A nephrostomy tube is a small, flexible catheter inserted through the skin of the back directly into the kidney to divert urine flow. This procedure is performed when a blockage, such as a kidney stone or tumor, prevents urine from draining normally to the bladder. The tube connects to an external drainage bag, which must be changed regularly to maintain hygiene and ensure the system functions correctly. Proper home care is necessary to avoid complications and protect the kidney from damaging back pressure and potential infection.
Supplies and Preparation
Before beginning the process, gather all necessary equipment and establish a clean work environment. You will need a new, sterile drainage bag, sterile or clean gloves, alcohol preparation pads or antiseptic wipes, and a tube clamp. Also required are sterile gauze pads, medical tape or a specialized securement device, and a skin barrier wipe. This wipe is a film that protects the skin from adhesive and moisture.
Begin by washing your hands thoroughly with soap and water for at least twenty seconds, then dry them completely. Set up supplies on a clean, dry surface, ensuring everything is within easy reach. Before starting the change procedure, the old drainage bag should be emptied completely into a toilet and measured if you are tracking output.
The Step-by-Step Changing Process
Once preparations are complete, you must first stop the flow of urine to prevent leakage during the swap. Use a non-toothed clamp, typically a specialized plastic clip, to gently but firmly close the nephrostomy tube several inches away from the insertion site. This action temporarily halts the flow of urine from the kidney.
With the tube clamped, carefully disconnect the tubing of the old drainage bag from the connector hub of the nephrostomy tube. The connection is often a twist-off or friction-fit mechanism. Discard the old bag immediately in a plastic waste bag.
Next, sanitize the exposed connection point on the nephrostomy tube, as this is a direct pathway into the kidney. Use an alcohol prep pad or antiseptic wipe to clean the exterior surface of the connector hub for at least thirty seconds. Allow it to air-dry completely for the recommended time, usually another thirty seconds, to ensure maximum germicidal effect and prevent bacteria from entering the system.
Take the new drainage bag, ensuring the cap or port is closed, and connect its tubing securely to the cleaned nephrostomy tube hub. Ensure the connection is tight and properly seated to prevent leaks. Finally, remove the clamp from the nephrostomy tube and observe the tubing to confirm that urine flow has resumed into the new bag.
Securing the Tube and Skin Care
After successfully connecting the new bag, focus on maintaining the health of the skin around the insertion site and securing the system. Gently remove the old dressing, taking care not to pull on the tube, and inspect the skin for any signs of irritation or breakdown. Clean the skin surrounding the tube entry point with mild, unscented soap and water, working outward from the tube to remove drainage or crusting.
Pat the area completely dry with a clean cloth or gauze pad, as moisture can lead to skin maceration and infection. Apply a specialized skin barrier wipe, such as a no-sting liquid film, to the surrounding skin area. This clear film acts as a protective layer, shielding the skin from slight urine leakage and adhesive from the securement dressing.
The nephrostomy tube must be secured with a specialized fixation device or a combination of tape and a split gauze pad to prevent tension on the kidney. This external anchor prevents the tube from being accidentally tugged or dislodged, which can cause significant pain and require urgent replacement. Ensure the drainage tubing is free of kinks and positioned below the level of the kidney, typically strapped to the leg, to utilize gravity for continuous drainage. The bag should be routinely emptied when it is no more than two-thirds full to prevent the weight from pulling on the tube.
Signs of Complications and When to Call for Help
Monitoring the nephrostomy site and your overall health for warning signs is a routine responsibility of home care. A sudden rise in body temperature above 100.4 degrees Fahrenheit (38 degrees Celsius) or the onset of chills indicate a systemic infection requiring immediate medical attention. Localized signs of infection include increasing redness, swelling, tenderness, or a thick, foul-smelling discharge.
Changes in urine output or quality are serious indicators of potential problems. If the drainage bag fails to collect urine for two or more hours, or if the urine becomes noticeably dark, cloudy, or contains bright red blood, the tube may be blocked or compromised. Persistent leakage of urine around the insertion site, rather than into the bag, suggests a blockage or that the tube has shifted out of position.
Any instance where the tube feels loose, is partially pulled out, or is completely dislodged constitutes an emergency. Seek care immediately to prevent the surgical tract from closing and urine from backing up into the kidney. Severe pain in the side or lower back that does not improve with standard pain medication also warrants an urgent call to your healthcare provider. Never attempt to re-insert a dislodged tube yourself.