Caring for the Nephrostomy Tube

What Is a Nephrostomy Tube?

Urine is drained from the kidney through a nephrostomy tube. The doctor inserts a catheter called a nephrostomy bag to collect urine straight from the kidneys. An individual can empty the bag by using the valve on it. A catheter inserted by a radiologist or surgeon reaches the kidney through the skin of the lower back. One kidney may have one tube, or it might have two kidneys with one tube in each.

The kidneys typically produce urine. Urine flows from the kidneys into the bladder and ureters. Urine is stored in the bladder, an organ. Urine exits the body through the urethra when the bladder is full. Numerous things can obstruct the passage of urine from the kidneys to the rest of the urinary tract. Urine flow issues can be caused by obstructions, infections, trauma, or injuries, among other things. The duration of a nephrostomy tube's use is typically brief, ranging from months to years, depending on why the patient requires it. One might need to learn how to change the bag and take care of the nephrostomy tube. If necessary for an extended period, an individual might need to see the provider frequently to have the nephrostomy tube changed out.

Nephrostomy tube insertion is typically an outpatient surgery that allows the patient to return home (unless the patient receives treatment for another condition while hospitalized). Other terms for nephrostomy tubes are nephrostomy catheters and percutaneous nephrectomies.

What Is the Need for a Nephrostomy Tube?

Various factors obstruct the flow of urine from the kidney. A few of these consist of:

• Renal calculi (kidney stones).

• Kidney infection.

• Injury or trauma to the kidney.

• Swelling post kidney surgery.

• Tumors.

• Tissue scarring.

• Urinary tract congenital condition—something the patients are born with.

• Aggressive prostate cancer, bladder, or ureter.

When urine does not pass through the body, the patient may have a significant kidney blockage. If urine backs up into the kidney, it may become severely enlarged. Hydronephrosis is the term for this condition, which may harm the kidneys.

What Care Should Be Taken for Placing the Nephrostomy Tube?

The nephrostomy tube insertion is done while the patient is sedated, and the process usually takes less than an hour.

• Before the Procedure: Before getting the nephrostomy tube inserted, make sure the patient completes the following:

  • Discuss all of the dietary supplements and prescription drugs with the doctor. The doctor will advise the patient when to stop taking any medicines that the patient should not be taking before the surgery. It is always advisable to see the doctor before stopping any medicine.

  • Ensure the patients follow the nephrostomy tube care instructions given by the doctor regarding any dietary or beverage restrictions. For instance, an individual might not be allowed to consume anything after midnight the night before the surgery.

• During the Procedure: The doctor injects an anesthetic to beat the location of the planned nephrostomy tube insertion. Then, to assist them in properly inserting the tube, they use imaging technologies, including fluoroscopy, CT scan, and ultrasound. Doctors will adhere a little disk to the skin to help keep the tube in place after it has been put.

How Should the Nephrostomy Tube Care Be Done?

The physician will provide nephrostomy tube care instructions. The patient must empty any urine accumulated in the drainage bag and check the tube daily.

• Examining the Nephrostomy Tube Inside the Patient: When examining the nephrostomy tube, be sure to look at the following:

  1. Make sure the dressing is clean, dry, and fastened. If it is soiled, loose, or damp, it must be replaced.

  2. Verify that there are no red spots or rashes on the skin surrounding the dressing.

  3. Examine the accumulated pee in the drainage bag. Its color should not have altered.

  4. Verify that the tubing connecting the dressing to the drainage bag is free of twists or kinks.

• While Emptying the Drainage Bag: When the drainage bag is about halfway complete, the patient must empty it into a toilet. Individual differences may exist in the intervals between bag emptying. For some folks, this will need to be done every few hours.

• Flushing the Tube: Generally, patients should flush the tube once a day at the latest, but after surgery, patients may have to flush more frequently. One will receive detailed instructions on how to flush the tube from the doctor. The standard protocol is as follows:

  1. Make sure the patients give their hands a good wash. Put on the gloves.

  2. Deactivate the drainage bag's stopcock. This plastic valve manages the fluid flow of the nephrostomy tube. It contains three apertures. The tubes that hold the dressing together have one opening linked to them. The third is attached to an irrigation port, while the other is connected to the drainage bag.

  3. Grab the irrigation port's cap and give it a good alcohol swab.

  4. Enter the irrigation port with a syringe filled with saline. Do not inject more saline solution than five milliliters or draw the syringe plunger back.

  5. Reposition the stopcock so that it is in the drainage position.

  6. When the syringe has been removed, the irrigation port should be recovered with a clean cap.

• Additional Points:

  1. Make sure the drainage bag stays below the kidney level. Urine backlog is avoided in this way. The drainage bag is often fastened to the leg with straps.

  2. Ensure the patients wash their hands with warm water and soap or use an alcohol-based sanitizer before handling the drainage bag, tubing, or dressing.

  3. While the nephrostomy tube is in place, patients should not bathe or swim. Showering again is permitted 48 hours after the operation. Use a handheld showerhead to prevent the dressing from getting wet.

  4. After the procedure, restrict the activity to a moderate level and only raise it if the patient can handle it properly. Avoid any motions that can strain the tubes or dressings.

  5. The patients must change their dressing once a week or more.

  6. Make sure the patient consumes enough liquids.

How Should a Nephrostomy Tube Be Maintained at Home?

Nephrostomy tube care at home can be done by

• Before handling the nephrostomy tube, wash one’s hands.

• Every day, wash the area surrounding the tube with soap and water.

• To prevent urine backup, place the drainage bag below the kidney.

• After taking the bag out of the tube, the patient can clean it if the patient has been advised the patient can reuse it. While the patient cleans the bag, collect the pee in a different container. Pour two parts vinegar to three parts water into the bag, seal it, and let it stand for twenty minutes to clean it. After that, dump it and let it air dry.

• Every two to three hours, or before it fills up fully, empty the drainage bag.

• When the patients have a nephrostomy tube, they should avoid swimming and baths. The patient can shower once the nephrostomy tube's end is covered with plastic wrap.

• Every three days, if the nephrostomy tube gets filthy or wet, change the dressing surrounding it. One will receive dressing change instructions from a nurse.

What Are the Complications of the Nephrostomy Tube?

Nephrostomy tube implantation is typically a safe operation. Infection is the most frequent problem that patients could experience. If the patient encounters any of the following symptoms, the patient should call the doctor right once since they could point to an infection:

• Fever higher than 38.3°C (101°F).

• Discomfort in the lower back or side.

• Pain, redness, or swelling at the dressing site.

• Chills.

• Urine with an unpleasant odor is quite dark or hazy.

• Red or pink urine.

If any of the following happens, the patient should also call the doctor as they could indicate a blockage:

• Drainage is only adequate if pee gathers for up to two hours.

• Either the dressing location or the tube leaks urine.

• Flushing the tubing is not possible.

• One loses the nephrostomy tube.

What Care Should Be Taken While Removing the Tube?

Eventually, the temporary nephrostomy tube will need to be removed. The doctor will inject an anesthetic at the location of the nephrostomy tube insertion to facilitate removal. After that, they will carefully remove the nephrostomy tube and dress the area where it was previously located. Throughout the recuperation period, one will be advised to stay hydrated, refrain from physically demanding activities, and refrain from bathing or swimming.

Conclusion

A temporary nephrostomy tube is implanted to allow urine to exit the body when it cannot normally pass through the urinary system. If the patient detects an infection or a blockage in the tubing or worries about the nephrostomy tube, the patient should contact the doctor immediately.