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percutaneous nephrostomy (PCN), nephroureteral stent (NUS), ureteral stent (JJ), suprapubic tube (SPT)
Bleeding risk
Bleeding risk
LOW bleeding risk
LOW bleeding risk
INR ≤ 3
Plt ≥ 20,000
CBC, INR/PT not routinely recommended
Anticoagulant/Antiplatelet Agent
Anticoagulants
Antiplatelets
Antibiotics
Antibiotics
No antibiotic therapy required for routine exchange in low risk patients
High risk patient = colonized urothelium, ileal conduit, ureteroplasty, renal transplant
Severe beta-lactam allergy = hives, anaphylaxis, or DRESS/SJS/TEN to any beta-lactam
High risk patient = Ceftriaxone
Ceftriaxone IV
Adult = 2 g
Peds = 50 mg/kg (max = 1 g)
High risk patient with severe beta-lactam allergy = Vancomycin AND Gentamicin
Vancomycin IV
Adult < 80 kg = 1000 mg
Adult > 80 kg = 1500 mg
Peds = 15 mg/kg (max = 1500 mg)
Gentamicin IV
Adult CrCl ≥ 10 mL/min = 5 mg/kg
Adult CrCl < 10 mL/min = 3 mg/kg
Peds = 2.5 mg/kg
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