Essay on an Evaluation of the Infection Prevention and Control Procedures of Percutaneous

Published: 2021/11/04
Number of words: 3844


A Percutaneous nephrostomy is a surgical procedure that is done with an aim of draining urine from the kidney which may be blocked into a thin plastic bag that is usually outside the body. During the process a nephrostomy tube which is a flexible rubber tube is used to drain the urine (Flannigan et al., 2014, 340). During the process, a patient is made to lie down on their stomach on a table. To relax and reduce the pain that might be felt by a patient, lidocine is injected. (Hameed et al., 2018, 1). Patients with the condition can experience some difficulties such as incomplete kidney stone removal, bleeding and injuries to the kidney or other organs.

Nephrostomy tube can be used for long term or short term. Patients who have a nephrostomy tube already are given an aesthesia to make them fall asleep and experience no pain during the procedure. To allow healing, a stent is placed at the ureter to drain urine from the kidney (Panache-Navarrete et al., 2020, 230). Due to the presence of large kidney stones found in the ureter, the procedure is very effective as it is also applied where other medical procedures have failed. With the nephrostomy tube in place, a patient may have some problems like, urine leakage, small debris inside the tube and bladder spasm (Jou et al., 2006, 30). When there are some debris inside a nephrostomy tube, and there may be an indication of urinary tract infection. When a nephron tube is used inappropriately, or used for a long period, it can lead to urethral trauma and some other urinary tract related problems. Patients with the percutaneous nephrostomy condition should be well taken care of thus an effective and a standardized care should be accorded to them (Flannigan et al., 2014, 338).

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Ruttonjee Hospital is a government hospital based at Wan Chai Island in Hong Kong. The hospital has a palliative care unit where the researcher has been working at the palliative care unit. The unit experiences a high number of patients and it has an average occupancy of about 80 patients. In the unit, there are patients who have been inserted with nephrostomy tube where most of them will be using the tube for a long term. Once the doctor has access to the kidney stones, he or she will insert a sheath into the kidney and use a specific device to break up the stones. The doctor will remove the shards once they are small enough. The surgeon may leave drainage tubes in the kidney when the treatment is finished. Patients who may have used the tube for a long time, have negative influences and may make them have along stay in the hospital. This makes the patient have a poor quality of life. Percutaneous nephrostomy may lead to morbidity and mortality and thereof cause a huge impact to the health system thus increasing the financial procedures. It is important to have a good system that enhances the safety and the quality of life for patience with this kind of conditions. Having a reliable and a valid infection control and prevention procedure which is main guidance for the healthcare is very important. Health professionals who have the knowledge to take care of the patients with the Percutaneous nephrostomy is of great importance as the patients feel safe and at ease.

In the essay been written, the researcher will define Percutaneous nephrostomy and its possible problems in the context of infection control procedures. The researcher will also compare the local protocol to that of Singapore on prevention of percutaneous nephrostomy. They will also evaluate the local protocol for preventing the disease and provide recommendations that could be used locally to enhance the prevention and control of percutaneous nephrostomy (Panach-Navarrete et al., 2020, 230).

Healthcare-Associated Infections

When patient is admitted in hospitals been treated from other conditions, there is a possibility of them getting some infections from the hospitals. The health care associated infections can happen in any health care facility e.g.; the end stage renal disease facilities, hospital or even the ambulatory surgical centres. The health care infections are known to cause death and illnesses. These kinds of infections have very serious financial, emotional and medical consequences. There are patients who are a great risk of having infections than others. People with low or compromised immune systems are more likely to catch an infection. Other factor that can cause one to have an infection are; when a patient stays with the tube that is used to drain urine for a long time, failure of the health care providers to wash their hands during some procedures and long stays at the hospitals (Jou et al., 2006,32). There are some common infections that a patient is likely to get while in the hospitals. They may include; urinary tract infection, primary bloodstream infections, gastrointestinal infection and surgical site infection whereas it may be inconceivable to dispose of health care infections completely, healthcare facilities can altogether diminish the hazard of contracting them. Avoidance measures incorporate the start of reconnaissance programs and more proactive disease control. There is a high prevalence of health care infections in Singapore acute care hospitals with the rating being 45.5%.

