A nephrostomy tube is a thin, flexible catheter inserted through the skin into a kidney to drain urine, providing an alternative pathway when the natural urinary system is blocked or damaged. Its purpose is to divert urine directly from the kidney into an external drainage bag. Consistent and unobstructed urine drainage is important for kidney health, as blockages can lead to urine backing up, potentially causing kidney swelling, damage, or infection.
Initial Assessment and At-Home Steps
When a nephrostomy tube is not draining, several at-home steps can help assess the situation. Check the entire length of the tubing for any kinks, twists, or bends, which can obstruct urine flow. Ensure the drainage bag is always positioned below the level of the kidney, as gravity assists proper drainage. Repositioning the body, such as gently changing from lying down to sitting or standing, might also help dislodge minor obstructions and encourage flow. These actions are initial checks to identify simple mechanical issues.
Verify that the stopcock is in the correct open position, allowing urine to drain into the bag. Sometimes, a luer lock cap might accidentally occlude the tube, preventing drainage. If urine output is low, consider your fluid intake, as dehydration can reduce urine production. These at-home steps are meant for basic troubleshooting before escalating concerns to a healthcare provider.
Recognizing Urgent Signs and When to Contact a Healthcare Provider
When a nephrostomy tube is not draining, recognizing urgent signs is important, as they can indicate a serious problem. Contact a healthcare provider immediately if you experience a fever or chills. Severe pain in your flank or back, especially if not relieved by over-the-counter medication, is another concerning symptom. Look for signs of infection around the tube insertion site, such as new or increased redness, swelling, or tenderness.
Persistent lack of drainage, even after performing at-home checks, warrants medical attention. Changes in urine appearance, such as cloudiness, foul odor, or bright red blood/clots, also warrant contact. Urine leaking around the tube insertion site can signal a blockage or tube malposition. If the tube accidentally comes out or if the stitches holding it in place become loose, seek immediate medical care.
Potential Reasons for Drainage Issues
Several underlying issues can cause a nephrostomy tube to stop draining effectively. One common reason is mechanical obstruction, such as a kink or twist in the tubing itself, preventing urine from flowing freely into the collection bag. The tube might also become blocked internally by debris, blood clots, or mineral deposits from the urine. After the initial insertion procedure, some blood in the urine is common for a few days, but larger clots can lead to blockages.
Dislodgement or migration of the tube, where it moves out of its optimal position within the kidney, can hinder proper drainage. An infection can also contribute to drainage problems, either by causing swelling around the tube site or by leading to the formation of pus or other material that clogs the tube. Sometimes, the tube might be unintentionally capped or have a closed valve, preventing flow. Reduced urine production due to dehydration can also result in minimal drainage, although this is distinct from a blocked tube.
Medical Management of Drainage Problems
When a nephrostomy tube drainage issue requires professional intervention, healthcare providers use various management strategies. Initially, they may attempt to flush the tube with sterile normal saline to clear any blockages caused by debris or blood clots. This procedure uses gentle pressure and should not be forced if resistance is met. Imaging studies, such as X-rays, ultrasound, or CT scans, visualize the tube’s position and identify the cause of blockage or dislodgement.
If flushing is unsuccessful or if imaging reveals significant issues, repositioning the tube under imaging guidance may be necessary. In some cases, if the tube is severely blocked, damaged, or dislodged beyond simple repositioning, it may need to be replaced entirely. If an infection is suspected or confirmed, antibiotics will be prescribed to treat it, addressing the underlying cause of the drainage problem.
Preventing Future Drainage Problems
Preventing future nephrostomy tube drainage problems involves daily care. Maintaining adequate hydration by drinking 1.5 to 2.5 liters of fluid daily, unless otherwise advised by a healthcare provider, can help keep urine dilute and reduce the risk of blockages from sediment. Inspect the tube regularly for kinks or twists, especially after changing clothes or during daily activities. Ensuring the drainage bag is always kept below the kidney level prevents backflow and promotes continuous drainage.
Regularly emptying the drainage bag, ideally when it is half to two-thirds full, prevents the bag from becoming too heavy, which could tug on the tube and potentially dislodge it. Adhering to the prescribed schedule for dressing changes around the insertion site, typically every few days or weekly, helps maintain cleanliness and prevents infection. Following all post-procedure instructions from your healthcare provider, including proper cleaning techniques and scheduled tube changes, helps ensure the tube functions effectively.