Percutaneous Nephrostomy Tube
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Nephrostomy Catheter Care Instructions
WHAT IS A PERCUTANEOUS NEPHROSTOMY CATHETER?
A percutaneous nephrostomy catheter is a small flexible, rubber tube that is placed through your skin into the kidney to drain your urine (diagram):
WHY DO I NEED A PERCUTANEOUS NEPHROSTOMY CATHETER?
1. You may have a blockage of the ureter (the structure that normally carries urine from the kidney to the bladder).
2. There may be a hole in the ureter or bladder, causing urine to leak.
3. To prepare for surgery or other procedures on the kidney and ureter, such as removal of a large kidney stone.
HOW DO I PREPARE FOR THE PROCEDURE?
If you are already a patient in the hospital, your doctors and nurses will provide you with instructions. You will to be admitted to the hospital after this procedure, so please follow these listed instructions:
Unless otherwise instructed, do not eat any solid foods within 6 hours or drink any clear liquids within 2 hours of your scheduled appointment.
Notify our department as soon as possible:
If you take glucophage, insulin, aspirin, or a blood thinner so that we can adjust your dosage. You may take your other medications as usual.
Let us know if you have an allergy to x-ray (contrast) dye so that we can take the necessary precautions.
Bring all your medications with you on the day of the procedure.
An Angio nurse will attempt to call you 1-2 days before your scheduled appointment to review these instructions, obtain important medical information, and answer any questions or concerns that you may have.
WHAT HAPPENS BEFORE THE PROCEDURE?
1. A nurse and an interventional radiologist (a doctor specially trained to perform this procedure) will talk with you about the procedure in detail, answer your questions, and ask you to sign a consent form.
2. You will be asked to put on a hospital gown, and remove anything metal such as jewelry or false teeth/dentures. If possible, you should leave your valuables and jewelry at home.
3. Your family or significant other(s) will be asked to go to our designated waiting area.
4. An IV will be started for fluids, antibiotics, and pain and sedation medication.
5. You may also need labwork drawn prior to the procedure.
WHAT HAPPENS DURING THE PROCEDURE?
You will be taken into our procedure room where you will be placed on the x-ray table, lying on your stomach. Your blood pressure, heart rate, and oxygen level will be watched closely. Betadine (a brown-colored iodine soap) will be used to wash the area where the tube will be inserted. Lidocaine or Xylocaine (the same medication a dentist uses to numb your mouth) will be injected to numb the skin and deeper tissues. It will sting and burn for a few seconds before the area becomes numb. A nurse will also be present to give you medications to help you relax and to reduce your pain.
The interventional radiologist will use x-rays and/or ultrasound to locate your kidney and a needle will be inserted through your skin into the kidneys. Contrast (x-ray) dye will be injected through the needle and the nephrostomy catheter will be inserted into the kidney. You may feel some pressure and discomfort when the tube is inserted.
The nephrostomy catheter site will be covered with a dressing. The catheter itself will be connected to a drainage bag.You may attach the bag to your leg with 2 rubber straps. The urine will flow from your kidney through the catheter into the bag. The fluid may contain some blood at first. However, the blood usually clears over time.
WHAT HAPPENS AFTER THE PROCEDURE?
After the procedure you will be taken to the recovery room or up to your hospital room on a stretcher. Your vital signs will be monitored frequently for a few hours. You may eat your usual diet, unless you are nauseated or your physician has other tests scheduled.
Because everyone is different, the length of stay in the hospital will vary. Before you are discharged from the hospital, an angio nurse will provide care instructions and supplies with a family member or significant other present.
HOW LONG WILL I NEED THE NEPHROSTOMY CATHETER?
This depends on the reason you needed the catheter:
1. A blockage of the ureter either by stones, infection, scar tissue, or tumor- as long as the blockage is present.
2. A hole in the ureter- until the hole has healed.
3. In preparation for surgery or another procedure on your kidney or ureter- until after surgery.
You doctors will discuss with you how long you are likely to need the drainage catheter.
NEPHROSTOMY CATHETER CARE INSTRUCTIONS
HOW DO I CARE FOR THE TUBE?
1. Empty the bag before it is completely full.
2. Sponge baths are recommended to keep the dressing dry.
3. You cannot go swimming .
3. You can take a shower if you put a plastic covering, such as Saran Wrap, over the area.
4. The dressing should be changed every 3 days or when it gets soiled, wet, or loose. This includes the split sponges, 4x4 gauze, and tape. It is very important to wash your hands before removing the old dressing and then again before applying the new dressing. Tegaderm (a clear plastic tape) holding the blue plastic ring in place and telfa should only be changed once a week or when it becomes soiled, wet, or loose.