Nephrostomy Tube -Associated Urinary Tract Infection

A nephrostomy tube is used when a patient has a blocked ureter or if there is a hole in the urinary tract. It is a thin catheter that is placed in the kidney to assist in the draining of urine. The blockage may be due to the kidney stones, a tumour or an infection (Jou et al., 2006,32) This causes the bladder to have a build-up of urine and the build-up causes a lot of pain, infection and inflammation. There is a risk of some infections on the tube if it is used for a long period of time. The nephrostomy tube is used to prevent infections and not to be a source of infections. To ensure that the tube stays clean and is well handled there are a few steps that a patient should always ensure are in place while handling the tube at home. The tube should be handled with clean hands. The area around the tube should be cleaned with soap and warm water every day and the patient should not swim or take baths when they have nephrostomy tubes on. The end of the nephrostomy tube should be wrapped with aplastic to avoid it having water. Before the bag can be completely full, it should be drained at least after every 2 to 3hours. A patient can have infections symptoms such as; blood in the urine, fever, pain in the edge which is sally below the rib cage, frequent urination and pain while urinating. A patient may also experience bleeding around the tube, have a leaking tube and failure of urine to be collected in the urine bag.

Risk Factors of Nephrostomy Tube

When nephrostomy tubes are inserted in patients, there is a high link of kidney infection. Urinary tract infections are mainly a significant risk factor for the kidney infection. This kind of infection requires quick medical attention. The symptoms that might be associated with the kidney infection include; vomiting, nausea and haematuria. Other risk factors consist of prolonged hospitalization, elderly, pregnant women, facially incontinence and immune compromised (Panach-Navarrete et al., 2020,230) The chance of complications is marginally low, with a 7% to 10% chance of minor complications and a 2% to 5% chance of major complications.

Local Protocol on Prevention of Percutaneous Nephrolithotomy in Hong Kong

Percutaneous renal surgery is considered one of the preeminent obvious propels interior the field of unimportantly meddlesome urologic techniques. Since the fundamental compelling launch of renal calculi by percutaneous nephrolithotomy PCNL is a technique that is predominant in applications such as resection of urolithelial tumors,drtaining of hydronephrotic kidneys and the endopyelotomy percutaneous nephrolithotomy(Bai et al., 2015,642).A convention on avoidance of (PCNL), gives a standardized. There are three standardized nursing rules that are commonly used that are related to nephrostomy care .The formation of a surgical percutaneous tract to get to the life structures of the pelvic-calyceal framework of the kidney was depicted by (Fernstrom and Johansson 1976) They begun with Percutaneous nephrostomy beneath locality anaesthesia, taken after by the dilatation of the tract serially over the following few days, with consequent stone evacuation beneath common anaesthesia employing a unbending 30° cystoscopy.

This cleared the approach to advancement & urological advances inside the strategy known as Percutaneous nephrolithotomy PCNL All healthcare masters ought to be taken after the rules in giving urethral catheter care and expecting nosocomial related urinary tract illness in my clinic. A well-trained understanding care collaborator is tried and true for purging the pee pack (Hameed et al., 2018, 1). The viable rules will be ordinarily looked into and revised each two a long time agreeing the overhauled proposals from Centres for Disease Control and prevention and other worldwide rules all patient care assistants are evaluated for proficiency level on nephrostomy tubes care by standard clinical reviews each year. They also perform every day cleansing meatal range agreeing the rule to advance meatal hygiene. Study appeared that schedule every day cleansing with water and cleanser is sufficient to preserve high meatal care.

Comparing the protocols of prevention between Hong Kong and Singapore

The Urological Affiliation of Hong Kong comprising of 25-part affiliations and one reinforcement parcel since its establishment in 1990, has organized to make Hong Kong rules for all urological locales. The committee people of the Urological Association of Asia on the clinical rules for urinary stone illness carried out a perception consider to predominant get it the varying qualities of the treatment stratagem among assorted locales (Taguchi et al., 2019, 708). The conventions of Hong Kong and Singapore with regard to shirking of PCNL were compared in subtle elements concurring to the recommendations from CDC. The similitudes and contrasts between the two zones were showed up as underneath.

Vital items of the protocolHong KongSingapore
Suitable for nephrostomy tubes
Suitable procedures for nephrostomy tubes
Suitable procedures for nephrostomy tubes care
Sample gathering
Offering Teaching and training
Appropriate safety of nephrostomy tubes
Having systems to remind
Removing the indwelling nephrostomy tube
Use of antibiotics before the procedure
Advise on the draining of the tube
Scrutiny resources
Establishment of strategies

