A nephrostomy tube is a thin, flexible catheter inserted through the skin on the back or side directly into the kidney to drain urine into a collecting bag outside the body. This procedure becomes necessary when the ureter is blocked by obstructions like kidney stones, a tumor, or scarring, causing urine to back up and potentially damage the kidney. While the tube is effective for protecting kidney function and clearing infection, sleeping comfortably with it can be a source of discomfort and anxiety for patients. Successfully navigating the night requires a practical approach to body positioning, drainage management, and tube security.
Optimal Sleeping Positions
The primary goal when choosing a sleeping position is to avoid placing pressure on the tube insertion site and to prevent the tubing from kinking. For individuals with a single tube, lying on the side opposite the insertion is the most comfortable and safe option. This position keeps the tube site elevated and ensures the tubing can run freely without being compressed by the body or the mattress.
Sleeping on the back is another good position, particularly for those with tubes in both kidneys. To enhance comfort and maintain spinal alignment, a small pillow or rolled towel can be placed underneath the lower back to support its natural curve. Elevating the upper body slightly with pillows can also improve comfort.
Strategic use of pillows can stabilize the chosen position and discourage accidental rolling onto the tube. A body pillow placed behind the back acts as a physical barrier to prevent turning onto the tube side during sleep. If side-sleeping, placing a pillow between the knees helps maintain proper hip and spinal alignment, reducing strain. Avoid sleeping directly on the abdomen or on the tube site, as this pressure risks pain and potential tube dislodgement or blockage.
Managing the Drainage System Overnight
Effective management of the drainage system overnight ensures continuous, unobstructed urine flow and prevents backflow toward the kidney. The drainage bag must always be positioned lower than the level of the kidney to allow for proper drainage, respecting the principle of gravity. Therefore, a larger capacity nighttime drainage bag should be connected to the tube system before bed.
This bag should be placed securely on the floor, in a dedicated container next to the bed, or hung from a specialized stand or the bed frame. Using a stand or container prevents the bag from being kicked or accidentally pulled, which could tug on the tube. Before connecting the night bag, empty the smaller daytime leg bag to maximize the system’s capacity overnight.
The path of the tubing from the insertion site to the bag must prevent kinks or loops. Any sharp bends or compression points can impede urine flow, potentially leading to pain or pressure buildup in the kidney. If the tubing length is limited, using an extension tube can provide enough slack to allow for minor positional changes without creating tension. The system should be checked after settling into the final sleeping position to confirm the tubing path is straight and the bag is correctly positioned.
Safety Measures for Tube Security
Securing the nephrostomy tube is necessary to prevent accidental pulling or dislodgement during unconscious movement in sleep. The primary technique involves creating a “slack loop” or providing strain relief near the insertion site. This slack ensures that any minor tug on the external tubing does not translate directly into a pull on the tube inside the kidney.
The tube should be anchored to the skin away from the immediate insertion site using specialized fixation devices or medical tape. A common method is to use a hydrocolloid or clear dressing to secure the tube’s hub or a portion of the tubing to the back or side. Further down the tubing, it can be secured to pajamas or an elastic belt using a safety pin or clip to manage movement and prevent catching on bedding.
Patients should be aware of the warning signs of tube dislodgement or blockage, including sudden, severe flank pain or a cessation of urine drainage into the bag. If the tube appears to have moved significantly, or if there is leakage around the insertion site combined with no drainage, a healthcare provider must be contacted immediately. Regular inspection of the site and the drainage system should be integrated into the nightly routine.