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PERKÜTAN NEFROSTOMİ SETLERİ. ÜRİNER SİSTEMDE İDRAR AKIŞINDA MEYDANA GELEBİLECEK SORUNLAR Pelvis Tümörür Stenosis, Kinking Üreter taşı Pelvik Taşlar Bası.

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... konulu sunumlar: "PERKÜTAN NEFROSTOMİ SETLERİ. ÜRİNER SİSTEMDE İDRAR AKIŞINDA MEYDANA GELEBİLECEK SORUNLAR Pelvis Tümörür Stenosis, Kinking Üreter taşı Pelvik Taşlar Bası."— Sunum transkripti:

1 PERKÜTAN NEFROSTOMİ SETLERİ

2 ÜRİNER SİSTEMDE İDRAR AKIŞINDA MEYDANA GELEBİLECEK SORUNLAR Pelvis Tümörür Stenosis, Kinking Üreter taşı Pelvik Taşlar Bası ( Tumour ) Mesane Tümörü Endoüroloji Nefrostomi

3 Tanımı: Böbreğin pelvis bölgesine delici bir sistemle giriş yapmak veya ameliyat amaçlı hazırlık yapmak (PNL) Giriş her zaman mümkün olan en kısa mesafeden yapılmalıdır. Endoüroloji Nefrostomi

4 Perkütan Nefrostomi Endikasyonları: •Endoscopik ameliyat öncesi giriş böbreği rahatlatmak için. •Üreterdeki sorunlardan dolayı idrar dranajı olmuyorsa (Taş, Üreter yaralanmaları, genleşme, tumör). •Böbreği rahatlamak için retrograd girişin mümkün olmadığı durumlarda. Endoüroloji Perkütan Nefrostomi

5 • İşlem basamakları –Giriş •Görüntülem sistemi ile yapılır –Ultrasound –Floroskopi –Dilatasyon •Dilatatorler yardımı ile kateter yerleştrmek için yeterli genişliğe dilate edilir –Kateter yerleştirme •Hekim tercihine göre tercih edilen kateter yerleştirilir ve idrar drenajı yapılır. Endoüroloji Perkütan Nefrostomi

6 Endoüroloji Nefrostomi • Superglide PCN SETİ 2 Step –Dilatasyonsuz Perkütan Nefrostomi Seti –İşlem basamaklarından dilatasyon yapılmadan yapılan kateter yerleştirilir • 3 step PCN Seti –Dilatasyonlu Perkütan Nefrostomi Seti –İşlem bütün basamakları gerçekleştirilerek yapılır ve kateter yerleştirilir

7 Endoüroloji Nefrostomi Superglide PCN Seti 2 Step • Giriş İğnesi (Punture Neddle) –17.5 G kalınlığında –20 cm (6 FR sette 12 cm) uzunluğunda –Kesik uçlu (Beweled Tip) –İki parçadan oluşur –Ultrasoundla giriş esnasında optimum görülebilirliği ve giriş kontrolünü sağlamak için uç kısmıdaki 3 adet halka ekojenik özellik sağlar –Bu şekilde ultrasounda en uygun görünürlük sağlanmış olur

8 Endoüroloji Nefrostomi Superglide PCN Seti 2 Step • Klavuz Tel (Guide-wire) –80 cm uzunluğundadır. –Gövdesi “stiff” sertdir. –Uç kısmı “Curves veya kıvrık” uçludur. Giriş esnasında böbreğe zarar vermesini engellemek için. –“Uncoated” denilen kaplaması olmayan klavuz teldir.

9 Endoüroloji Nefrostomi Superglide PCN Seti 2 Step • Kateter Düzleştirici –Ürün kateterle beraber sunulmakda. İçi boş metal kılıf ve içinde de naylon mandren bulunur. –Giriş yapıldıkdan sonra klavuz telin üzerinden kateter düzleştirici ve kateterle beraber böbreğe yerleştirlir. Çıkarılması ile beraber kateter böbrek için loop şeklini alır. –Kateter böylece iki aşamada dilatasyona gerek olmadan yerleştirlir.

