Percutaneous Nephrostomy
You had a procedure called percutaneous nephrostomy. This means that urine was drained from your kidney to prevent pain, infection, and kidney damage. You had the procedure because your kidney or the tube leading from the kidney to the bladder (ureter) was blocked by a kidney stone or tumor, or perhaps due to another problem. The blockage caused a backup of urine in your kidney.
A thin, flexible tube (catheter) will stay in place until the problem that caused the buildup of urine has been treated. This may be as soon as a day or as long as weeks to months. The catheter bag is taped to your leg so that you can walk around.
How to Care for Your Nephrostomy Tube
Activity
• Don’t lift anything heavier than 10 pounds until your healthcare provider says it’s OK.
• Don't do any strenuous activities, such as mowing the lawn, vacuuming, playing sports, or anything that will cause your tubing to be pulled or moved.
• Slowly increase your activity level with short, frequent walks 3 to 4 times a day.
• Don’t drive while you are still taking pain medicine. Wait until your healthcare provider says it’s OK to drive.
Home care
• Eat your normal diet.
• Drink 8 to 12 (8-ounce) cups of liquid each day unless you were told to limit liquids because of another condition.
• Wear loose, comfortable clothes that won’t pull or kink the catheter tube.
• Check your dressing often to make sure the tubing is secure.
• Don’t let the drainage bag hang freely, or it will pull on the catheter. Keep it secured to your leg or hold it temporarily.
• Empty the drainage bag often to keep the weight of the bag from pulling on the catheter.
o Empty the bag when it is 1/2 to 2/3 full.
o Always empty the bag before you go to bed.
o Wash your hands before and after emptying the bag.
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When do I call the doctor?
Skin that is:
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Red
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Swollen
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Tender to the touch
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Pulled away from the drain tube
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You have a fever of 101 F or more
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You have severe pain in your side or pain that was not there before.
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The fluid in the drain changes color or smells bad or discharge around the catheter.
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If you have any of the above symptoms, call by the next day (within 24 hours).
*If your tube falls out or gets pulled out, and you are actively losing large amounts of blood from the site, apply firm pressure to the site with a clean, dry towel for at least 10 minutes. If after 10 minutes of firm pressure, you are still soaking the towel, dial 911 or report to the closest Emergency Room for immediate medical attention!
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What should I expect?
It is very important to take care of your nephrostomy tube. This will help prevent infection. The following pages give you detailed instructions on how to change your bandage and clean around the drain tube. It also includes Information on bathing, your antibiotic medicines, and follow up visits.
When should I change the bandage?
· Change the bandage and clean the skin around the drain tube at least once a week.
· If the bandage gets wet or dirty, change it and clean around the drain tube. Do this even if you just changed the bandage the day before.
How do I change the bandage?
You will need a family member or friend to change the dressing for you.
You will need these supplies when you change the bandage and clean around the drain tube.
· Water-proof pads (“chux”) you can throw away
· Plain soap and warm water or an alcohol-based hand cleaner
· Disposable medical gloves – they do not have to be sterile
· Gauze pads (4x4s) -- you will need a total of 3 (three)
· Clean wash cloth
· Tegaderm
· Trash bag
Step 1. Remove the old bandage.
1. Lie down on your belly or side with the drain tube facing up.
Stopcock Flush Adaptor Tube
2. Place the water-proof pad (chux) so that it soaks up any spills as you clean the drain tube area.
Stopcock Flush Adaptor Tube
3. The person cleaning the drain tube should wash their hands with soap & water or hand cleaner and put on a new pair of medical gloves.
Wash hands and put on gloves.
4. Carefully remove the old bandage. Press on the skin next to the drain tube with one hand and gently remove the tape with the other hand.
5. Throw the old bandage in the trash bag.
6. Check the skin near the tube for signs of infection. See if the skin is:
· red
· swollen
· tender to the touch
· pulled away from the drain tube
If you have any of the above symptoms, call the VIR Clinic by the next day (within 24 hours).
Step 2. Cleaning the skin.
1. Hold the drain tube in place while you are cleaning around it so it doesn’t pull out.
Carefully hold the drain in place.
