Nephrostomy Tube Insertion and Care

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What is a Nephrostomy?
Urine from a normal kidney drains through a narrow, muscular tube called a ureter into the bladder. If this becomes blocked (obstructed) by a stone, blood clot, tumour, damage to the urinary system or infection, a nephrostomy tube is required. A nephrostomy is a small tube inserted through the skin into the kidney to allow urine to drain from the kidney into a collecting bag outside the body. A nephrostomy tube can also be inserted at the time of an operation on a large kidney stone to protect the urinary tract.

What happens before the Nephrostomy Tube is inserted?
• You will have a routine blood test to ensure your bloods are normal.
• If you are on medication that thins your blood such as aspirin, dypiridamole, clopidogrel, or warfarin, there will be a period of discontinuation prior to the procedure. The doctors will make the required arrangements.
• On the day a doctor will explain the reason why you need the tube inserted and will ask you to sign a consent form.
• You will be nil by mouth 4 hours prior to the procedure.
• The nephrostomy tube is inserted in the x-ray department by a Consultant Radiologist. You will need to wear a theatre gown to allow the radiologist easy access to the insertion site.

How is the tube inserted?
The nephrostomy tube is inserted through your skin into the affected kidney. A local anaesthetic is given at the site of entry which is in your side/back. You will also have a small needle inserted into your hand or lower arm called a cannula. This allows painkillers and sometimes a sedative (to help you relax) to be administered. The procedure usually lasts 30-90 minutes.

What happens during the procedure?
You will lie on an x-ray table on your back and be tilted on your side. The radiologist will ensure the procedure is kept sterile throughout. The side the nephrostomy will be inserted will be cleaned with antiseptic. The radiologist will use an ultrasound machine to decide on the most suitable point to insert the nephrostomy tube. Your skin around this point will be anaesthetised with a local anaesthetic and a fine needle inserted into the kidney.

When the radiologist is sure that the needle is in a satisfactory position, a guide wire will be placed into the kidney through the needle, which enables the nephrostomy tube to be positioned correctly. This tube will then be stitched in place, a dressing fixed to the skin surface and a drainage bag attached. Throughout this procedure your heart rate, blood pressure and pulse will be monitored. Once the procedure is finished you will be transferred back to the ward.

What happens next?
Your doctor will explain what further treatment is required. This may be another x-ray procedure, operation or permanent nephrostomy tube.

Living with a nephrostomy tube
This may be temporary in the majority of patients or permanent outcome in a very small number of patients and you may be required to be discharged with the tube in place. You will be taught to care for the nephrostomy before you go home and a district nurse will be arranged to visit to offer advice and support.

Looking after a Nephrostomy drainage bag
The nephrostomy tube is normally attached to a nephrostomy drainage bag which is usually worn under your clothing and can be strapped to your thigh or below the knee depending on tube length or secured to clothing with a safety pin. It is important NOT to leave the bag hanging as the weight of the urine and any tugging may cause the tube to become displaced or to fall out and it is recommended the bags should be emptied at three-quarters full to avoid this problem. The nephrostomy bag and dressings should be changed every 7 days. Please Note: the bags and dressings supplied by the hospital are not available in the community, however, alterative products are available.

You may shower after 48 hours after the tube has been inserted but try to keep the tube site dry and you can protect the skin with plastic wrap during showering. Swimming is not recommended with a nephrostomy tube in place.

What are my restrictions?
Movement may be restricted. You may find it uncomfortable to bend or stretch. Climbing stairs may be uncomfortable and this can be overcome by holding your hand over the nephrostomy site.

What happens if the tube comes out?
The nephrostomy tube is stitched in place and is coiled under the dressing. If, for any reason the tube comes out, you need to contact your GP immediately and may need to return to hospital. If you have any worries about the tube please contact your District Nurse or Urology Nurse Practitioner.

What should I do if I notice blood in the bag?
Blood in the urine can indicate an infection. Please make arrangements to see your GP or contact your District Nurse. Increase your fluid intake up to 2 litres/3.5 pints a day.