10 Endoüroloji Nefrostomi Superglide PCN Seti 2 Step • Nefrostomi Kateteri –Yüksek kalitede “Poliüretan”dan üretilmiştir. –Radyopak özelliktedir. –Kateterde çökme görülmez (Kink) –”Dış yüzeyi Hidrofilik özelliğe sahiptir. –Kateterin kolayca dokulardan geçmesini sağlayıp kolay yerleştirilmesini sağlar. –Hidrofilik özellik konnektör kısmındaki yeşil marker ile belirtilmiştir. –Konnektör katetere sıkıca bağlanmıştır. (Diğer ürünlerde konekketör daha sonradan takılır)

11 Endoüroloji Nefrostomi Superglide PCN Seti 2 Step • Nefrostomi Kateteri –Kateterin üzerindeki çentikler, tesbit esnasında kullanılması esnasında kateteri hareket etmesini büyük ölçüde engeller –6 FR kalınlığındaki pediatric kateterde bu çentikler tüm gövde boyunca bulunur. Çocuklarda böbrek ve hastanın gövdesi arasında 2 cm civarında bir mesafe bulunur.

12 Endoüroloji Nefrostomi Superglide PCN Seti 2 Step • Nefrostomi Kateteri –Stopcock drenajı kontrol etmek istenirse katetere opsiyonel olarak takılabilir –İdrar torbası adaptörü kateteri idrar torbasına bağlamak için kullanılır

13 Endoüroloji Nefrostomi Superglide PCN Seti 2 Step • Ürün üzerinde 3 adet dokümantasyon amaçlı kullanılan sticker bulunmaktatır

14 • Ürün 3 farklı boyda üretilmiştir –Pediatrik 6 FR –Erişkin 8-10 FR • Çalışılacak klinikler –Üroloji –Radyoloji •Girişimsel Radyoloji Endoüroloji Nefrostomi Superglide PCN Seti 2 Step

15 Endoüroloji Nefrostomi 3 Step PCN Seti • Giriş İğnesi (Punture Neddle) –17.5 G kalınlığında –20 cm (6 FR sette 12 cm) uzunluğunda –Kesik uçlu (Beweled Tip) –Üç parçadan oluşur –Ultrasoundla giriş esnasında optimum görülebilirliği ve giriş kontrolünü sağlamak için uç kısmıdaki 3 adet halka ekojenik özellik sağlar –Bu şekilde ultrasounda en uygun görünürlük sağlanmış olur

16 Endoüroloji Nefrostomi 3 Step PCN Seti • Klavuz Tel (Guide-wire) –O.035” kalınlığında –80 cm uzunluğundadır. –Gövdesi “stiff” sertdir. –Uç kısmı “Curves veya kıvrık” uçludur. Giriş esnasında böbreğe zarar vermesini engellemek için. –“Uncoated” denilen kaplaması olmayan klavuz teldir.

17 Endoüroloji Nefrostomi 3 Step PCN Seti • Dilatator –İç içe geçen iki parçadan oluşan “Peel-away” yırtılabilir dilatator, –Dış kalınlık yerleştirilecek olan kateterden 1 FR fazla, iç kısım ise kateterle aynı kalınlıktadır. –Dilatasyn için bu iki parçe beraber yerleştirilir. Daha sonra iç kısım çıkartılır. –Kalan diğer dilatator parçası sayesinde kateter dokulara temas etmeden ve dokunun daralma riski olmadan yerleştirilir.

18 Endoüroloji Nefrostomi 3 Step PCN seti • Nefrostomi Kateteri –Yüksek kalitede “Poliüretan”dan üretilmiştir. –Radyopak özelliktedir. –Kateterde çökme görülmez (Kink) –Üzerinde turuncu renkli kateter düzleştirici bulunur. –Konnektör katetere sıkıca bağlanmıştır. (Diğer ürünlerde konekketör daha sonradan takılır)

19 Endoüroloji Nefrostomi 3 Step PCN Seti • Nefrostomi Kateteri –Kateterin üzerindeki çentikler, tesbit esnasında kullanılması esnasında kateteri hareket etmesini büyük ölçüde engeller –6 FR kalınlığındaki pediatric kateterde bu çentikler tüm gövde boyunca bulunur. Çocuklarda böbrek ve hastanın gövdesi arasında 2 cm civarında bir mesafe bulunur.

