Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [178], C).
2. 2.Show
   Screen the bed.
   To ensure patient privacy (NMC [178], E). To allow dust and airborne organisms to settle before the field is exposed (Fraise and Bradley [81], E).
3. 3.Show
   Wash hands using bactericidal soap and water and alcohol‐based handrub, and apply personal protective equipment.
   To reduce the risk of infection (NHS England and NHSI [161], C).
4. 4.Show
   Prepare the trolley, placing all equipment required on the bottom shelf.
   The top shelf acts as a clean working surface. E
5. 5.Show
   Take the trolley to the patient's bedside, disturbing the screens as little as possible.
   To minimize airborne contamination (Fraise and Bradley [81], E).
6. 6.Show
   Assist the patient into the supine position and expose the ureteric stent.
   To enable access to the externalized ureteric stent. E

Procedure

1. 7.Show
   Prepare the dressing pack on the top shelf of the trolley.
   To ensure the sterile field is ready for the procedure. E
2. 8.Show
   Clean hands with soap and water and/or an alcohol‐based handrub.
   Hands may have become contaminated by handling the outer packs (NHS England and NHSI [161], C).
3. 9.Show
   With a clean gloved hand, disconnect the drainage bag and discard.
   To allow access to the stent. E
4. 10.Show
   Put on non‐sterile gloves.
   To reduce the risk of cross‐infection (NHS England and NHSI [161], C).
5. 11.Show
   Clean the stent and connect the Bander stent adaptor if not adapted or insert a blunt needle into the end of the stent.
   To minimize the risk of infection (Loveday et al. [135], R) and to enable instillation of the flush.
6. 12.Show
   Attach a sterile syringe containing 5 mL 0.9% sodium chloride to the stent connector or blunt needle.
   To prepare to flush. E
7. 13.Show
   With gentle pressure, flush the liquid into the stent and gently aspirate.
   To remove potential occlusions from the drainage channel (Radecka and Magnusson [202], R).
8. 14.Show
   Apply a new sterile drainage bag, and connector if required, to the stent, being careful not to touch the hubs. Urine should begin to flow.
   To enable clean passage of urine and to minimize contamination from bacteria within the drainage bag. E

Post‐procedure

1. 15.Show
   Dispose of waste in a clinical waste bag and seal the bag before moving the trolley.
   To ensure correct and safe disposal of contaminated waste (DEFRA [63], C).
2. 16.Show
   Cover the patient and then draw back the curtains.
   To maintain the patient's dignity (NMC [178], C).
3. 17.Show
   Record information in relevant documents; this should include:

   • date and time of procedure
   • procedure(s) performed
   • dressing and bag type used
   • condition of skin
   • any problems or concerns during the procedure
   • any swabs or samples taken during the procedure (e.g. exit site swab or urine sample)
   • any referrals made following the procedure
   • a review date for next dressing and/or bag change.
   To provide a point of reference or comparison in the event of later queries (NMC [178] C).
4. 18.Show
   If the patient is being discharged home, refer them to the community nurse and provide clear guidelines for equipment provision and plan for review and/or change of nephrostomy.
   To ensure continuity of care. E