Transradial Catheterization in the Prone Position: A Technique that Simplifies Complex Post-procedural Renal Intervention for Patients Undergoing Renal Angiography for Nephrostomy-Related Hemorrhage

Excerpt

Percutaneous renal interventions, including percutaneous nephrostomy (PCN) or nephroureterostomy (PCNU) tube insertion, and percutaneous nephrolithotomy (PCNL), are common procedures that allow for minimally invasive therapy. Postoperative hemorrhage is a major potential complication. In patients who fail conservative management, transcatheter embolization has emerged as the treatment of choice [1]. If the initial angiogram does not demonstrate an active bleed (Fig. 1), the renal catheter must be repositioned for a repeat angiogram, as the tube may tamponade or obstruct visualization (Fig. 2) [2]. This procedure is started in the supine position for femoral artery access with the patient turned mid-procedure to access the indwelling catheter. Repositioning the patient while maintaining arterial access can be challenging and hazardous. Additionally, the femoral approach is associated with an increase in patient discomfort, difficulty with using the bathroom, difficulty feeding oneself or self-care, and difficulty with walking post-procedure. Also, the patient must be pronated after femoral vascular access is established. This may lead to catheter dislodgement and significant bleeding intra-procedure since the access site is not well visualized [3].

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