20 Endoüroloji Nefrostom 3 Step PCN Seti • Nefrostomi Kateteri –Stopcock drenajı kontrol etmek istenirse katetere opsiyonel olarak takılabilir –İdrar torbası adaptörü kateteri idrar torbasına bağlamak için kullanılır

21 Endourology Percutaneous nephrostomy Three Step Technique - step by step - ( FIRST STEP ) The puncture with the three parts needle, ( 17.5 G / 1.3 mm, approx. 200 mm long ) with marked tip for a better visibility - take out of the inner needle stylet - application of the guide wire, 0.035“,800mm, safety J - tip, PTFE coated - take out of the puncture cannula - ( Second step ) Insertion of the two part dialator - Take out of the inner part of dilator ( the outer sheath of dialator is in situ ) - Take out of the guide wire

22 Endourology Percutaneous nephrostomy Three Step Technique - step by step: - ( Third step ) Application of the catheter through the outer dilator sheath into the renal pelvis ! The catheter must be prepared bevore the insertion. The pig tail tip is embroiled into the orange straightener. Then the catheter can be insert into the renal pelvis. - take out of the outer dilator sheath with the straightener - Safeguarding of the catheter with a suture - Connection of the adapter for urin bag to nephrostomy catheter and connection of urin bag - Bandaging of puntcure site

23 Endourology Percutaneous nephrostomy Instruments for three step technique: Ref: Puncture set, Ch. 6 ( Latex free ) - Three part puncture needle, 17.5G/1.3 mm, 200 mm, marked tip ( 3 rings ) - Guide wire, 0.035“, 800mm, safety J - tip, PTFE coated - Two part dilator, 18 cm long, approx. O.D. of outer sheath 8 Ch./Fr., approx. O.D. of inner dilator 6 Ch./Fr., - Nephrostomy catheter made of PU, Ch./Fr. 6, 50 cm long, x - ray, pigtail end, open tip, 6 eyes, with straightener - - Two way stopcock - Adapter for urin bag

24 Endourology Percutaneous nephrostomy Instruments for three step technique: Ref: Puncture set, Ch. 8 ( Latex free ) - Three part puncture needle, 17.5G/1.3 mm, 200 mm, marked tip ( 3 rings ) - Guide wire, 0.035“, 800mm, safety J - tip, PTFE coated - Two part dilator, 18 cm long, approx. O.D. of outer sheath 10 Ch./Fr., approx. O.D. of inner dilator 8 Ch./Fr., - Nephrostomy catheter made of PU, Ch./Fr. 8, 50 cm long, x - ray, pigtail end, open tip, 6 eyes, with straightener - Two way stopcock - Adapter for urin bag

25 Endourology Percutaneous nephrostomy Advantages of our Two- and Three step techniques: - Due to the notches at the shaft, the catheter always stays in the correct position - Very long and good experiances - Very good biocompatibility of materials - Very good visibility of puncture needle tip - Very good material quality. No shaft breaks. No kinks at the shaft. - Easy to use

26 Endourology SUPERGLIDE PCN 2 Step Our competitors: Bard / Angiomed - Very large range in 1-, 2-, und 3- Step technique ( more than 45 Ref.No. ) - Catheters in Ch. 6 / 7 / 8 / 9 and 10 are deliverable - Puncture cannulae with MS tip ( good visibility in ultra sound ) - Very strong competitor - No hydrogel coated catheters in the program !

27 Endourology SUPERGLIDE PCN 2 Step Our competitors Boston Scientific / Microvasive - Different products in Ch Pigtails with lock-system - Very good market position in some countries ( Scandinavia, Italy ) - No hydrogel coated catheters in the program !

28 Endourology SUPERGLIDE PCN 2 Step Our competitors: Cook - Different catheters in Ch Very large range - Pigtails with lock-system - Very good market position in some countries ( Scandinavia, Italy ) - No hydrogel coated catheters in the program !

29 Endourology SUPERGLIDE PCN 2 Step Our competitors: Porges - Sufficient Program - Puncture sets in Ch deliverable - No hydrogel coated catheters in the program !

30 Endourology Further new products Puncture cannulae As a replacement for the puncture set Ref , following products are proposed: Ref Three part puncture cannula with marked tip ( three rings ) 120 mm long/ 17,5 G, max. I.D. 0,038”, Qty = 5 pieces List price ( gross ): 29,40 EUR / 1 piece Ref Two part fine puncture cannula, 200 mm long / 23 G, Compatible to , Qty = 5 pieces, List price ( gross ): 19,10 EUR / 1 piece The puncture set, Ref , is not available any more

31 Puncture cannulae As a replacement for the puncture set Ref., following products are proposed Ref Three part puncture cannula with marked tip ( three rings ) 200 mm long / 17,5 G, max. I.D. 0,038”, Qty = 5 pieces List price ( gross ): 28,10 EUR / 1 piece Art.Nr Two part fine puncture cannula, 280 mm long / 23 G, Compatible to , Qty = 5 pieces, List price ( gross ): 17,65 EUR / 1 piece Important note: Our old puncture sets, Ref , will be deleted as soon as possible. Endourology Further new products

