A nephrostomy bag is an external medical device designed to drain urine directly from the kidney when the normal path to the bladder is blocked or compromised. The system consists of a flexible catheter inserted through the skin of the back and into the kidney’s urine-collecting system. This catheter connects to a drainage bag worn outside the body, which collects the urine. This device manages urine flow and prevents complications that arise when the kidney cannot properly drain.
Why Nephrostomy Drainage is Needed
The primary reason for placing a nephrostomy tube is to relieve an obstruction within the upper urinary tract, preventing urine flow from the kidney to the bladder. Normally, the kidney filters waste to produce urine, which travels down the ureter to the bladder. Blockages can occur due to kidney stones, scar tissue (strictures), tumors, or external compression from other growths.
When the ureter is blocked, urine backs up into the kidney, causing swelling (hydronephrosis). This fluid buildup increases pressure, which can damage filtering units and potentially lead to permanent loss of kidney function. Nephrostomy drainage quickly decompresses the kidney, allowing it to function properly and helping to clear infections. In emergency situations, especially when a blocked kidney is infected, this drainage can be lifesaving.
Understanding the Components and Placement
The nephrostomy system consists of the catheter and the external drainage bag. The catheter is a thin, flexible tube inserted through a small incision on the patient’s flank or lower back. Its tip is positioned inside the renal pelvis, the central urine-collecting area of the kidney.
The insertion procedure is typically performed by an interventional radiologist using imaging guidance, such as ultrasound or fluoroscopy. Once positioned, the catheter is secured with a locking mechanism, such as a “pigtail” coil inside the kidney, and sutures or a disk on the skin to prevent accidental dislodgement. The external end connects to a sterile drainage bag, usually strapped to the leg, to collect the urine.
Essential Daily Care and Management
Proper daily care is necessary to keep the nephrostomy system working effectively and prevent infection at the insertion site. The drainage bag must be emptied regularly, typically when it is one-third to one-half full, or at least four to five times per day. Emptying the bag through the spout prevents the weight from pulling on the catheter, which could cause discomfort or dislodgement.
Maintaining a clean and dry insertion site is important for skin integrity and infection prevention. The dressing around the tube should be inspected daily and changed at least every two to three days, or immediately if it becomes wet, dirty, or loose. When changing the dressing, gently clean the skin around the tube with soap and water and thoroughly dry it before applying a fresh, sterile dressing.
The tubing must be checked frequently for kinks or twists that could impede urine flow. The drainage bag must always be kept below the level of the kidney so gravity assists drainage and prevents backflow. Securing the catheter to the skin with medical tape or a stabilization device prevents excessive movement or tugging, which commonly causes pain and accidental removal.
Recognizing and Handling Common Issues
Living with a nephrostomy tube requires vigilance to recognize signs of potential problems needing prompt medical attention. A sudden decrease or complete absence of urine output, despite adequate fluid intake, signals a possible catheter blockage. This obstruction may be caused by blood clots, sediment, or a kinked tube, and might require flushing with sterile solution as instructed by a healthcare provider.
Signs of infection at the insertion site include increased redness, swelling, tenderness, warmth, or pus-like or foul-smelling drainage. More serious systemic signs, such as fever or chills, demand immediate contact with a doctor. Leakage of urine around the tube indicates the catheter is either partially blocked or has moved out of its proper position within the kidney.
If the catheter slips out completely (dislodgement), it is a medical emergency because the tract into the kidney can close rapidly. Any patient experiencing pain, heavy bleeding, or a tube that has come out must contact their healthcare provider immediately, as these issues affect kidney health. A displaced or non-draining tube often requires prompt replacement by a specialist to maintain kidney function.