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Nephrostomy Tube Care
Definition
A percutaneous nephrostomy tube (PNT) is a urinary diversion system comprised of a collection bag, a
Purpose
The purpose of PNT care is to prevent complications when a PNT is in use.
Precautions
Aspiration of fluid from the nephrostomy tube is prohibited as such action will damage the renal pelvis. Gravity drainage is used to collect specimens, and the nurse should never use force when irrigating the tube. A tube should never be irrigated with more than 5 ml of solution, since the capacity of the renal pelvis is between 4 and 8 ml. The nurse must avoid dislodging the tube while removing the dressing.
Preparation
The nurse should wash hands prior to beginning the procedure, then assemble all of the following equipment:
- disposable underpad
- clean gloves
- measuring tape
- sterile gloves
- sterile cotton tip applicators (4)
- sterile 0.9% NaCl or povidone-iodine solution or sponges
- sterile 4×4 pad or transparent dressing
- sterile 2×2 pads
- tape
- pouch belt
Description
The nurse should provide privacy for the patient in preparation for the procedure. He or she should position the patient on the side opposite the tube site with the nephrostomy site up. This provides better viewing of the tube and allows an easier dressing change.
The nurse should put on clean gloves and place a disposable underpad beneath to the patient to absorb any drainage. To minimize tension at the site and to prevent dislodging, the nephrostomy tube should be anchored with a small piece of tape. The collection bag must be emptied. The old dressing can be removed by carefully loosening the edges, and then moving to the center of dressing. Care should be taken to avoid dislodging the tube while removing the dressing. A sterile cotton-tip applicator placed on the catheter will help stabilize the catheter while removing the dressing. The site is then assessed for signs of infection, any moisture, or other drainage. The PNT is then measured from exit site to tip. If the PNT length is longer than the measurement at time of insertion, the catheter may have migrated out, and the physician should be notified at that point. The nurse should remove the soiled gloves at this time and replace with sterile ones. The exit site should be cleansed with the agent of choice (0.9% saline or povidone-iodine solution), using sterile 2×2 pads. Each pad can only be used once. Cleansing should start at the exit site and work outward in a circular motion; this action should be repeated twice. If there is any crusted matter at the site, this must be loosened and removed by using a cotton-tip applicator moistened with 0.9% saline. Then, sterile dressing should be applied. After removing the old tape, the tube must be secured with new tape to the skin below the dressing, approximately 2.5 inches (6.5 cm) from the exit site. The patient will need to be assisted in the application of the pouch belt. Anchoring the PNT with tape reduces trauma and minimizes the possibility of dislodging or kinking the tubing; adding the belt further secures the PNT. The nurse may remove gloves at this point and wash hands. The patient's dressing needs to be dated and initialed, and will need to be changed daily, or more often if necessary.
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