PERK

1
PERKÜTAN NEFROSTOMI SETLERI
2
Endoüroloji Nefrostomi
ÜRINER SISTEMDE IDRAR AKISINDA MEYDANA
GELEBILECEK SORUNLAR
Pelvis Tümörür Stenosis, Kinking Üreter tasi
Pelvik Taslar Basi ( Tumour ) Mesane Tümörü
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Endoüroloji Nefrostomi
Tanimi Böbregin pelvis bölgesine delici bir
sistemle giris yapmak veya ameliyat amaçli
hazirlik yapmak (PNL) Giris her zaman mümkün
olan en kisa mesafeden yapilmalidir.
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Endoüroloji Perkütan Nefrostomi

• Perkütan Nefrostomi Endikasyonlari
• Endoscopik ameliyat öncesi giris böbregi
  rahatlatmak için.
• Üreterdeki sorunlardan dolayi idrar dranaji
  olmuyorsa (Tas, Üreter yaralanmalari, genlesme,
  tumör).
• Böbregi rahatlamak için retrograd girisin mümkün
  olmadigi durumlarda.

5
EndoürolojiPerkütan Nefrostomi

• Islem basamaklari
• Giris
• Görüntülem sistemi ile yapilir
• Ultrasound
• Floroskopi
• Dilatasyon
• Dilatatorler yardimi ile kateter yerlestrmek için
  yeterli genislige dilate edilir
• Kateter yerlestirme
• Hekim tercihine göre tercih edilen kateter
  yerlestirilir ve idrar drenaji yapilir.

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EndoürolojiNefrostomi

• Superglide PCN SETI 2 Step 340012
• Dilatasyonsuz Perkütan Nefrostomi Seti
• Islem basamaklarindan dilatasyon yapilmadan
  yapilan kateter yerlestirilir

• 3 step PCN Seti 340013
• Dilatasyonlu Perkütan Nefrostomi Seti
• Islem bütün basamaklari gerçeklestirilerek
  yapilir ve kateter yerlestirilir

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EndoürolojiNefrostomiSuperglide PCN Seti 2 Step

• Giris Ignesi (Punture Neddle)
• 17.5 G kalinliginda
• 20 cm (6 FR sette 12 cm) uzunlugunda
• Kesik uçlu (Beweled Tip)
• Iki parçadan olusur
• Ultrasoundla giris esnasinda optimum
  görülebilirligi ve giris kontrolünü saglamak için
  uç kismidaki 3 adet halka ekojenik özellik saglar
• Bu sekilde ultrasounda en uygun görünürlük
  saglanmis olur

8
EndoürolojiNefrostomiSuperglide PCN Seti 2 Step

• Klavuz Tel (Guide-wire)
• 80 cm uzunlugundadir.
• Gövdesi stiff sertdir.
• Uç kismi Curves veya kivrik uçludur. Giris
  esnasinda böbrege zarar vermesini engellemek
  için.
• Uncoated denilen kaplamasi olmayan klavuz
  teldir.

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EndoürolojiNefrostomiSuperglide PCN Seti 2 Step

• Kateter Düzlestirici
• Ürün kateterle beraber sunulmakda. Içi bos metal
  kilif ve içinde de naylon mandren bulunur.
• Giris yapildikdan sonra klavuz telin üzerinden
  kateter düzlestirici ve kateterle beraber böbrege
  yerlestirlir. Çikarilmasi ile beraber kateter
  böbrek için loop seklini alir.
• Kateter böylece iki asamada dilatasyona gerek
  olmadan yerlestirlir.

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EndoürolojiNefrostomiSuperglide PCN Seti 2 Step

• Nefrostomi Kateteri
• Yüksek kalitede Poliüretandan üretilmistir.
• Radyopak özelliktedir.
• Kateterde çökme görülmez (Kink)
• Dis yüzeyi Hidrofilik özellige sahiptir.
• Kateterin kolayca dokulardan geçmesini saglayip
  kolay yerlestirilmesini saglar.
• Hidrofilik özellik konnektör kismindaki yesil
  marker ile belirtilmistir.
• Konnektör katetere sikica baglanmistir. (Diger
  ürünlerde konekketör daha sonradan takilir)

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EndoürolojiNefrostomiSuperglide PCN Seti 2 Step

• Nefrostomi Kateteri
• Kateterin üzerindeki çentikler, tesbit esnasinda
  kullanilmasi esnasinda kateteri hareket etmesini
  büyük ölçüde engeller
• 6 FR kalinligindaki pediatric kateterde bu
  çentikler tüm gövde boyunca bulunur. Çocuklarda
  böbrek ve hastanin gövdesi arasinda 2 cm
  civarinda bir mesafe bulunur.

