Developing a Training Model for Percutaneous Nephrostomy Placement under Ultrasound and Fluoroscopy Guidance

Monday, March 6, 2023

3:40 PM – 3:50 PM

Location: Phoenix Convention Center, 222AB

Presenting Author(s)

Marina Borrego, n/a

Research Laboratory Technician
UT Health San Antonio

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Carlos B. Ortiz, MD

Resident
UT Health San Antonio
JL

Jorge Lopera, MD, FSIR

Attending
UT Health Science Center in San Antonio

Disclosure(s):

Marina Borrego, n/a: No financial relationships to disclose

Carlos B. Ortiz, MD: No financial relationships to disclose

Purpose: Percutaneous nephrostomy (PCN) is a commonly performed procedure that can be challenging for trainees who lack direct experience. We aim to utilize an ex vivo model to simulate hydronephrosis for PCN placement training with ultrasound and fluoroscopic guidance.

Materials and Methods: Twenty porcine kidneys were harvested from a local slaughterhouse with a segment of the ureter attached. A bovine shoulder steak was placed on top of each kidney to mimic retroperitoneal tissue and increase the difficulty of the procedure. After the ureter was cannulated with a 5-Fr sheath, saline was injected to dilate the collecting system and simulate hydronephrosis. Under supervision of an experienced IR physician, IR trainees and faculty attempted a PCN placement using ultrasound guidance followed by fluoroscopy guidance. An attempt was considered successful if the operator was able to puncture a calyx with a coaxial introducer system and insert an 8-Fr nephrostomy drain into the collecting system. The fluoroscopic time, radiation dose, total punctures, success (yes/no), and experience level of each operator were collected for each training session. Standard statistical analysis was performed to compare these variables by level of training and placement technique.

Results: All attempts for ultrasound guided (n=20) and fluoroscopy guided (n=20) placements were successful. IR trainee and faculty comparisons are summarized in Table 1. Average fluoroscopic time for ultrasound was 1.8 ± 0.9 minutes and 3.6 ± 2.7 minutes for fluoroscopy (p < 0.01). Average radiation dose for ultrasound was 1.8 ±1.1 mGy and 4.9 ± 4.1 mGy for fluoroscopy (p < 0.01). Average punctures using ultrasound were 2.2 ± 2.3 and 2.6 ± 2.6 for fluoroscopy (p > 0.01).

Conclusion: This PCN training model allows for a low-risk environment for IR trainees and faculty to practice procedural skills using ultrasound and fluoroscopy guidance.