A nephrostomy tube provides an alternate route for urine to drain from the kidney when the normal pathway is blocked by issues like kidney stones, infection, or a tumor. This thin, flexible tube is inserted through the skin of the back directly into the renal pelvis, the part of the kidney that collects urine, preventing damaging back pressure. The tube connects to an external drainage bag, which collects the urine. Proper management and periodic changing of the bag, along with care for the skin site, are necessary to prevent infection and ensure efficient drainage.
Supplies Needed and Preparation
Gathering all necessary supplies and preparing the environment is essential before changing the bag to maintain sterility. You will need a new, sterile drainage bag, antiseptic wipes (such as alcohol or chlorhexidine), clean gloves, and materials for securing the tube, like tape or a specialized fixation device. Adhesive remover wipes or spray are helpful for loosening the securing device without painful tugging on the tube. Keep a basin ready for disposing of the old bag and a separate receptacle for soiled dressings and wrappers.
The preparatory steps focus on hygiene and positioning. Wash your hands thoroughly with soap and water for at least 20 seconds, then put on clean gloves. Position yourself comfortably, either sitting upright or lying on the side opposite the tube, for easier access to the connection site. Ensure the new bag is accessible and that you have a clean, flat surface for sterile supplies. This setup minimizes the time the connection point is exposed and reduces the chance of contamination.
Step-by-Step Guide for Changing the Bag
Changing the nephrostomy bag is a sequential procedure designed to prevent the introduction of microorganisms. First, empty the existing drainage bag completely into the toilet or a measurement container before disconnecting it. Locate the connection hub where the drainage tube meets the bag tubing. If a three-way stopcock is present, turn it to the “off” position for the drainage bag to temporarily stop urine flow.
Carefully detach the old bag from the connection point, avoiding pulling on the tube to prevent pain or dislodgment. Immediately use an antiseptic wipe to thoroughly clean the exposed end of the nephrostomy tube connector for 30 seconds. Allow the connector to air-dry completely to ensure disinfection, as this connection point is a common pathway for bacteria. Dispose of the old drainage bag according to your healthcare provider’s instructions while the connector dries.
Once the connector is dry, securely attach the new, sterile drainage bag, ensuring a tight seal to prevent leaks. If using a stopcock, turn the tap back to the “open” position so urine flows into the new bag. Check the entire length of the tubing for kinks or twists that could obstruct flow. Finally, secure the tube to your skin or clothing using a specialized device or tape to prevent accidental pulling or migration.
Daily Management of the Skin Site
Routine care of the exit site is a daily task focused on infection prevention and skin integrity. Clean the skin around the tube once daily using mild soap and warm water. Gently wipe in a circular motion, starting at the tube and moving outward, to remove crusted material or drainage without pushing contaminants toward the insertion point. After cleaning, carefully pat the skin dry with a clean cloth or gauze, as moisture increases the risk of skin breakdown.
The tube must be anchored securely at all times to minimize movement and friction against the skin, which prevents irritation or accidental dislodgment. A specialized fixation device or secure dressing absorbs minor drainage and provides a barrier against contamination. Check the skin daily for signs of irritation, such as redness, swelling, or new tenderness. Any small amount of clear or yellowish drainage should be cleaned away completely during the daily routine.
When to Contact a Healthcare Provider
Contact a healthcare provider immediately if you observe signs suggesting a complication, such as infection or tube blockage.
Signs of Systemic or Localized Infection
A fever of 101°F (38.3°C) or higher, especially with chills, indicates a systemic infection requiring prompt medical attention. Localized infection signs at the insertion site include:
- Worsening redness or swelling.
- Increased pain not relieved by medication.
- Presence of pus-like or foul-smelling drainage.
Drainage Issues
Changes in the urine draining into the bag can also signal an issue. Contact your provider if you notice:
- New or bright red blood in the urine.
- Urine that is suddenly cloudy or has a strong, unpleasant odor.
- Little to no urine draining over several hours, despite usual fluid intake, which may indicate a blockage or kinking.
- Leakage of urine around the tube site, suggesting improper drainage.
- The tube appears to have moved or completely fallen out.