12
EndoürolojiNefrostomiSuperglide PCN Seti 2 Step

• Nefrostomi Kateteri
• Stopcock drenaji kontrol etmek istenirse katetere
  opsiyonel olarak takilabilir
• Idrar torbasi adaptörü kateteri idrar torbasina
  baglamak için kullanilir. 546476

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EndoürolojiNefrostomiSuperglide PCN Seti 2 Step

• Ürün üzerinde 3 adet dokümantasyon amaçli
  kullanilan sticker bulunmaktatir

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EndoürolojiNefrostomiSuperglide PCN Seti 2 Step

• Ürün 3 farkli boyda üretilmistir
• Pediatrik 6 FR
• Eriskin 8-10 FR
• Çalisilacak klinikler
• Üroloji
• Radyoloji
• Girisimsel Radyoloji

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EndoürolojiNefrostomi3 Step PCN Seti

• Giris Ignesi (Punture Neddle)
• 17.5 G kalinliginda
• 20 cm (6 FR sette 12 cm) uzunlugunda
• Kesik uçlu (Beweled Tip)
• Üç parçadan olusur
• Ultrasoundla giris esnasinda optimum
  görülebilirligi ve giris kontrolünü saglamak için
  uç kismidaki 3 adet halka ekojenik özellik saglar
• Bu sekilde ultrasounda en uygun görünürlük
  saglanmis olur

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EndoürolojiNefrostomi3 Step PCN Seti

• Klavuz Tel (Guide-wire)
• O.035 kalinliginda
• 80 cm uzunlugundadir.
• Gövdesi stiff sertdir.
• Uç kismi Curves veya kivrik uçludur. Giris
  esnasinda böbrege zarar vermesini engellemek
  için.
• Uncoated denilen kaplamasi olmayan klavuz
  teldir.

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EndoürolojiNefrostomi3 Step PCN Seti

• Dilatator
• Iç içe geçen iki parçadan olusan Peel-away
  yirtilabilir dilatator,
• Dis kalinlik yerlestirilecek olan kateterden 1 FR
  fazla, iç kisim ise kateterle ayni kalinliktadir.
• Dilatasyn için bu iki parçe beraber
  yerlestirilir. Daha sonra iç kisim çikartilir.
• Kalan diger dilatator parçasi sayesinde kateter
  dokulara temas etmeden ve dokunun daralma riski
  olmadan yerlestirilir.

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EndoürolojiNefrostomi3 Step PCN seti

• Nefrostomi Kateteri
• Yüksek kalitede Poliüretandan üretilmistir.
• Radyopak özelliktedir.
• Kateterde çökme görülmez (Kink)
• Üzerinde turuncu renkli kateter düzlestirici
  bulunur.
• Konnektör katetere sikica baglanmistir. (Diger
  ürünlerde konekketör daha sonradan takilir)

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EndoürolojiNefrostomi3 Step PCN Seti

• Nefrostomi Kateteri
• Kateterin üzerindeki çentikler, tesbit esnasinda
  kullanilmasi esnasinda kateteri hareket etmesini
  büyük ölçüde engeller
• 6 FR kalinligindaki pediatric kateterde bu
  çentikler tüm gövde boyunca bulunur. Çocuklarda
  böbrek ve hastanin gövdesi arasinda 2 cm
  civarinda bir mesafe bulunur.

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EndoürolojiNefrostom3 Step PCN Seti

• Nefrostomi Kateteri
• Stopcock drenaji kontrol etmek istenirse katetere
  opsiyonel olarak takilabilir
• Idrar torbasi adaptörü kateteri idrar torbasina
  baglamak için kullanilir. 546476

