A nephrostomy tube is a small, flexible catheter inserted through the skin directly into the kidney to drain urine. This medical device provides an alternate pathway for urine flow when the body’s natural drainage system is blocked or compromised. By diverting urine from the kidney’s collecting system to an external drainage bag, the tube relieves pressure that can damage kidney tissue. This diversion is often a temporary measure designed to protect and preserve kidney function.
Primary Reasons for Placement
The most common reason for placing a nephrostomy tube is to bypass an obstruction within the urinary tract that prevents urine from flowing normally from the kidney to the bladder. Blockages in the ureter—the narrow tube connecting the kidney and bladder—can be caused by various medical conditions. These include large kidney stones, internal tumors, external cancers (like prostate or cervical cancer), or scar tissue resulting from previous surgery or chronic inflammation.
When urine cannot drain freely, it backs up into the kidney, causing swelling known as hydronephrosis. This increased pressure can quickly lead to pain, infection, and permanent damage if left untreated. A nephrostomy tube immediately relieves this back pressure, which is crucial if an infection is present, as an obstructed kidney poses a high risk of sepsis. The tube can also be placed to allow a physician to access the kidney for other procedures, such as removing a complex kidney stone or delivering chemotherapy directly to the renal collecting system.
The Insertion Procedure
Placing a nephrostomy tube is a minimally invasive procedure, typically performed by an interventional radiologist or a urologist. The patient is positioned, usually lying on their stomach, and the area on the back or flank is sterilized and numbed with a local anesthetic. A mild sedative or pain medication is often administered intravenously for comfort.
The physician uses real-time imaging guidance, such as ultrasound or fluoroscopy (a type of live X-ray), to precisely locate the kidney and the best entry point. A small needle is inserted through the skin into the renal pelvis, the central urine-collecting area of the kidney. A flexible guide wire is threaded through this needle, and the nephrostomy tube is advanced over the wire to its final position. The tube is secured to the skin with a suture or specialized dressing and connected to a drainage bag.
Daily Care and Management
Living with a nephrostomy tube requires careful daily maintenance to prevent infection and ensure proper function. The dressing covering the insertion site must be kept clean and dry, usually requiring a change every three days or whenever it becomes soiled or wet. When changing the dressing, the skin around the tube should be gently cleaned and inspected for any signs of irritation.
The external tube must be secured to the body with tape or a specialized fixation device to prevent accidental pulling or kinking. The drainage bag must remain positioned below the level of the kidney, allowing gravity to facilitate continuous urine flow. It is important to empty the drainage bag when it is approximately half full to avoid excessive tension on the insertion site.
Patients must avoid activities that may dislodge the tube, such as heavy lifting or vigorous exercise. While showering is permitted, the dressing should be covered with plastic wrap and changed immediately if it becomes damp. Full immersion in water, including bathing, swimming, or using a hot tub, is prohibited to minimize the risk of waterborne bacteria entering the insertion site. In some cases, a physician may prescribe flushing the tube with sterile saline several times a week to prevent clogging.
Recognizing Potential Issues
Several signs and symptoms indicate a potential issue with the nephrostomy tube that requires immediate medical attention. The most serious concern is infection, which may present as a fever greater than 100.4°F, chills, or significant redness, swelling, or pus-like discharge at the tube site. Blockage is suggested by a sudden absence of urine draining into the collection bag or the onset of severe flank pain.
Any significant bleeding that continues beyond the first 48 hours after placement, or the recurrence of bright red blood and clots in the urine, should be reported promptly. If the tube accidentally falls out or has visibly moved a significant distance, seek immediate care. Attempting to reinsert the tube at home is strongly discouraged due to the risk of severe injury.