Learn what a nephrostomy tube does, and what is involved in nephrostomy dressing. Also read on for nephrostomy tube care instructions.
A nephrostomy is an artificial opening created between the kidney and the skin, which allows for direct drainage of urine from the upper part of the urinary system (renal pelvis) when normal urine flow from the kidney to the bladder is impeded. Usually a nephrostomy tube is placed through this opening and is connected to a drainage bag for ease of care.
The nephrostomy tube provides permanent or temporary urinary drainage following a procedure or to relieve ureteric obstruction. It may be inserted by open surgery in an operating theatre or under image guidance by the radiologist.
When Your Child Needs a Nephrostomy Tube
• Temporary drainage of the kidney (a few days) after an interventional procedure through the kidney e.g. ante grade stent insertion or removal of renal calculi
• Long-term decompression of an obstructed system (weeks to months) to relieve ureteric obstruction and improve renal function
Pre-operation Prep
You will be given information to prepare your child before the procedure or operation. Inform your doctor if your child is on medication (especially blood thinning medication e.g. warfarin). He should usually stop taking these medications seven to 10 days before surgery, as they increase the risk of excessive bleeding. The doctor will inform you when to stop and restart the medication. Blood and urine samples will be taken for investigation.
Post-operation Nephrostomy Dressing
A nephrostomy dressing will be covering the site of the tube which will be checked by the nursing staff. There may be blood draining from the tube, which is normal and should decrease in a few days. Your child should drink the recommended amount of fluid to flush the blood from the kidneys, unless otherwise advised. He may be required to stay in the hospital for two to three days and may be discharged with the tube attached to a drainage bag.
Caring for Nephrostomy Tube Patients
Information on caring for the tube will be provided to you or a family member before your child is discharged from the hospital. Consult your doctor on the recommended amount of fluids your child should drink daily and the minimal amount of urine you can expect your child to pass daily. Make sure you are provided with extra drainage bags and given information on how to obtain more supplies.
All patients discharged with a nephrostomy tube will be referred to the outpatient Children’s Surgery Centre. Follow-up visits at the outpatient Children’s Surgery Centre will be scheduled for a regular nephrostomy tube dressing change.
Daily Nephrostomy Tube Care Instuctions and Nephrostomy Tube Irrigation
• Empty the drainage bag as required and record the amount drained, if instructed by your child’s doctor
• Ensure that the tube is kept straight and not twisted to allow proper flow of urine
• Keep the tube well-secured
• Nephrostomy tube irrigation may be needed if there is absence of urine or urine flow in the drainage system, blood in the urine or if flank pain occurs — you will be taught how to do this if regular irrigation is required
Nephrostomy Tube Dressing Change
• Change the dressing 24 hours after insertion and thereafter, on a weekly basis or more frequently if it becomes soiled, damp or loose
• Gauze dressings should be replaced every day
• Transparent dressings should be replaced every seven days
During dressing change, check your child’s skin condition at the catheter exit site for:
• Inflammation
• Erythema
• Skin breakdown
• Discharges
If you note any of the above, please inform the Children’s Surgery Centre nurses or your doctor.
Note: Changes of dressings and drainage bags should be done at the Children’s Surgery Centre every week.
Changing the Drainage Bag in Event of Displacement
• Wash your hands well
• Clean the nephrostomy tube at the connection point with an alcohol swab
• Be careful not to touch the tubing where it fits together
• Gently pinch with your fingers the soft nephrostomy tubing to prevent any leakage
• Connect to a new drainage bag
• Make sure your bag is below the level of your kidneys to prevent urine flowing back into the kidney
Bathing Your Child
While the nephrostomy tube is in place, your child will not be able to take a bath. Instead, you will need to give your child sponge baths. Showers are allowed as long as the tube is secured with plastic wrap. Do not let the water pound on the tubing. A change of dressing is required if the dressing gets wet after a shower.
Swimming is not allowed as long as the tube is in place.
Nephrostomy Tube Irrigation
Your doctor will order flushing of nephrostomy tube if there is absence of urine, if urine remains heavily bloodstained, if the patient has persistent flank pain or there is suspected blockage.
• Do not aspirate or force irrigation. If resistance occurs, ask the patient to lie down on their back and then again on their side
• Do not flush greater than 5ml of sterile normal saline
• Observe for continuous urine flow and signs of infection
Note: A Medical Officer (MO) or a Specialised Care Nurse can perform nephrostomy tube irrigation.
When to Visit the Doctor
Please call the Children’s Surgery Centre Nurse at 6394 8036, if problems occur such as:
• Urine changes colour, smells foul or becomes bloody
• Urine leakage around the catheter causing the dressing to become wet
• Pain in the back, sides or abdomen
• Fever or vomiting
• Urine drainage stops
• Skin around the tube becomes raw, irritated or develops a rash, causing pain or discomfort
• Discharges around the tube
If the nephrostomy tube falls out, it must be replaced as soon as possible, as the insertion site may begin to close. You will need to seek immediate medical attention at KK Hospital, Children’s Emergency, Children’s Tower, Basement 1.
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