21
Endourology
Percutaneous nephrostomy
Three Step Technique - step by step - ( FIRST
STEP ) The puncture with the three parts needle,
( 17.5 G / 1.3 mm, approx. 200 mm long ) with
marked tip for a better visibility - take out
of the inner needle stylet - application of the
guide wire, 0.035,800mm, safety J - tip, PTFE
coated - take out of the puncture cannula - (
Second step ) Insertion of the two part
dialator - Take out of the inner part of dilator
( the outer sheath of dialator is in situ ) -
Take out of the guide wire
22
Endourology
Percutaneous nephrostomy
Three Step Technique - step by step - ( Third
step ) Application of the catheter through the
outer dilator sheath into the renal pelvis !
The catheter must be prepared bevore the
insertion. The pig tail tip is embroiled into the
orange straightener. Then the catheter can be
insert into the renal pelvis. - take out of the
outer dilator sheath with the straightener -
Safeguarding of the catheter with a suture -
Connection of the adapter for urin bag to
nephrostomy catheter and connection of urin
bag - Bandaging of puntcure site
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Endourology
Percutaneous nephrostomy
Instruments for three step technique Ref 340005
- Puncture set, Ch. 6 ( Latex free ) - Three
part puncture needle, 17.5G/1.3 mm, 200 mm,
marked tip ( 3 rings ) - Guide wire, 0.035,
800mm, safety J - tip, PTFE coated - Two part
dilator, 18 cm long, approx. O.D. of outer sheath
8 Ch./Fr. , approx. O.D. of inner dilator 6
Ch./Fr., - Nephrostomy catheter made of PU,
Ch./Fr. 6, 50 cm long, x - ray, pigtail end,
open tip, 6 eyes, with straightener - - Two way
stopcock - Adapter for urin bag
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Endourology
Percutaneous nephrostomy
Instruments for three step technique Ref 340005
- Puncture set, Ch. 8 ( Latex free ) - Three
part puncture needle, 17.5G/1.3 mm, 200 mm,
marked tip ( 3 rings ) - Guide wire, 0.035,
800mm, safety J - tip, PTFE coated - Two part
dilator, 18 cm long, approx. O.D. of outer sheath
10 Ch./Fr. , approx. O.D. of inner dilator 8
Ch./Fr., - Nephrostomy catheter made of PU,
Ch./Fr. 8, 50 cm long, x - ray, pigtail end,
open tip, 6 eyes, with straightener - Two way
stopcock - Adapter for urin bag
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Endourology
Percutaneous nephrostomy
Advantages of our Two- and Three step
techniques - Due to the notches at the shaft ,
the catheter always stays in the correct
position - Very long and good experiances -
Very good biocompatibility of materials - Very
good visibility of puncture needle tip - Very
good material quality. No shaft breaks. No
kinks at the shaft. - Easy to use
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Endourology
SUPERGLIDE PCN 2 Step
Our competitors Bard / Angiomed - Very large
range in 1-, 2-, und 3- Step technique ( more
than 45 Ref.No. ) - Catheters in Ch. 6 / 7 / 8 /
9 and 10 are deliverable - Puncture cannulae
with MS tip ( good visibility in ultra sound ) -
Very strong competitor - No hydrogel coated
catheters in the program !
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Endourology
SUPERGLIDE PCN 2 Step
Our competitors Boston Scientific /
Microvasive - Different products in Ch. 8 -
14 - Pigtails with lock-system - Very good
market position in some countries ( Scandinavia ,
Italy ) - No hydrogel coated catheters in the
program !
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Endourology
SUPERGLIDE PCN 2 Step
Our competitors Cook - Different catheters in
Ch. 6 - 10 - Very large range - Pigtails with
lock-system - Very good market position in some
countries ( Scandinavia, Italy ) - No hydrogel
coated catheters in the program !
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Endourology
SUPERGLIDE PCN 2 Step
Our competitors Porges - Sufficient Program -
Puncture sets in Ch. 8 - 14 deliverable - No
hydrogel coated catheters in the program !
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Endourology
Further new products
Puncture cannulae As a replacement for the
puncture set Ref. 340001-000120, following
products are proposed Ref. 340002-120175
Three part puncture cannula with marked tip (
three rings ) 120 mm long/ 17,5 G, max. I.D.
0,038, Qty 5 pieces List price ( gross )
29,40 EUR / 1 piece Ref. 340002-200230 Two
part fine puncture cannula, 200 mm long / 23
G, Compatible to 340002-120175, Qty 5
pieces, List price ( gross ) 19,10 EUR / 1
piece The puncture set, Ref. 340001-000120, is
not available any more
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Endourology
Further new products
Puncture cannulae As a replacement for the
puncture set Ref., 340001-000200 following
products are proposed Ref. 340003-200175 Three
