Care of the Patient With a Nephrostomy Tube

The urinary system normally consists of 2 kidneys and 2 ureters that lead to the bladder and the urethra. The system may become obstructed from a variety of reasons, such as scar tissue, kidney stones, or tumors. In order to relieve such obstructions and prevent complications such as hydronephrosis and kidney failure, a nephrostomy tube may be indicated. A nephrostomy tube is a thin catheter that is placed into the kidney through a small incision in the back to drain the urine. The tubes drain via gravity (Figure 1). This is connected to a drainage bag and is managed at home by the patient. These tubes may be temporary, long-term, or even permanent.  

Because the procedure is very easy and morbidity is low, nephrostomy is becoming an increasingly widespread and accepted technique, with the number of patients who undergo this procedure increasing exponentially. Subsequently, there are many people living with nephrostomy tubes that need support. The procedure is usually performed in an outpatient setting by an interventional radiologist or urologist using local anesthesia.

Patients often have difficulty with managing the care of nephrostomy tubes, as the tubes are inserted into the back, which makes it difficult to reach and visualize. The dressings have to be changed at least weekly (Figure 2), and the tubes may need to be flushed. As such, some patients may need a home care nurse to assist them. Complications may arise from nephrostomies; therefore, good information on how to properly maintain the tubes is paramount. Some of the complications include local pain and redness at the insertion site, leakage of urine around the tube, obstruction of the tube, and pyelonephritis.

Local pain and redness at the insertion site may be caused by adhesive allergy, localized skin infection, or sensitivity to concentrated urine that is leaking around the tube. A different type of dressing may be needed if the patient is allergic to adhesives. If urine is leaking around the tube, check for kinks, make sure all valves are open to allow the urine to flow, check the drainage bag, and change if necessary. If the tube is full of particles, it may need to be flushed; be advised that a provider order is needed for flushing. If the patient has a fever over 101°F with or without chills, pain in the back or side, dark or red/pink or cloudy urine, or malodorous urine, this may indicate a serious infection and needs medical evaluation. In addition, if the patient has redness and swelling around the tube, accompanied by pain at the site and/or fever, this too may indicate an infection at the insertion site that warrants medical evaluation. If the tube becomes dislodged or has decreased output or bleeding around the site, the patient will need to be evaluated by a provider.   

After a review of the literature, United Ostomy Associations of America, Inc. (UOAA) found limited resources for the questions that arise when a person is living with a nephrostomy. In response to this lack of information, the UOAA has recently released the “Nephrostomy Facts Booklet.” This is a 16-page booklet designed to help people living with nephrostomy tubes. The booklet was co-authored by 2 certified wound and ostomy nurses and reviewed by 3 urologists. As part of UOAA’s research, a person living with 2 nephrostomy tubes was included in the development of the booklet. She related many challenges, such as how to protect the tubes while showering, how to choose appropriate clothing, and how to change the dressings, as well as how to live alone with the tubes with limited assistance. Her input was invaluable to the development of the resource. 

             Nephrostomy tubes can be challenging to manage, and patients need education and support. This booklet was developed to help those patients and also provides a good source of information for nurses caring for such patients. The booklet covers topics such as facts, simple anatomy, changing the dressing, and flushing the tubes. There is also a page on troubleshooting common problems. The booklet is located on the UOAA website, www.ostomy.org, and is free to print.

Kimberly Adams is currently the hospital-based Clinical Leader of Wound and Ostomy Services for the Concord Hospital Regional System. 

Kimberly is a 1988 graduate of Concord Hospital School of Nursing, having completed her Bachelor of Science in Nursing through Chamberlain College in 2012, Wound and Ostomy Board Certification through Emory University in 2012, and her Master of Science in Nursing Education through Norwich University in 2017. She is a member of Wound, Ostomy and Continence Nurses Society, New England Region Wound, Ostomy Continence Nurses Society.

Kimberly is dedicated to education and empowerment for people living with ostomies.