Pre‐procedure

ActionRationale

1. 1.Show
   Check with surgical team whether prophylactic antibiotics are required prior to removal.
   To prevent infection secondary to a colonized stent (Abbott et al. [1], E).
2. 2.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed. Another member of staff may be needed to reassure the patient during the procedure.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [178], C; Walker [242], C).
3. 3.Show
   Check the patient's medical notes to confirm which ureteric stent is to be removed. Once confirmed, establish the number and site(s) of sutures (both internal and external).
   To ensure only documented stents are removed. To ensure all non‐absorbable sutures are removed prior to attempting removal of the stent. E
4. 4.Show
   Offer the patient analgesia as per chart.
   To promote comfort (NMC [178], C).
5. 5.Show
   Empty the ileal conduit bag and remove. Or empty drainage bags.
   To prepare for stent removal. E

Procedure

1. 6.Show
   Perform all steps of the procedure (below) using aseptic technique. Clean the site using 0.9% sodium chloride.
   To reduce the risk of infection (Fraise and Bradley [81], E).
2. 7.Show
   If the stent is sutured in place, hold the knot of the suture with metal forceps and gently lift upwards.
   To facilitate removal. E

   Plastic forceps tend to slip against nylon sutures. To allow space for the scissors or stitch cutter to be placed underneath. E
3. 8.Show
   Cut the shortest end of the suture as close to the skin as possible and remove the suture.
   To minimize cross‐infection by allowing the suture to be liberated from the drain without drawing the exposed part through tissue (Pudner [201], E).
4. 9.Show
   Warn the patient of the pulling sensation they will experience and reassure them throughout.
   To promote patient comfort and co‐operation (Walker [242], E). Another member of staff may be needed to reassure the patient during the procedure.
5. 10.Show
   Loosening up of the stent should be done if possible, especially for a stent that has been in for some time. This can be done by gently rotating the drain to loosen it from the embedded tissue.
   To minimize pain and reduce trauma. E

   Drains that have been left in for an extended period will sometimes be more difficult to remove due to tissue growing around the tubing (Walker [242], E).
6. 11.Show
   With one gloved hand, place a finger on each side of the stent exit site, exerting gentle pressure to stabilize the skin around the stent. Using the other hand, take a firm grasp of the stent as close to the skin as possible and gently pull downwards to start removing it. Steady, gentle traction should be used to remove the stent rather than sudden, jerky movements. If there is resistance, ensure that the other gloved hand is still exerting gentle pressure around the exit site.
   Using a firm grasp for the shortest possible length of time minimizes patient discomfort (Walker [242], E).

   The stent should be removed easily; if there is resistance then discontinue the procedure and contact the surgical team. E
7. 12.Show
   Once removed, the stent should be inspected to ensure that it is intact. The end of the stent should be clean cut and not jagged.
   This clean appearance ensures that the whole stent has been removed. E

   If you have any doubt that the stent is intact, the surgeons should be contacted to inspect the stent before disposal.
8. 13.Show
   If there is a request for the tip to be sent to microbiology, cut it off cleanly, using sterile scissors, and send it in a sterile pot. Also send a wound swab of the exit site.
   To recognize and treat suspected infection (Fraise and Bradley [81], E; Walker [242], E).

Post‐procedure

1. 14.Show
   Dispose of the used drainage system in a clinical waste bag.
   To ensure correct and safe disposal of contaminated waste. E
2. 15.Show
   Replace the patient's stoma bag if an ileal conduit (refer to stoma care section later in this chapter).
   To ensure the stoma is covered and to avoid urine leakage. E
3. 16.Show
   Record information in relevant documents; this should include:

   • date and time of procedure
   • procedure(s) performed
   • 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.
   To provide a point of reference or comparison in the event of later queries (NMC [178], C).