32 Competitors: - All suppliers of nephrostomy puncture sets - Angiomed with MS tip ( visibility ) Our advantage: Marking rings !!! Endourology Puncture cannulae

33 Endourology Further new products Ref SUPERGLIDE Nephrostomy balloon catheter, 24 cm long, Ch. / Fr , Qty = 5, List price ( gross ): 28,99 EUR / 1 piece Ref SUPERGLIDE Nephrostomy balloon catheter, 41 cm long, Ch. / Fr , Qty = 5, List price ( gross ): 29,64 EUR / 1 piece - Hydrogel coated over 5 cm of the length It means less traumatic and easier application - with a hollow stylet, central open, max. I.D. 0,038“ Note When changing a catheter, we recommend using a ENDOGUIDE guide wire with a straight safety tip with a maximum diameter of 0.038" that is at least twice as long as the catheter to be exchanged.

34 Endourology Further new products SUPERGLIDE Nephrostomy balloon catheters Description SUPERGLIDE nephrostomy balloon catheters are double-lumen balloon catheters made of silicone with a centrally open tip, coated with Hydrogel over a length of approx. 5 cm. SUPERGLIDE nephrostomy balloon catheters are supplied with a hollow stylet and can be inserted or changed over a guide wire with a maximum diameter of 0.038". They are available in two different lengths, approx. 24 and 41 cm, and in Ch./Fr. 12 – 24. Balloon fill volumes and size are indicated on the funnel of each individual catheter. SUPERGLIDE nephrostomy balloon catheters are graduated in centimetres and have a radiopaque tip. Indications Rüsch nephrostomy catheters are indicated for the routine percutaneous drainage of the kidney. Contraindications Uncorrected or uncorrectable coagulative disorders and renal tuberculosis are some of the known contraindications for this procedure. The suitability of each patient must be individually assessed by a physician or other suitably qualified medical personnel.

35 Endourology Further new products SUPERGLIDE Nephrostomy balloon catheters Preparation for Use Clean and disinfect the area around the catheter using normal established techniques. Remove the catheter and other items from the packaging using aseptic technique. Directions for Use When using catheters with a central opening, a guide wire is placed in the renal pelvis, e.g. through the in situ nephroscope. Remove the nephroscope. Immediately before insertion, about 5 cm of the catheter tip is dipped into a container of 0.9% saline solution or distilled water to activate the Hydrogel coating. After approx. 30 seconds, check that the balloon is intact using the maximum permitted filling volume. Push the catheter over the guide wire until the catheter is in the desired position in the renal pelvis. Confirm placement of the catheter using normal radiographic technique. If the catheter has a balloon, inflate it to fix the catheter in the renal pelvis. A Luer syringe or, for some products, a Luer-Lock syringe may be used to inflate the balloon. Inflate the balloon with sterile water. The capacity of the balloon is indicated on the funnel of the catheter or on the label of the packaging. Do not overinflate. Note We recommend checking the volume of fluid in the balloon every 7-10 days and correcting it if necessary. To do this, deflate the balloon completely with a syringe without displacing the catheter, and fill it again with the maximum permitted volume.

36 Endourology Further new products SUPERGLIDE Nephrostomy balloon catheters Remove the guide wire, if used. The catheter may be secured to the skin by one or more sutures around the proximal catheter shaft or with a tape. A dressing should be applied to the puncture site in normal fashion. To change a catheter with a central opening, the guide wire is first pushed through the indwelling catheter until the tip of the guide wire is in the renal pelvis. Note When changing a catheter, we recommend using a guide wire with a straight safety tip with a maximum diameter of 0.038" that is at least twice as long as the catheter to be exchanged. In the case of balloon catheters, the balloon must be deflated before the catheter is removed. Depending on the product, either a Luer tip or Luer-Lock syringe is used to deflate. Aspirate the syringe gently to remove the inflation fluid. Do not use excessive aspiration on the syringe during deflation as this may cause a vacuum collapse of the inflation lumen which may impair normal drainage. The old catheter is slowly removed and discarded. The new catheter is advanced over the guide wire. Fill the balloon with sterile water only. Potential Complications Infection and irritation are some of the complications known to be associated with catheter placement in the upper urinary tract.

