Percutaneous nephrostomy tube
Genitourinary
Kidneys are part of your urinary system that produce urine. The flow of urine goes from your kidney to the bladder through tubes called the ureter. The bladder collects urine and acts as a reservoir until you feel the need to urinate. Urine then passes from the bladder through the urethra and then out of your body.
The flow of urine can become blocked in a multitude of ways such as by stones, infection, cancer, or injury. This results in excessive back pressure proximal to the blockage point which causes the urinary system to become dysfunctional. This elevated pressure can cause many problems.
Percutaneous nephrostomy tubes can be used to relieve pressure creating a divergent tract outside of the body.
A physician uses imaging to visualize the kidney. Then, the nephrostomy tube is placed in the correct place under real time image guidance and secured in place. Contrast will be given through the tube to confirm proper placement.
Skin Care
- Wash your hands with soap and water before and after care.
- Remove old dressing if a dressing is being used. Check for redness, swelling, any drainage or excess skin growing around the tube.
- Wash skin around the tube with soap and warm water. Clean around the nephrostomy tube to remove any drainage and/or crusting. Rinse soap off with clear water and dry thoroughly. Keep this site clean and dry.
- A dressing may be used around the nephrostomy tube site.
Emptying the Bag
- Urine bag should be emptied once the bag is full unless specific time interval is given by provider
- Wash your hands with soap and water before and after care.
- Put on gloves prior to emptying.
- Document volume within bag into MDC tracker.
- If urine is cloudy, has a foul smell or there is blood, document the picture in MDC tracker.
- Turn the three way stop adapter to a closed position to ensure no urine leak once the bag is disconnected.
- Carefully disconnect the bag from the tubing and empty it into the toilet or other container.
- Be sure not to touch the bag to the toilet, otherwise use a cleaning swab prior to reconnecting or replacing the bag.
- Reconnect drainage bag to tubing and turn three way adapter to open allowing flow of urine from tubing into the bag.
Flushing the Nephrostomy Tube
If your catheter does not have a stopcock:
- Take the saline syringe out of the wrapper.
- Place a towel under the catheter connection before disconnecting the catheter from the drainage bag. Place the end of the drainage bag on the towel.
- Clean the end of the catheter with an alcohol pad.
- Pick up the syringe and remove the cap. Hold the syringe up so the air bubble is at the top of the syringe. Push the plunger up to push the air bubble out of the syringe. Then attach the saline syringe to the end of the catheter.
- Gently push on the plunger to flush no more than 5 ML of saline into the catheter. Stop if you feel any pressure and do not pull back on the plunger.
- Set down the syringe on the catheter and pick up the end of the drainage bag.
- Clean the end of the drainage bag with an alcohol wipe. Then pick up the catheter end and remove the syringe.
- Connect the catheter back to the end of the drainage bag.
- Throw away the syringe in the trash. Remove your gloves. Wash and dry your hands.
If your catheter has a stopcock:
- Check that the stopcock is “off” to the injection port.
- Clean the injection cap on the stopcock with alcohol.
- Take the syringe out of the wrapper. Remove the cap on the end of the syringe. Hold the syringe straight up so the air bubble is up in top of the syringe and gently push until the bubble is out of the syringe.
- Put the saline syringe into the injection cap of the stopcock.
- Turn the stopcock off to the drainage bag (closed). The stopcock flange faces the bag. This opens the injection port.
- Gently push on the syringe plunger to put in 5 - 10 ML of saline. Do not force in the saline or pull back on the plunger.
- Turn the stopcock off to the injection port, allowing the flow of urine into the bag.
- . Remove the syringe from the injection cap on the stopcock.
- Throw away the syringe in the trash. Remove your gloves. Wash and dry your hands
Signs of infection
If you notice severe redness, tenderness, warmth, a foul odor, thick yellow green drainage, or fever, call your care team immediately.
Dislodgement
Try to replace the tube into the opening about 1-2 inches and tape the tube to your abdomen. DO NOT USE THE TUBE. Then call your care team. .
Leaking
Small amount of leaking around the nephrostomy tube is common. You can apply a dressing under the tube to help soak the fluid. If the drainage becomes excessive, call your care team for evaluation.
Skin or excess tissue growing where the tube enters skin
This is called granulation tissue, which is the body’s natural response to the tube. It is normal for this tissue to bleed a little when bumped or irritated. Call your care team to discuss treatment. This is not an emergency but should be addressed in a timely manner.
Nephrostomy tube is clogged or clinked
Try to slowly push / pull warm water into the tube with a 10 ml syringe. Repeat steps every 10-15 minutes. Never put any object into the tube to unclog it. If you are unable to unclog the tube, call your child's care team.
Call your doctor and seek immediate medical care if you notice the following signs and symptoms:
- Signs of infection
- Increase pain, swelling, warmth, redness around drain site
- Pus/urine draining from the insertion site
- Fever
- Sudden change in color and smell of your drainage
- Tube is coming loose out of your insertion site