Nephrostomy care is a crucial unit of healthcare institutions, which conduct renal surgeries and artificial filtrations for patients with severe kidney dysfunctions. Current advancements in technology allow healthcare centers to adopt and implement Electronic Health Record (EHR) system, which enables medical professionals to effectively treat people. Besides, data capture instruments in nephrostomy care units open up new opportunities for quick mass information gathering, such as health conditions, personal history, and potential risks (Karlsson et al., 2016).
Due to the availability of this technological support, nephrostomy care can effectively develop and schedule a strategic planning process. The given procedure involves outlining crucial tasks and setting both short-term and long-term goals.
In 1941, Rupel and Brown operated the first nephrostomy surgery and they used a cystoscope and nephrostomy tube. Previously, a highly similar procedure was used for renal dysfunctions, such as urostomy (Patel & Nakada, 2017). The key difference between these two kidney surgeries is that the latter is conducted on the distal part of the urinary tract. The main idea behind the nephrostomy process is producing an artificial pathway between urinary diversion instruments and renal tubes.
There are two methods of setting nephrostomy tubes and related instruments. In the first case, this is done during surgery, and in the second, with the help of a percutaneous puncture of the renal pelvis (Vargas-Cruz et al., 2017). In principle, the production of nephrostomy is exclusively medical manipulation, and the patient takes only passive participation in it. As a rule, nephrostomy is established for such pathological conditions as urolithiasis, ureteral tumors, or obstruction (Abdeljaleel et al., 2018).
At the same time, it can have both medical and diagnostic purposes. For example, in cases of purulent kidney diseases, nephrostomy is often performed to take the contents of the pelvis for analysis (Thakur, 2018). Nephrostomy setting takes a prolonged period. For example, if a patient is operated on for urolithiasis, his nephrostomy wearing period can last up to six months, during which it is necessary to carefully monitor and care for the tube (Ahmad et al., 2017). In the case of other pathologies, such as a partial obstruction of the ureter with callus, the period of wearing of the nephrostomy may not exceed one month.
However, during complicated situations, urologists try not to burden patients with a catheter and do not perform the procedure, replacing it with other, more benign treatment methods (Tan, Turba, & Deane, 2016). These medical drawbacks undergo a data capture process, where the intricate information is recorded. It allows an effortless collection of patient-specific knowledge for possible health assessments (O’Toole et al., 2018). Nephrostomy care units increase their productivity by applying the given approaches.
Taking care of the nephrostomy tube, regardless of the timing of the last installation, should always be as thorough as possible. The electronic health record is highly useful in classifying and categorizing patient background information for future precautions (Akhavizadegan, 2017). Also, not only the condition of the patient during treatment but also the timing of his final rehabilitation depends on proper time management.
These approaches are conducted through an EHR information base (Mehta, 2015). There are some simple rules for caring for nephrostomy: perfect and absolute cleanliness around the puncture wound, regular and frequent disposal of the urine, and constant kidney cleansing.
In any case, the injury, whatever it may be, is the source of infection in the human body; therefore, a puncture wound with nephrostomy is no exception (Sethi, Rhodes, Mato, & Hogan, 2017). To prevent the penetration of infection along this path, it is necessary to carefully and daily sterilize the puncture wound with antiseptic solutions and perform sterile dressings. Drugs, such as chlorhexidine or fumagillin solution, can be used as antiseptics (Austin & Rajkumar, 2017). Moreover, the patient is recommended to purchase a sterile bandage or gauze cut for home clothing.
Furthermore, it is highly important to conduct regular evacuations of the urinal sac. At its core, a nephrostomy is a tube through which urine enters a special reservoir, called a urinal (Ristolainen, Ross, Gavsin, Semjonov, & Kruusmaa, 2014). It is an ordinary plastic bag that has a hermetic clasp. On each of the urinals, there is a particular label that indicates the level of urine that requires replacing the urinal (Basiri, Shakiba, Hoshyar, Ansari, & Golshan, 2018). Failure to renew the reservoir threatens the patient with a return flow of urine into the cavity of the renal pelvis.
Consecutively, it can have a double adverse effect on the patient (Morizane & Lam, 2015). First, the increased pressure in the renal pelvis can affect the tightness of the surgical sutures. Secondly, the return of urine is always danger due to the high possibility of kidney infection (Batura & Gopal Rao, 2019). The given precautions are eliminated with data capturing and through planning instruments, which are in combination with EHR can lead to entirely safe procedures. The efficiency is improved through full automation of data assessment and analysis (Saleem & Herout, 2018). These combined methodologies advance the treatment process and disease prevention.
Additionally, it is crucial to frequently cleanse and clean the kidney tubes. As a rule, passive outflow through the nephrostomy is not always enough to ensure proper circulation in the pelvis (Chiancone et al., 2016). Therefore, in addition to nephrostomy, it is necessary to periodically apply active drainage. This process requires not only one but two tubes, which are installed into the cavity of the renal pelvis during puncture (Brandt et al., 2018). By actively feeding the antiseptic into one of the tubes, with the second one, it is possible to obtain a washing liquid containing stagnant urine with sand residues. The planning process is highly important in identifying the correct step-by-step procedure strategy.
There are some possible complications and drawbacks related to nephrostomy intervention. The first group of complications caused by the process itself, and it refers to the procedure of the production of this catheter (Chung, Briggs, Turney, & Tapping, 2016). For example, if percutaneous access is used to set up a nephrostomy, during the latter, the needle can damage the artery near the kidney. This will lead to serious hemorrhage in the retroperitoneal tissue and the formation of a peritoneal hematoma (Hadjipavlou, Tasleem, Santos, Smith, & Sriprasad, 2016). This clinical complication is dangerous, because the hematoma may not dissolve.
It can become infected, which will lead to inevitable surgical intervention in the retroperitoneal space (Chang, Chen, Jou, Li, & Chen, 2019). Also, due to the hematoma access to the renal pelvis is made, this may result in blood appearing in the urine. This may lead to an incorrect diagnosis and the appointment of the wrong treatment.
The second group of complications that may accompany nephrostomy is a kidney infection. Secondary postoperative pyelonephritis, which at the same time develops, has a very aggressive course and is poorly amenable to traditional antibacterial treatment (Cavallone et al., 2017).
To correct the pathology that has arisen, it is necessary to use powerful modern antibacterial agents that are not very cheap. This is why the given pathology should be prevented rather than applying the treatment, which is enabled by collecting information on EHR (Herout et al., 2018). Through an in-depth analysis of the patient’s personal health background information, he/she can avoid undergoing the mentioned medical interventions.
In conclusion, the conducted studies suggest that nephrostomy care at present can and should be applied in urological practice. The indications for it are significantly narrowed, which is natural in the conditions of the development of technical progress, which has not bypassed medicine. EHR, data capture, and strategic planning are among the most effective tools to promote better care. The given instruments will help and assist medical specialists in treating urine drainage issues of patients due to the currently developed technology, the improved technical features of the operation, and the advanced method for determining the recovery time for urine outflow after removal of nephrostomy tubes.
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