chapter  22
8 Pages

CO2 Guided Percutaneous Nephrostomies Including the Blunt Needle Technique

WithIrvin F. Hawkins

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.