Complications of percutaneous nephrostomy in a district general hospital

Özet

Objective: Percutaneous nephrostomy (PCN) is one of the commonest procedures performed. There arecurrently no European recommendations on the accepted rate of complications. The aim of the present studyis to report the complication rate of PCN with the specific emphasis on sepsis and septic shock, the causativeorganisms, sensitivities to antibiotics, and associated risk factors.Material and methods: Retrospectively collected data on patients undergoing acute or elective PCN atthe Department of Radiology, Countess of Chester Hospital (COCH), in the UK between January 2014 andDecember 2016 were analyzed after the study was approved by Local Audit Department at COCH.Results: A total of 66 patients underwent 90 acute or elective PCNs. Three patients developed major post-PCNcomplication (two patients developed septic shock and the third suffered a hemorrhagic episode requiringblood transfusion). Nephrostomy tube complications (blockage, leaking, fracturing and kinking of the catheter)occurred in 4 patients. Complications were more common when the PCN was performed out of working hours(71.4% [10/14], and 17.3% [9/52] for PCNs performed within, and out of working hours, respectively: p<0.001).The age of the patients did not seem to correlate with the development of complications (p<0.001). Of all 25patients, in whom septicemia was diagnosed prior to PCN tube insertion, 12 developed septic shock and 13 hadsigns of sepsis for longer than 24 h. Fifteen patients had positive urine cultures. The most common organismisolated was Escherichia coli. Blood culture isolates included: Escherichia coli, Eggerthella lenta, Enterococcus, Proteus mirabilis, Pseudomonas aeruginosa and Streptococcus pneumonia.Conclusion: Our complication rates were within United States proposed target ranges. Our data may helpto serve as a baseline for outcome targets in the European centres.