Valuation on the Local Protocol for Preventing of PCNL


The local protocol serves as a viable direction to encourage healthcare providers in prevention of PCNL.The protocol focuses on guidelines and recommendations that are considered international on the prevention of pcnl. It puts more emphasis on hand cleanliness and on the maintenances of aseptic procedures methods during nephrostomy tube handling (Tirtayasa et al., 2017, 420). A nurse screens your blood weight, breathing, and heart rate whereas the interventional radiologist completes the method. They make a cut in your skin and utilize a needle to bolster the direct wire and catheter tube through. The approach strictly focuses on proper hygiene when inserting the tubes as it very important in the prevention of the infection. The protocol too gives points of interest on nephrostomy tube procedure as reference for healthcare experts. Other than, it profoundly prescribed to properly securement the indwelled nephrostomy tube on particular area such skin to anticipate visit development and urethral harm as well as nephrostomy tube dislodgement. Taking care of the nephrostomy tube is of very great importance. The bag and the tube should always be clean to avid infections. In the event that the patient may be a repetitive stone previous, at that point stone analysis, serum (ionized) calcium, phosphorus, uric corrosive, magnesium, as well as urinary calcium, phosphate, uric corrosive, magnesium, citrates and cysteine levels are examined at slightest once.

Moreover, the local protocol will be looked into and re-examined each two years based on the upgraded suggestion of worldwide rules to keep all the updated informationand to supply a more dependable and approved direction to healthcare professionals in avoidance of PCNL (Beiko et al., 2020,102). On the other hand, it especially offers suggestions on bladder water system in focuses of intrigued which it isn’t endorsed by communicable illness unless impediment happens, though it is as it were briefly said in Ireland’s convention. A small flexible telescope is placed in the urethra through a process known as cystoscopy. The process takes a few minutes to perform it.Through the research, it was found that momentary ceaseless bladder water system with standard saline after transurethral resection of bladder tumour can diminish the frequency of first repeat of non-muscle-invasive bladder cancer. Final but not the least, the nearby protocol particularly provides recommendation of utilizing versatile bladder ultrasound scanner which did not say neither in CDC nor Singapore conventions. The volume of urine is mostly monitored by the use of the versatile ultra sound scanner. This is usually used on patients that are having intense maintenance of urine. It diminishes the risks of use of nephrostomy tubes and the hazard of PCNL.


In spite of the fact that the show conventions contain of most of the things suggested by centres for malady control and anticipation. A couple of the things may require encourage subtle components and elaboration in organize to form it more completed and viable for healthcare specialists to require after and execute. Firstly, the current update framework isn’t clear adequate to educate staff the need of evacuation of the nephrostomy tube. Patients and their caregivers inevitably may bewilder or baffle around the care of the nephrostomy tube (Beiko et al., 2020, 102). Some bloods misfortune will happen with this strategy but once patients require a blood transfusion. In an event where one has some questions on the issues regarding blood transfusion, it is important to ask the health care provider about it.When the parcel of information is sent to you with respect to your surgery, you may moreover get an authorization shape for you to require to the Ruddy Cross. You must facilitate this with the Ruddy Cross in your zone. Though exceptional, possible damage to encompassing tissue/organs counting bowel, vascular structures, spleen, liver, lung, pancreas and gallbladder may require advance surgery. Misfortune of kidney work is uncommon but could be a potential risk. Scar tissue may moreover frame within the kidney or ureter requiring advance surgery. To improve the self-care adequacy, it is important to have a tailor made health care programme that is specially designed for one to have an understanding on the long term urinary nephrostomy as this promotes the quality of life one has.

Recommendations to Enhance Prevention of PCNL in Local Settings

In spite of the fact that the current protocol and practice in the setting are comprehensive and viable in prevention of PCNL A few proposals are recommended so as to improve the management in avoidance of PCNL. First the use of nephrostomy tubes should be reduced to diminish the rate of infections. There should be a reminder system (Schoenthaler et al., 2015,1602). A reminder system when used effectively should reduce the rate of PCNL. With the use of the reminder, care givers can be constantly be reminded to monitor and review the use of nephrostomy tubes. The duration in which the nephrostomy tubes are used should be reduced to avoid infection to the patients. Treatment of nephrolithiasis includes crisis management of renal (ureteral) colic, counting surgical mediations where demonstrated, and therapeutic treatment for stone infection. It has also been noted that the longer the tube is used, the higher the chances are there to have infections. The use of an external bundle device can significantly reduce the use of the tubes. This in return will reduce the duration in which the patient stays with the nephrostomy tube.

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In crisis settings where concern exists around conceivable renal failure, the centre of treatment ought to be on rectifying lack of hydration, treating urinary infections, avoiding scarring, distinguishing patients with a single useful kidney, and decreasing dangers of intense kidney damage from differentiate nephrotoxicity, especially in patients with pre-existing azotemic. PCNL in solitary kidneys is secure with an satisfactory complication rate if performed in a high volume centre. Results are great, in spite of the fact that assistant strategies may be vital. Renal function remains steady or moves forward after strategy. There may likely a variety of elective gadget other than urinary catheter. We ought to search for upgraded universal rules or practices for any other effective ways to bargain with the circumstance instead of fair keep utilizing nephrostomy tubes as the only way to lighten the corresponding problems. Final but not the slightest, a few of patients 10 may got to utilize the urinary catheter for a long period of time. It is imperative to have an effective and practical data instructive program for quiet and critical care-givers on long-term nephrostomy tubes care (De La Rosette et al., 2012,253). We ought to exceedingly consider giving a tailor-made instruction program for patients with long-term nephrostomy tubes to improve self-care and problem-solving technique to anticipate PCNL and advance way better quality of life.


