ABSTRACT
A 25-gauge needle is advanced into the renal pelvis with ultrasound guidance. Ten to
30 cc of CO2 are injected, which always initially fills the posterior calyces. Using
fluoroscopic guidance, an 18-gauge blunt needle (or any needle) is steered into the
calyx, the blunt stylus is removed, and a 0.035-in guidewire is placed. This system has
proven to be extremely easy, with a 100% success rate, even in nondilated systems. In
over 300 nephrostomies, we have experienced only one bleeding complication, which
did not require intervention.
