Your kidneys are part of your urinary system and work to produce urine. Normally, the urine that is produced flows from the kidneys into a tube called a ureter. The ureter connects your kidneys to your bladder. When enough urine has collected in your bladder, you feel the need to urinate. Urine passes from the bladder, through your urethra, and out of your body.
Sometimes there is a block in your urinary system and urine can’t flow as normal. Blockages can be caused by a number of things, including:
- kidney stones
- injury to the kidney or ureter
- an infection
- a congenital condition that you’ve had since birth
A nephrostomy tube is a catheter that’s inserted through your skin and into your kidney. The tube helps to drain urine from your body. The drained urine is collected in a small bag located outside of your body.
Placing the nephrostomy tube
The procedure to place your nephrostomy tube typically takes less than an hour and will be performed while you’re sedated.
Before your procedure
Prior to having your nephrostomy tube placed, you should be sure to do the following:
- Talk to your doctor about any medications or supplements that you’re taking. If there are medications you shouldn’t take prior to your procedure, your doctor will instruct you on when to stop taking them. You should never stop taking medications without speaking to your doctor first.
- Be sure to adhere to any restrictions set by your doctor regarding food and drink. For example, you may be restricted from eating anything after midnight the evening before your procedure.
During your procedure
Your doctor will inject an anesthetic at the site where the nephrostomy tube is to be inserted. They’ll then use imaging technology such as ultrasound, CT scan, or fluoroscopy to help them place the tube correctly. When the tube has been inserted, they’ll attach a small disk to your skin to help hold the tube in place.
Caring for your tube
Your doctor will instruct you on how to care for your nephrostomy tube. You’ll have to inspect your tube on a daily basis as well as empty any urine that has collected in the drainage bag.
Inspection of your nephrostomy tube
When you inspect your nephrostomy tube, you should check the following:
- Verify that your dressing is dry, clean, and secure. If it’s wet, dirty, or loose, it will need to be changed.
- Check your skin around the dressing to make sure there’s no redness or rash.
- Look at the urine that has collected in your drainage bag. It shouldn’t have changed in color.
- Be sure there are no kinks or twists in the tubing that leads from your dressing to the drainage bag.
Emptying your drainage bag
You’ll need to empty your drainage bag into a toilet when it’s approximately halfway full. The amount of time between each emptying of the bag can vary from person to person. Some people will need to do this every few hours.
Flushing your tubing
You typically need to flush your tubing at least once a day, but you may need to flush more often following your procedure. Your doctor will give you specific instructions on how to flush your tubing. The general procedure is as follows:
- Wash your hands thoroughly. Put on gloves.
- Turn off the stopcock to the drainage bag. This is a plastic valve that controls fluid flow through your nephrostomy tube. It has three openings. One opening is attached to the tubes attached to the dressing. Another is attached to the drainage bag, and the third is attached to an irrigation port.
- Remove the cap from the irrigation port and swab thoroughly with alcohol.
- Using a syringe, push saline solution into the irrigation port. Do not pull the syringe plunger back or inject more than 5 milliliters of saline solution.
- Turn the stopcock back to the drainage position.
- Remove the syringe from the irrigation port and recover the port with a clean cap.
Additional things to remember
- Be sure to keep your drainage bag below the level of your kidneys. This prevents urine backup. Often, the drainage bag is strapped to your leg.
- Whenever you handle your dressing, tubing, or drainage bag, be sure you’ve cleaned your hands with soap and warm water or with an alcohol-based sanitizer.
- You shouldn’t bathe or swim while you have a nephrostomy tube in place. You may shower again 48 hours after your procedure. It’s helpful to use a handheld showerhead, if possible, in order to avoid getting your dressing wet.
- Try to limit yourself to light activity following your procedure and only increase your activity level if you tolerate it well. Avoid any movements that could put strain on the dressings or tubing.
- You’ll need to change your dressing at least once a week.
- Be sure to drink a lot of fluids.
Complications of a nephrostomy tube
Placing a nephrostomy tube is generally a safe procedure. The most common complication that you’re likely to encounter is infection. You should contact your doctor immediately if you experience the following symptoms, as they may indicate an infection:
- a fever over 101°F (38.3°C)
- pain in your side or lower back
- swelling, redness, or tenderness at the site of your dressing
- urine that is very dark or cloudy, or smells bad
- urine that is pink or red
You should also contact your doctor should any of the following occur, as it may be a sign of a blockage:
- Urine drainage is poor or no urine has collected for over two hours.
- Urine leaks from the dressing site or from your tubing.
- You can’t flush your tubing.
- Your nephrostomy tube falls out.
Removing the tube
Your nephrostomy tube is temporary and will eventually need to be removed. During removal, your doctor will inject an anesthetic at the site where the nephrostomy tube was inserted. They’ll then gently remove the nephrostomy tube and apply a dressing to the site where it used to be.
During your recovery period, you’ll be instructed to drink plenty of fluids, avoid strenuous activity, and avoid bathing or swimming.
Placement of a nephrostomy tube is temporary and allows urine to drain outside of your body when it can’t flow through your urinary system as normal. You should contact your doctor immediately if you have any concerns about your nephrostomy tube or suspect an infection or a block in your tubing.