HOW DO I CHANGE THE DRESSING?
1. Assemble supplies: telfa, tegaderm, scissors, split gauze sponges, 4x4 gauze sponges, tape, connecting tube and drainage bag- if needed.
2. Carefully remove the old dressing, being careful not to pull the drainage catheter and keeping the blue plastic ring against the skin.
3. Inspect the skin around the catheter. Note any unusual redness, tenderness, or drainage. (SEE PROBLEMS YOU MAY EXPERIENCE).
4. Wash your hands thoroughly with soap and warm water.
5. Cut a round piece of telfa, the same size as the blue disc, or slightly larger. Cut a slit in the telfa, so that it will fit around the catheter. Place the telfa under the blue disc.
6. Fold a new Tegaderm in half and cut a hole in the center about the same size of the nipple on the blue disc. Put the catheter through this hole and apply the Tegaderm to the skin. If the catheter is attached to a drainage bag, you must first disconnect the bag, then slip the catheter through the Tegaderm.
7. Place two split gauze sponges around the catheter.
8. Fold 4x4 gauze on each side of the catheter, so you are able to curl the catheter once without kinking it. The catheter should rest on the gauze and not to the skin.
9. Cover the catheter with 4x4 gauze and secure the dressing with tape.
10. Put a piece of tape below the dressing to hold the catheter and act as a safety device.
11. The external drainage bag should be rinsed out and cleaned once a week with soap and warm water. Please allow to dry thoroughly. You will be given a second bag to use for these changes.
Supplies may be provided at each appointment. It will be helpful to bring a list of what you need.
You will be scheduled for your tube to be checked every 4 weeks and to be changed every 8 weeks. If you have a morning appointment, please do not eat breakfast, you may have clear liquids. If you have an afternoon appointment, you may eat a light breakfast, but please do not eat lunch. You may take your medications as usual. However, if you are a diabetic on oral hypoglycemics, do not take your pill if you skip breakfast. For those who are diabetic and take insulin regularly: take half of your NPH dose and take your normal dose of Regular insulin if you are eating breakfast. We have chemstrips to take your sugar level and lollipops if you feel your sugar is getting low.
If you are unable to keep your appointment or will be late, please call and let us know.
PROBLEMS YOU MAY EXPERIENCE:
1. The blue plastic ring comes away from the skin.
a. If this is only slightly away from the skin, push it back so that it touches the skin. It should move easily without much force.
b. If it is more than 1 inch away form the skin, you need to call the Angio/Interventional Radiology department, explain the problem and make an appointment for the tube to be checked.
2. The catheter becomes kinked.
a. If it is only slightly kinked, straighten it out and redress it.
b. If the kink is severe and/or there is a knot in the catheter, you need to make an appointment for a tube check.
3. The catheter stops draining into the bag. This may occur for 4 reasons.
a. The catheter may be kinked, so check it when you change the dressing.
b. The stopcock may be turned off, so check to make sure that it is open. When the knob is in line (parallel) with the catheter it is open.
c. If you have done the above and it still does not drain, the catheter may be blocked or the catheter may have moved. Please call the Angio/Interventional Radiology department and make an appointment ASAP to get your tube checked.
4. Skin rash.
If the skin under the tape becomes irritated, you may need to change the type of tape you are using. We can provide you with different tape at your next visit.
5. Leakage around the catheter site and/or the blue plastic ring.
Some clear to light yellow drainage around the catheter insertion site is to be expected for the first 1 to 3 days. If this drainage soaks through the dressing or becomes bloody or contains pus, please call the Angio/Interventional Radiology department for an appointment to check your tube ASAP.
a. Some discomfort is to be expected for the first week after the insertion of a new catheter. Tylenol, Aspirin, or Ibuprofen may help decrease the pain.
b. If you suddenly develop pain, please call your primary physician and make an appointment to see him/her.
If you get a fever for more than 12 hours, without another cause for the fever, such as a cold or flu, or if your urine becomes cloudy or bloodier, call the Angio/Interventional Radiology department. If your tube is draining internally, you may be instructed to connect the tube to a drainage bag.
ANY QUESTIONS OR CONCERNS?
DAYTIME- UVA Angio/Interventional Radiology Department- (434)924-9401
AT NIGHT OR WEEKENDS - UVA Emergency room and ask for the Angio/Interventional
Radiology Fellow on call- (434)924-9400
Thank you for choosing the University of Virginia Health System.
We welcome the opportunity to serve you. Thank you!
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