standards of Practice Committee. Quality Improvement Guidelines for Percutaneous Nephrostomy. J Vasc Interv Radiol. 2016 Mar;27(3):410-4.
Montvilas P, Solvig J, Johansen TE. Single-centre review of radiologically guided percutaneous nephrostomy using "mixed" technique: success and complication rates. Eur J Radiol. 2011 Nov;80(2):553-8.
Zagoria RJ, Dyer RB. Do's and don't's of percutaneous nephrostomy. Acad Radiol. 1999;6 (6): 370-7.
Hausegger KA, Portugaller HR. Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications. Eur Radiol. 2006;16 (9): 2016-30.
Referanslar
Percutaneous Urinary System Interventions. Karaköse S. Turkiye Klinikleri J Radiol-Special Topics. 2012;5(1):56-64.
Dagli M, Ramchandani P. Percutaneous nephrostomy: technical aspects and indications. Semin Intervent Radiol. 2011 Dec;28(4):424-37.
Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, Knoll T, Lingeman JE, Nakada SY, Pearle MS, Sarica K, Türk C, Wolf JS., EAU/AUA Nephrolithiasis Guideline Panel. 2007 guideline for the management of ureteral calculi. J Urol. 2007 Dec;178(6):2418-34.
Goodwin, W. E., W. C. Casey, and W. Woolf. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc 1955 157(11): p.891–4.
Seldinger, S. I., Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta radiol 1953 39(5): p.368–76.
Hogan, M. J., B. D. Coley, V. R. Jayanthi, et al. Percutaneous Nephrostomy in Children and Adolescents: Outpatient Management 1. Radiology 2001 218(1): p.207–210.
Egilmez, H., I. Oztoprak, M. Atalar, et al. The place of computed tomography as a guidance modality in percutaneous nephrostomy: analysis of a 10-year single-center experience. Acta Radiol 2007 48(7): p.806–813.
Grabe M, B. -J. T., Botto H, Wullt B, Çek M, Naber KG. Guidelines on urological infections. Eur Ass Urol (EAU), 2011: p.33–39.
Hopper KD, Sherman JL, Luethke JM, Ghaed N. The retrorenal colon in the supine and prone patient. Radiology. 1987 Feb;162(2):443-6.
Zegel, H., H. Pollack, M. Banner, et al. Percutaneous nephrostomy: comparison of sonographic and fluoroscopic guidance. Am J of Roentgen 1981 137(5): p.925–927.
Nielsen, O. S. and E. Grossmann. Ultrasonically guided percutaneous nephrostomy. Scand J Urol Nephrol 1990 24(3): p.219–21.
Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, Saad WE., Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Standards of Practice Committee of the Society of Interventional Radiology. Addendum of newer anticoagulants to the SIR consensus guideline. J Vasc Interv Radiol. 2013 May;24(5):641-5.
Cohn S, ed. Perioperative Medicine. Londra: Springer-Verlag; 2011.
Venkatesan AM, Kundu S, Sacks D, Wallace MJ, Wojak JC, Rose SC, Clark TW, d'Othee BJ, Itkin M, Jones RS, Miller DL, Owens CA, Rajan DK, Stokes LS, Swan TL, Towbin RB, Cardella JF., Society of Interventional Radiology Standards of Practice Committee. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and Canadian Interventional Radiology Association [corrected]. J Vasc Interv Radiol. 2010 Nov;21(11):1611-30; quiz 1631.
Wolf JS, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ., Urologic Surgery Antimicrobial Prophylaxis Best Practice Policy Panel. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008 Apr;179(4):1379-90
Young M, Leslie SW. Percutaneous Nephrostomy. 2023 Jun 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29630257.
Ko R, Soucy F, Denstedt JD, Razvi H. Percutaneous nephrolithotomy made easier: a practical guide, tips and tricks. BJU Int. 2008;101(5):535–9.
Miller NL, Matlaga BR, Lingeman JE. Techniques for fluoroscopic percutaneous renal access. J Urol. 2007;178(1):15–23.
Sampaio FJ, Zanier JF, Aragao AH, Favorito LA. Intrarenal access: 3- dimensional anatomical study. J Urol. 1992;148(6):1769–73.
Kim et al. BMC Urology (2020) 20:22 https://doi.org/10.1186/s12894-020-00594-6.
Clark TW, Abraham RJ, Flemming BK. Is routine micropuncture access necessary for percutaneous nephrostomy? A randomized trial. Can Assoc Radiol J. 2002 Apr;53(2):87-91.
Ramchandani P, Cardella JF, Grassi CJ, Roberts AC, Sacks D, Schwartzberg MS, Lewis CA., Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol. 2003 Sep;14(9 Pt 2):S277-81.
Farrell TA, Hicks ME. A review of radiologically guided percutaneous nephrostomies in 303 patients. J Vasc Interv Radiol. 1997 Sep-Oct;8(5):769-74.
Radecka E, Magnusson A. Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiol. 2004 Apr;45(2):184-8.
Degirmenci T, Gunlusoy B, Kozacioglu Z, Arslan M, Ceylan Y, Ors B, Minareci S. Utilization of a modified Clavien Classification System in reporting complications after ultrasound-guided percutaneous nephrostomy tube placement: comparison to standard Society of Interventional Radiology practice guidelines. Urology. 2013 Jun;81(6):1161-7.
Wah TM, Weston MJ, Irving HC. Percutaneous nephrostomy insertion: outcome data from a prospective multi-operator study at a UK training centre. Clin Radiol. 2004 Mar;59(3):255-61.
Lewis S, Patel U. Major complications after percutaneous nephrostomy-lessons from a department audit. Clin Radiol 2004;59:171-9.
Gupta, S., M. Gulati, K. U. Shankar, et al. Percutaneous nephrostomy with real-time sonographic guidance. Acta Radiol 1997 38(3): p.454–457.
Pabon-Ramos WM, Dariushnia SR, Walker TG, d'Othée BJ, Ganguli S, Midia M, Siddiqi N, Kalva SP, Nikolic B., Society of Interventional Radiology Standards of Practice Committee. Quality Improvement Guidelines for Percutaneous Nephrostomy. J Vasc Interv Radiol. 2016 Mar;27(3):410-4.
Montvilas P, Solvig J, Johansen TE. Single-centre review of radiologically guided percutaneous nephrostomy using "mixed" technique: success and complication rates. Eur J Radiol. 2011 Nov;80(2):553-8.
Zagoria RJ, Dyer RB. Do's and don't's of percutaneous nephrostomy. Acad Radiol. 1999;6 (6): 370-7.
Hausegger KA, Portugaller HR. Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications. Eur Radiol. 2006;16 (9): 2016-30.