Health care infection can cause a lot of risks to the health of a human. With the increased use of the nephrostomy tubes, the health of many people especially those that have prolonged use of the devise is at risk. The long stays in the hospitals, poor quality of life and dreariness are but just a few factors that can cause the health care infections. Good and exceptional care should be given to patients with nephrostomy condition. The nephrostomy tube should always be in a very safe and clean condition to prevent infections to the patients. Nephrostomy tube situation is frequently imperative to avoid seriously renal disappointment in patients with cancer with obstructive uropathy or in patients with ureteral leak. Be that because it may, there have been confined conveyed ponders on the rate and chance of nephrostomy tube related pyelonephritis in patients with cancer. Thus, in this consider we chosen rates of nephrostomy tube related pyelonephritis and slanting risk factors in patients with cancer. Consequently, it is uncommonly crucial to healthcare experts to urge it roughly the microbial etiology, danger components, pathogenesis and the chain of malady of PCNL. A significant and strong contamination control and anticipation protocol plays a basic part to supply a transcendent direction for health care experts in prevention of PCNL. There should be frequent check to the protocol to ensure that there is improvements to the adequacy of prevention and control of PCNL. This would mean an improved life to the patients with the nephrostomy tubes.

Reference list

Bai, Y., Wang, X., Li, X., Pu, C., Yuan, H., Tang, Y., Li, J., Wei, Q. and Han, P., 2015. Management of catheter-related bladder discomfort in patients who underwent elective surgery. Journal of endourology29(6), pp.640-649.

Beiko, D., Razvi, H., Bhojani, N., Bjazevic, J., Bayne, D.B., Tzou, D.T., Stoller, M.L. and Chi, T., 2020. Techniques–Ultrasound-guided percutaneous nephrolithotomy: How we do it. Canadian Urological Association Journal14(3), p.E104.

De La Rosette, J.J., Opondo, D., Daels, F.P., Giusti, G., Serrano, A., Kandasami, S.V., Wolf Jr, J.S., Grabe, M., Gravas, S. and Croes Pcnl Study Group, 2012. Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. European urology62(2), pp.246-255.

Flannigan, R., Choy, W.H., Chew, B. and Lange, D., 2014. Renal struvite stones—pathogenesis, microbiology, and management strategies. Nature reviews Urology11(6), pp.333-341.

Hameed, B.M., Chawla, A., Hegde, P., Odugoudar, A. and Vasa, T., 2018. Safety and Viability of Totally Tubeless Ambulatory Percutaneous Nephrolithotomy (APCNL) in the Fast Paced World. The Open Urology & Nephrology Journal11(1).

Jou, Y.C., Cheng, M.C., Lin, C.T., Chen, P.C. and Shen, J.H., 2006. Nephrostomy tube-free percutaneous nephrolithotomy for patients with large stones and staghorn stones. Urology67(1), pp.30-34.

Panach-Navarrete, J., Tonazzi-Zorrilla, R. and Martínez-Jabaloyas, J.M., 2020. Dislodgement in long-term patients with nephrostomy tube: Risk factors and comparative analysis between two catheter designs. Journal of endourology34(2), pp.227-232.

Schoenthaler, M., Wilhelm, K., Hein, S., Adams, F., Schlager, D., Wetterauer, U., Hawizy, A., Bourdoumis, A., Desai, J. and Miernik, A., 2015. Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of treatment costs (endoscopes and disposables) in patients with renal stones 10–20 mm. World journal of urology33(10), pp.1601-1605.

Taguchi, K., Cho, S.Y., Ng, A.C., Usawachintachit, M., Tan, Y.K., Deng, Y.L., Shen, C.H., Gyawali, P., Alenezi, H., Basiri, A. and Bou, S., 2019. The Urological Association of Asia clinical guideline for urinary stone disease. International Journal of Urology26(7), pp.688-709.

Tirtayasa, P.M.W., Yuri, P., Birowo, P. and Rasyid, N., 2017. Safety of tubeless or totally tubeless drainage and nephrostomy tube as a drainage following percutaneous nephrolithotomy: A comprehensive review. Asian journal of surgery40(6), pp.419-423.

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