A nephrostomy tube is a small, flexible catheter inserted through the skin on your back directly into one of your kidneys to drain urine into an external bag. This procedure is performed when the normal flow of urine from the kidney to the bladder is blocked, often due to kidney stones, tumors, or injury. If urine cannot drain properly, pressure builds up, which can rapidly damage the kidney and potentially lead to severe infection. Because the tube creates a direct channel, or tract, from the skin to the kidney, its dislodgement is an urgent medical event requiring immediate attention. The tract can begin to close quickly, making reinsertion much more difficult or impossible without forming a new access point.
Immediate First Steps When Dislodgement Occurs
When you realize your nephrostomy tube is out, stop any movement and remain calm. Immediately assess if the tube is fully dislodged or only partially migrated, as both situations require urgent care. A dislodged tube prevents the kidney from draining, potentially causing urine backup, pain, and a severe infection called urosepsis.
Manage the open tract site to prevent contamination and control any leakage. Gently place a clean, dry dressing or sterile gauze directly over the opening in your back. Apply gentle, steady pressure to keep the area clean while preparing to seek medical care. Never attempt to reinsert the tube yourself, as this risks serious injury to the kidney or introducing infection.
Save the dislodged catheter, as medical staff will need to inspect it to determine the size and type for replacement. Check the area for any signs of complications, such as excessive bleeding or infection (pus or unusual odor). These initial actions protect the patient and help preserve the tract until professional medical help is reached.
Preparing for Reinsertion and Medical Contact
Make urgent contact with your healthcare team immediately. Call the interventional radiologist or urologist who placed the tube, as they are best equipped to handle the replacement. If you cannot reach them or if it is after hours, proceed immediately to the nearest Emergency Room. Time is a critical factor because the tract can begin to close within hours, making successful reinsertion more likely if attempted within 24 to 48 hours of dislodgement.
When speaking with medical staff, provide specific information to expedite your care. Confirm the date the tube was placed, the reason for the nephrostomy, and the specific type of tube, if known. Gather your medical records, a list of current medications, and the saved dislodged tube and drainage bag before transport.
The medical team will typically reinsert a new tube through the existing tract using imaging guidance, such as fluoroscopy. This technique uses continuous X-ray images to guide a wire through the tract and into the kidney’s collecting system. This confirms the correct position before the new tube is placed and is much less invasive than creating an entirely new access point, which may be required if the original tract has fully closed.
Strategies for Preventing Tube Dislodgement
Preventative care and routine maintenance are essential to avoid tube dislodgement. A primary strategy involves using securement techniques to anchor the tube firmly to the skin and prevent accidental pulling. This includes proper taping methods and the use of specialized fixation devices, such as a StatLock, which stabilize the catheter at the exit site.
Activity modification is also important for prevention. Consciously avoid sudden movements or twisting that could create tension on the tube. Patients should avoid vigorous exercise or activities that put strain on the muscles near the insertion site. Routinely drain the collection bag, ideally when it is half to two-thirds full, to prevent the weight of the urine from pulling down on the catheter.
Day-to-day management requires careful dressing changes and routine inspection of the insertion site. Change the dressing whenever it becomes wet, soiled, or as often as instructed by your provider. During changes, inspect the skin for irritation, redness, or leakage, and ensure the tube is not kinked or twisted. Contact your doctor proactively if you notice persistent leakage around the tube, loose sutures, or kinking, as these signs indicate impending problems.