2. Wet a gauze 4x4 with soap and water.
3. Start cleaning where the drain tube comes out of the skin.
4. Wipe the skin gently in a circle. Move away from the drain tube in bigger and bigger circles.
Clean the skin carefully.
5. Gently pat the skin with the clean washcloth until it is dry.
6. Put on a fresh bandage. You will need three clean gauze 4x4s and a Tegaderm.
· Fold one of the gauze in half.
· Place it under the drain tube.
· Fold second gauze in half.
· Place it above the drain tube.
· Place the third gauze on top of the other two gauze and drain tube.
· Cover with a Tegaderm.
What about the drainage bag?
· Rinse out the bag two times a week. Use warm soapy water. You may use dish soap.
· Do not disconnect the drainage bag from the nephrostomy tube, except to rinse the drainage bag. The doctor will change the bag when the nephrostomy tube is replaced.
How should I bathe?
· Don’t take a tub bath or swim or sit in a hot tub while you have a nephrostomy tube.
· Do take showers, but keep the area around the drain tube dry. Keep it dry by taping a piece of plastic wrap over it or by wrapping plastic wrap around your body to cover it.
How do I take antibiotics?
• Your doctor may want you to take an antibiotic.
• Follow the instructions on the antibiotic medicine bottle.
• Make sure you take all of the antibiotic. Don’t stop taking it before you have finished all the pills unless your doctor tells you.
When is my follow up visit?
• Your Nephrostomy tube should be changed every 10 to 12 weeks if no other complications arise or as directed by your provider. Write down any questions you have for the doctor and take them with you.
• Make a list of the medicines you are taking and take it with you, or take in the actual medicines in their original bottles.
What if I have problems with the drain tube?
If your drain tube is leaking, unscrew the cap. Make sure the black string coming from the drain tube (if there is one) is threaded into the center of the cap.
Thread black string carefully into cap to avoid leaks.
After this, if the drain tube still leaks, call your doctor within the next 12 hours.
How to flush the stopcock:
• The person cleaning the drain tube should wash their hands with soap & water or hand cleaner and put on a new pair of medical gloves if they choose to.
Wash hands and put on gloves (if wearing gloves).
• Open the package of saline in a syringe.
• Unscrew and remove the cap on the drain tube. Put the cap on a clean surface so that nothing touches the inside of the cap. If anything touches the inside of the cap, germs could get into your drain tube and you could get an infection.
Drain tube cap.
• Turn the stopcock on the drain tube to the “on” position.
Turn the stopcock to the “on” position.
• Slowly push the 10ml of saline solution into the drain tube.
Attach syringe and flush drain tube.
• Attach syringe and flush drain tube.
• Turn the stopcock to the “off” position.
Turn the stopcock to the “off” position.
• Remove the syringe.
• Screw the cap back on the drain tube. Use a new cap if you are not sure the old one is clean.
• Remove your gloves and throw both the syringe and your gloves in the trash.
How to Use the Flush Adaptor Tube
Please Note: Depending on where your drain site is, your care team might have used a connector for your drain that looks like the one below. It does not have a "stopcock."
Follow these steps to flush this type of drain tube
• Wash hands: The person cleaning the drain tube should wash their hands with soap and water or hand cleaner. They can also put on a new pair of medical gloves if they want to.
• Close the clamp: Close the plastic clamp. This makes sure the fluid goes into the part of the tube that's inside the body – and not straight into the drainage bag.
• Open saline package: Open the package of saline in a syringe.
• Clean the port: Clean the needleless port with an alcohol wipe. If you don't have alcohol wipes, use warm soapy water and a clean cloth. Hold the drain securely with one hand, then scrub the port back and forth for 15 seconds to remove germs.
• Attach the syringe: Attach the syringe to the needleless port with a push-and-twist motion.
• Flush the tube: Push on the end of the saline syringe to flush the fluid through the tube.
• Remove and dispose: Untwist the empty syringe and throw it away. (Next time you flush, use a new syringe.)
• Unclamp the clamp: When you do this, you should see the saline you just flushed flow into the drainage bag.
Flushing the tube as ordered by your doctor helps keep your tube from getting blocked.