Can I get a urine infection?
This is possible. You may notice symptoms of frequently going to the toilet, burning or stinging when passing urine. You may have a fever and feel generally unwell. If these symptoms occur, you need to take a sample of urine passed in the normal way to your GP. Your GP will treat the infection with antibiotics.

Can I prevent an infection occurring?
You can prevent some infections from occurring. You need to drink up to 2 litres a day. Ensure you wash your hands thoroughly before changing your drainage bags and after. Keep the drainage bag closed at all times except when emptying. Empty the drainage bag only when necessary and not before.

What happens if the bag does not drain?
If the tube does not drain any urine for more than an hour, you need to check that the tube has not got any kinks in it. You need to check the tube tap is open and has not been accidentally turned. Ask yourself if you have drunk enough. Try drinking half a litre of fluid and if no urine drains after these checks, contact your GP/District Nurse.

Will I have pain?
Discomfort may be felt. Painkillers can be taken to relieve this. If you experience severe pain you need to see your GP or District nurse urgently.

Will I pass urine in the normal way?
You may pass some urine if you have 2 kidneys the other one will work as normal.

Can I eat and drink normally?
You can eat and drink like you normally do.

Will my sleep be affected?
Lying on the side of the nephrostomy tube can be uncomfortable. You will have to find a position that suits you.

Can I exercise?
Gentle exercise is fine. More strenuous exercise may cause dislodgement of the nephrostomy tube, and pain so this should therefore be avoided.

When can I go back to work?
This depends on your job and the nature of the problem. Light housework or office work is fine. Please discuss this with your doctor prior to discharge.

Can I drive?
If you are comfortable whilst driving then there are no restrictions. However you should inform your Insurance company.

Advice and Guidance for your District Nurse Guidelines for the management of Nephrostomy Tubes

Nephrostomy Care
Change nephrostomy dressing and bag every seven days.

Nephrostomy Bags
Are available from Bullen Healthcare (0800 756 2429).
• NS721.1730S bag x 10/PIP code 305-1539 Manfred Sauer (30cm long)
• NS721.1720S bag x 10/PIP code 305-1547 Manfred Sauer (20cm long)
• LM750NDB bag x 10 LINC Medical (80 cm long)

Nephrostomy Dressing
Allevyn/Biatain 10cm x 10cm
Transparent non occlusive dressing

For further advice and information please contact the Urology Nurse Practitioner or the X-ray intervention suite at Milton Keynes University Hospital.

Flushing the Nephrostomy Tube
Only flush the nephrostomy tube if indicated in the District Nurse referral letter, if there are clots or grit in the tube, if the patient has developed pain suddenly in their kidney as this may be a sign the tube has become blocked and if the tube has stopped draining.

Please Note: if the nephrostomy tube is not being flushed the three way tap can be removed.

• Sterile dressing pack
• Sterile gloves
• 10ml-20ml syringe
• 10ml-20mls sterile normal saline or sterile water
• Alcohol wipe

• Check the tube and bag to ensure there are no kinks that may be causing a mechanical obstruction to the drainage of urine and check the tube to see if there is a leur lock cap and if it has become closed accidentally. If there is a mechanical obstruction that can be easily resolved a flush may not be required.
• Open dressing pack and prepare equipment, draw the saline or water into the syringe.
• Remove the nephrostomy bag or remove a cap from the three way tap for access to the tube.
• Wearing sterile gloves, wipe around the port with an alcohol wipe.
• Apply gentle and even pressure to instil the saline or water into the nephrostomy tube. Gentle aspiration may be required to dislodge a blockage. However excessive force may cause bleeding. Allow the flush and urine to flow out of the tube with gravity. Process can be repeated if necessary.
• Reapply connections and change nephrostomy bag and dressing if required.
• If you are still concerned please contact the urology department via switchboard, otherwise refer the patient to the Emergency Department (ED).