part puncture cannula with marked tip ( three
rings ) 200 mm long / 17,5 G, max. I.D. 0,038,
Qty 5 pieces List price ( gross ) 28,10 EUR /
1 piece Art.Nr. 340003-280230 Two part fine
puncture cannula, 280 mm long / 23 G, Compatible
to 340003-200175, Qty 5 pieces, List price (
gross ) 17,65 EUR / 1 piece Important note Our
old puncture sets, Ref. 340001-000200, will be
deleted as soon as possible.
32
Endourology
Puncture cannulae
Competitors - All suppliers of nephrostomy
puncture sets - Angiomed with MS tip ( visibility
) Our advantage Marking
rings !!!
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Endourology
Further new products
Ref. 340408 - SUPERGLIDE Nephrostomy balloon
catheter, 24 cm long, Ch. / Fr. 12 -
24, Qty 5, List price ( gross ) 28,99 EUR / 1
piece Ref. 340409 - SUPERGLIDE Nephrostomy
balloon catheter, 41 cm long, Ch. /
Fr. 12 - 24, Qty 5, List price ( gross ) 29,64
EUR / 1 piece - Hydrogel coated over 5 cm of
the length It means less traumatic and easier
application - with a hollow stylet, central open,
max. I.D. 0,038 Note When changing a catheter,
we recommend using a ENDOGUIDE guide wire with a
straight safety tip with a maximum diameter of
0.038" that is at least twice as long as the
catheter to be exchanged.
34
Endourology
Further new products
SUPERGLIDE Nephrostomy balloon catheters Descript
ion SUPERGLIDE nephrostomy balloon catheters are
double-lumen balloon catheters made of silicone
with a centrally open tip, coated with Hydrogel
over a length of approx. 5 cm. SUPERGLIDE
nephrostomy balloon catheters are supplied with
a hollow stylet and can be inserted or changed
over a guide wire with a maximum diameter of
0.038". They are available in two different
lengths, approx. 24 and 41 cm, and in Ch./Fr. 12
24. Balloon fill volumes and size are indicated
on the funnel of each individual catheter.
SUPERGLIDE nephrostomy balloon catheters are
graduated in centimetres and have a radiopaque
tip. Indications Rüsch nephrostomy catheters are
indicated for the routine percutaneous drainage
of the kidney. Contraindications Uncorrected or
uncorrectable coagulative disorders and renal
tuberculosis are some of the known
contraindications for this procedure. The
suitability of each patient must be individually
assessed by a physician or other suitably
qualified medical personnel.
35
Endourology
Further new products
SUPERGLIDE Nephrostomy balloon catheters Preparat
ion for Use Clean and disinfect the area around
the catheter using normal established
techniques. Remove the catheter and other items
from the packaging using aseptic
technique. Directions for Use When using
catheters with a central opening, a guide wire is
placed in the renal pelvis, e.g. through the in
situ nephroscope. Remove the nephroscope.
Immediately before insertion, about 5 cm of the
catheter tip is dipped into a container of 0.9
saline solution or distilled water to activate
the Hydrogel coating. After approx. 30 seconds,
check that the balloon is intact using the
maximum permitted filling volume. Push the
catheter over the guide wire until the catheter
is in the desired position in the renal
pelvis. Confirm placement of the catheter using
normal radiographic technique. If the catheter
has a balloon, inflate it to fix the catheter in
the renal pelvis. A Luer syringe or, for some
products, a Luer-Lock syringe may be used to
inflate the balloon. Inflate the balloon with
sterile water. The capacity of the balloon is
indicated on the funnel of the catheter or on the
label of the packaging. Do not overinflate.
Note We recommend checking the volume of fluid
in the balloon every 7-10 days and correcting it
if necessary. To do this, deflate the balloon
completely with a syringe without displacing the
catheter, and fill it again with the maximum
permitted volume.
36
Endourology
Further new products
SUPERGLIDE Nephrostomy balloon catheters Remove
the guide wire, if used. The catheter may be
secured to the skin by one or more sutures around
the proximal catheter shaft or with a tape. A
dressing should be applied to the puncture site
in normal fashion. To change a catheter with a
central opening, the guide wire is first pushed
through the indwelling catheter until the tip of
the guide wire is in the renal pelvis.
Note When changing a catheter, we recommend
using a guide wire with a straight safety tip
with a maximum diameter of 0.038" that is at
least twice as long as the catheter to be
exchanged. In the case of balloon catheters, the
balloon must be deflated before the catheter is
removed. Depending on the product, either a Luer
tip or Luer-Lock syringe is used to deflate.
Aspirate the syringe gently to remove the
inflation fluid. Do not use excessive aspiration
