A nephrostomy tube is a flexible tube inserted through the skin into the kidney to drain urine when the normal urinary tract is blocked. Obstruction might be caused by kidney stones, tumors, or injury, preventing urine from flowing to the bladder. The tube diverts urine flow, relieving pressure and protecting the kidney from damage or infection. Flushing the nephrostomy tube is necessary to maintain its patency—keeping the tube open and functional. This prevents the build-up of sediment, mucus, or clots that could lead to a blockage and compromise drainage.
Preparing for the Flushing Procedure
Preparation begins with gathering all necessary supplies, including sterile normal saline solution, a 10 milliliter (mL) syringe, antiseptic wipes, clean gloves, and a waste receptacle. The volume of saline used is small, typically 5 to 10 mL, because the renal pelvis only holds this amount of fluid. Always confirm the exact type and amount of saline prescribed by the healthcare provider, and never exceed this volume.
Maintaining a sterile environment is paramount to prevent introducing bacteria into the urinary system. Start with thorough hand hygiene, washing hands with soap and water, and ensuring a clean work surface. If a caregiver is performing the flush, they should put on clean gloves after washing their hands. Before connecting the syringe, the tubing connection port, often a stopcock valve, must be cleaned with an antiseptic wipe and allowed to air dry.
Step-by-Step Nephrostomy Tube Flushing
The flushing process begins by accessing the tube’s port, which often involves a three-way stopcock valve that controls urine flow and serves as the entry point for the flush. If a stopcock is present, turn the lever to temporarily stop the flow toward the drainage bag and open the port for the syringe. The syringe, prefilled with the prescribed amount of sterile saline, should have any air bubbles gently expelled before being firmly attached to the cleaned connection port.
Once secured, inject the saline into the tube using a slow, gentle, and consistent push on the plunger over several seconds. No force should be used during this injection; the saline must flow in easily. Immediately stop if any resistance is felt. The injection should be performed without pain, though a cool sensation may be felt. Do not attempt to pull back or aspirate the fluid, as this can damage delicate kidney tissues.
After the saline is fully instilled, return the stopcock lever to its original position to allow urine to drain into the collection bag. Unscrew and discard the syringe, then place a new sterile cap securely onto the connection port to maintain a closed system. The goal is to see urine flow resume or increase into the drainage bag, indicating the tube is successfully cleared.
Monitoring and Troubleshooting Common Issues
Immediate monitoring during and after the flush is necessary to identify potential complications. The most common issue is difficulty injecting the fluid due to resistance. If the plunger meets resistance or if the patient experiences new or increased pain at the insertion site while flushing, the procedure must be stopped instantly. Resistance indicates a partial or full tube blockage, or a kink in the tubing, requiring prompt attention from a healthcare provider.
Watch for leakage of fluid or urine around the tube’s exit site during or immediately following the flush. Leakage suggests the tube’s tip is no longer positioned correctly within the kidney or that the tube is partially dislodged. Signs of infection, such as fever greater than 100.4 degrees Fahrenheit, chills, new redness, swelling, or foul-smelling discharge at the tube site, warrant an immediate call to the medical team.
A sudden decrease in the amount of urine draining into the bag over several hours, despite adequate fluid intake, is a significant sign that the tube may be blocked and requires professional assessment. If the tube accidentally comes completely out, cover the site with a sterile dressing and seek emergency medical care without attempting to reinsert it. If any step of the process feels wrong, or if any unusual symptoms arise, contact the healthcare provider immediately for guidance.