37 Endourology Percutaneous nephrostomy Competitors: - BARD Angiomed ( very wide range of puncture sets ) - Microvasive (very wide range of puncture sets, locking loop system on the pigtail ) - Cook (very wide range of pucture sets, locking loop system on the pigtail ) - Porges ( adequate range ) - B. Braun ( small range, not in the focus )

38 Endourology Percutaneous nephrostomy Other instruments for percutaneous nephrostomy Fascial dilations set: Ref Ch./Fr. 9( 54 cm long ), I.D. 1 mm / 0.039“, to use as guide for next dilators Ch./Fr. 12/15/17/19/21/23/25/27/29 ( 36 cm long ) made of PU, Qty = 1 Ref Exchange dilators, Ch , Qty = 10

39 Endourology Percutaneous nephrostomy Application of set Ref. : After the puncture and the application of guide wire ( max. 0,038", stiff, flexible J-end ) the doctor start the dilation with the 9 Ch. instrument ( 54 cm long ). This instrument left in the channel as guide for other dilators. All other dilators ( these are 36 cm long ) have an I.D. in approx. 3.0 mm and are prepared to be pushed over this first dilator, but one after the other.

40 Endourology Percutaneous nephrostomy Other instruments for percutaneous nephrostomy Fascial dilations set: Ref Ch./Fr. 6/8/10/12/14 ( gray )/16/18/20/22/24/26/28, approx. 32 cm long, made of PU, To use with max “ guide wire ! Ref Exchage dilators, Ch./Fr. 6-36, Qty=5

41 Endourology Percutaneous nephrostomy Application of set Ref : After the puncture and the application of guide wire ( max. 0,038", stiff, flexible J-end ) the doctor can start with the dilation, one dilator after the other. The I.D. of all dilators, Ch , approx. 32 cm long, are prepared for max. 0,038" guide wires.

42 Endourology Percutaneous nephrostomy Other instruments for percutaneous nephrostomy: Renax tubes - Ref.: , I.D. Ch , 16 cm long After the dilation the doctor can use Renax tubes ( Amplatz ) to safe the dilated channel and to use a nephroscope.

43 Endourology Percutaneous nephrostomy Other instruments for percutaneous nephrostomy Balloon catheters for nephrostomy, with hollow stylet: Ref: Ch./Fr , 24 cm long, made of silicone Ref: Ch./Fr , 41 cm long, made of silicone Special features: - Application over a stiff guide wire 0.038“,, possible, ( The optimum change with a stiff guide wire, with flexible - straight tip ) - Very Flat balloon - Very good biocompatibility - X-ray tip - Easy tu use becuase of hollow stylet - Wide range

44 Endourology Percutaneous nephrostomy Other instruments for percutaneous nephrostomy Balloon catheters for nephrostomy: Ref: Ch./Fr , 45 cm long, made of silicone, with detachable funnel, for application through the shaft of nephroscopes !!! Ref: Exchange catheter, Ch./Fr , 45 cm long, made of silicone, not detachable funnel !!! Special features: - Application through the shaft of nephroscopes possible ( Ref: ) - Very Flat balloon - Very good biocompatibility - X-ray tip - Wide range

45 Endourology Percutaneous nephrostomy Other instruments for percutaneous nephrostomy Nephostomy catheter for postoperative drainage ( after plastic surgery at the pelvis of the kidney ): Ref: Renal fistula catheter, Ch./Fr , made of silicone, w/o balloon, with funnel, open tip, 1 eye, 40 cm long.

46 Endourology Percutaneous nephrostomy Other instruments for percutaneous nephrostomy Special nephrostomy catheters for intraoperative application ( for postoperative drainage of the pelvis and ureter ): Ref: Nephrostomy catheters w/o balloon, with ureteral stent, 2 eyes, catheter 40 cm long, stent approx. 35 cm long, Sizes ( Ch.Fr. ) - 12x4/14x5/16x6/16x8/18x8/20x8/22x8, made of silicone, Qty = 5 Ref Nephrostomy catheter with flat balloon, X-ray tip, with ureteral stent, 2 eyes, catheter 40 cm long, stent approx. 35 cm long, Sizes ( Ch.Fr. ) - 12x4/14x5/16x6/16x8/18x8/20x8/22x8/24x8, made of silicone, Qty = 1

47 Endourology The customers don't use any unknown instruments. The medical staff in the hospital must be informed exactly about the function of our instruments. I thank you for your attention and wish you much success !


"PERKÜTAN NEFROSTOMİ SETLERİ. ÜRİNER SİSTEMDE İDRAR AKIŞINDA MEYDANA GELEBİLECEK SORUNLAR Pelvis Tümörür Stenosis, Kinking Üreter taşı Pelvik Taşlar Bası." indir ppt

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