on the syringe during deflation as this may cause
a vacuum collapse of the inflation lumen which
may impair normal drainage. The old catheter is
slowly removed and discarded. The new catheter is
advanced over the guide wire. Fill the balloon
with sterile water only. Potential
Complications Infection and irritation are some
of the complications known to be associated with
catheter placement in the upper urinary tract.
37
Endourology
Percutaneous nephrostomy
Competitors - BARD Angiomed ( very wide range
of puncture sets ) - Microvasive (very wide
range of puncture sets , locking loop system
on the pigtail ) - Cook (very wide range of
pucture sets , locking loop system on the
pigtail ) - Porges ( adequate range ) - B.
Braun ( small range, not in the focus )
38
Endourology
Percutaneous nephrostomy
Other instruments for percutaneous
nephrostomy Fascial dilations set Ref.
340200 - Ch./Fr. 9( 54 cm long ), I.D. 1 mm /
0.039, to use as guide for next dilators
Ch./Fr. 12/15/17/19/21/23/25/27/29 ( 36 cm long
) made of PU, Qty 1 Ref. 340201 - Exchange
dilators, Ch. 9 - 29, Qty 10
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Endourology
Percutaneous nephrostomy
Application of set Ref. 340200 After the
puncture and the application of guide wire (
max. 0,038", stiff, flexible J-end ) the doctor
start the dilation with the 9 Ch. instrument (
54 cm long ). This instrument left in the
channel as guide for other dilators. All other
dilators ( these are 36 cm long ) have an I.D. in
approx. 3.0 mm and are prepared to be pushed
over this first dilator, but one after the other.
40
Endourology
Percutaneous nephrostomy
Other instruments for percutaneous
nephrostomy Fascial dilations set Ref. 340900
- Ch./Fr. 6/8/10/12/14 ( gray )/16/18/20/22/24/26/
28, approx. 32 cm long, made of PU, To
use with max. 0.038 guide wire ! Ref. 340901 -
Exchage dilators, Ch./Fr. 6-36, Qty5
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Endourology
Percutaneous nephrostomy
Application of set Ref. 340900 After the
puncture and the application of guide wire (
max. 0,038", stiff, flexible J-end ) the doctor
can start with the dilation, one dilator after
the other. The I.D. of all dilators, Ch. 6 - 28,
approx. 32 cm long, are prepared for max. 0,038"
guide wires.
42
Endourology
Percutaneous nephrostomy
Other instruments for percutaneous
nephrostomy Renax tubes - Ref. 341100, I.D.
Ch. 20 - 36, 16 cm long After the dilation the
doctor can use Renax tubes ( Amplatz ) to safe
the dilated channel and to use a nephroscope.
43
Endourology
Percutaneous nephrostomy
Other instruments for percutaneous
nephrostomy Balloon catheters for nephrostomy,
with hollow stylet Ref 340400 - Ch./Fr. 12 -
24, 24 cm long, made of silicone Ref 340401 -
Ch./Fr. 12 - 24, 41 cm long, made of
silicone Special features - Application over a
stiff guide wire 0.038,, possible, ( The
optimum change with a stiff guide wire, with
flexible - straight tip ) - Very Flat balloon -
Very good biocompatibility - X-ray tip - Easy tu
use becuase of hollow stylet - Wide range
44
Endourology
Percutaneous nephrostomy
Other instruments for percutaneous
nephrostomy Balloon catheters for
nephrostomy Ref 340500 - Ch./Fr. 12 - 24, 45 cm
long, made of silicone, with detachable
funnel, for application through the shaft of
nephroscopes !!! Ref 340502 - Exchange catheter,
Ch./Fr. 12 - 24, 45 cm long, made of
silicone, not detachable funnel !!! Special
features - Application through the shaft of
nephroscopes possible ( Ref 340500 ) - Very
Flat balloon - Very good biocompatibility - X-ray
tip - Wide range
45
Endourology
Percutaneous nephrostomy
Other instruments for percutaneous
nephrostomy Nephostomy catheter for
postoperative drainage (after plastic surgery at
the pelvis of the kidney ) Ref 179800 - Renal
fistula catheter, Ch./Fr. 10 - 24, made of
silicone, w/o balloon, with funnel, open
tip, 1 eye, 40 cm long.
46
Endourology
Percutaneous nephrostomy
Other instruments for percutaneous
nephrostomy Special nephrostomy catheters for
intraoperative application ( for postoperative
drainage of the pelvis and ureter ) Ref
179000 - Nephrostomy catheters w/o balloon, with
ureteral stent, 2 eyes, catheter 40 cm
long, stent approx. 35 cm long, Sizes (
Ch.Fr. ) - 12x4/14x5/16x6/16x8/18x8/20x8/22x8,
made of silicone, Qty 5 Ref. 179005 -
Nephrostomy catheter with flat balloon, X-ray
tip, with ureteral stent, 2 eyes,
catheter 40 cm long, stent approx. 35 cm long,
Sizes ( Ch.Fr. ) - 12x4/14x5/16x6/16x8/18x8
/20x8/22x8/24x8, made of silicone, Qty
1
47
Endourology

The customers don't use any unknown
instruments. The medical staff in the hospital
must be informed exactly about the function of
our instruments. I thank you for your
attention and wish you much success !