Nephrostomy Tube Care

WHAT YOU SHOULD KNOW:

Nephrostomy Tube Care (Aftercare Instructions) Care Guide

A nephrostomy tube is a catheter (thin plastic tube) that is inserted through your skin and into your kidney. The nephrostomy tube drains urine from your kidney into a collecting bag outside your body. You may need a nephrostomy tube when something is blocking the normal flow of urine. A nephrostomy tube may be used for a short or a long period of time. The nephrostomy tube comes out of your back, so you will need someone to help care for your nephrostomy tube.

INSTRUCTIONS:

Medicines:

  • Antibiotics may be given to prevent or treat an infection caused by bacteria. You may need to take antibiotics for 5 to 10 days after the tube is placed.

  • Take your medicine as directed. Contact your primary healthcare provider (PHP) if you think your medicine is not helping or you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Follow up with your PHP as directed:

You may need a test called a nephrostogram to make sure your nephrostomy tube is in the correct place. Write down your questions so you remember to ask them during your visits.

How to clean the skin around the nephrostomy tube and change the bandage:

Since the nephrostomy tube comes out of your back, you will not be able to care for it by yourself. Ask someone to follow the general directions listed below to care for your nephrostomy tube. Ask your PHP how your skin should be cleaned and what skin barriers and attachment devices to use.

  • Gather the items you will need.

    • Disposable (single use) under-pad, and a clean washcloth

    • Plain soap, warm water, and new medical gloves

    • Sterile gauze bandages

    • Clear adhesive dressing or medical tape

    • Skin barrier

    • Tube attachment device

    • Protective skin film

    • Hydrogen peroxide and saline solution (if ordered by a caregiver)

    • Medicine for your skin (if ordered by a caregiver)

    • Trash bag

  • Check the tube entry site.

    • Place the under-pad where it will catch drainage as you are working with the nephrostomy tube.

    • Wash your hands with soap and water. Put on new medical gloves.

    • Gently remove the old bandage and skin barrier. Do this by holding the skin beside the tube with one hand. With the other hand, gently remove sticky tape and the skin barrier by pulling in the same direction as hair growth. Do not touch the side of the bandage that is placed over or around the tube. Throw the bandage and skin barrier away in a trash bag.

    • Look for signs of infection, such as skin redness and swelling. Report any skin changes to caregivers.

    • There may be a black mark on the tube to mark the place where the tube enters the skin. Check to see that the black mark is next to the skin. If it is further down the tube, the tube has moved. A caregiver needs to put it back in.

  • Clean the catheter site.

    • Hold the tube in place to keep it from being pulled out while you are cleaning around it.

    • You will need to clean the area twice. For the first cleaning, wet a new gauze bandage with soap and water. You may be directed to use hydrogen peroxide instead. Begin at the entry site of the tube. Wipe the skin in circles, moving away from the entry site. Remove blood and any other material with the gauze. Do this as often as needed. Use a new gauze bandage each time you clean the area, moving away from the entry site.

    • For the second cleaning, wet a new gauze bandage with water. You may be directed to use saline solution instead. Begin at the entry site of the tube. Wipe the skin in circles, moving away from the entry site. Use a new gauze bandage each time you clean the area, moving away from the entry site.

    • Gently pat the skin with a clean washcloth to dry it. Put medicine on the skin if directed by a caregiver.

  • Apply the skin barrier and bandages.

    • Cut an opening in the center of the skin barrier large enough to fit around the tube. Cut a slit from the outside edge of the skin barrier to the center opening so that you can fit it around the nephrostomy tube. Place the skin barrier around the nephrostomy tube. Make sure the skin barrier is not touching stitches that may be holding the tube in place. Put a protective skin film over the skin barrier if directed by a caregiver.

    • Roll up a bandage to make it thick, and wrap it around the place where the tube enters the skin. Place it to support the tube, and stop it from kinking or bending. Tape the bandage in place, and apply more bandages if directed by a caregiver.

    • An attachment device may be placed over the bandages to help keep the nephrostomy tube in place.

    • Bring the tubing forward to the front and tape it to the skin. Do not stretch the tube tight, because this may pull the nephrostomy tube out.

How often to change the bandage, skin barrier, and tube attachment device:

Change the bandage around the tube, the bolsters, skin barriers, and tube attachments at least every 7 days. If your bandages, barriers, or devices get dirty or wet, change them right away, and as often as needed. If your nephrostomy tube is to be used for a long period of time, the tube needs to be changed every 2 to 3 months. Caregivers will tell you when you need to make an appointment to have your tube changed.

How to care for the urine drainage bag:

You may use a reusable or a single-use (disposable) urine bag. If you are using a disposable urine bag, use it only once, and then throw it away. If you have a reusable urine drainage bag, ask when and how to clean it. The following are general directions for cleaning a reusable urine drainage bag:

  • Ask if you need to measure and write down how much urine is in the bag before you empty it. Drain urine out of the drainage bag when it is ½ to ⅔ full. Open the spout at the bottom of the bag to empty the urine into the toilet.

  • You may need to detach the drainage bag from the nephrostomy tube to clean it. If so, attach a new drainage bag tightly to the nephrostomy tube.

  • You may need to use a solution such as phosphoric acid to clean the bag. Ask what kind of cleaning solution to use. Use a plastic syringe (without a needle) to gently force the cleaning solution into the drainage bag as you clean it.

  • Ask if you should leave the cleaning solution in the bag for a time before you drain it out. When it is time to drain the bag, drain the cleaning solution out through the spout at the bottom.

  • Ask what to use to rinse the urine drainage bag. After you rinse the bag, empty it and hang it up to air dry before using it again. Throw reusable bags away after you use them for 1 week.

How to prevent problems with your nephrostomy tube:

  • Change bandages, skin barriers, and attachment devices as directed. This helps to prevent infection. Throw away or clean your drainage bag as directed by your PHP.

  • Wipe the connecting ends of the drainage bag with alcohol or iodine before reconnecting the bag to the tube. This helps prevent infection.

  • Keep the tube taped to your skin and connected to a drainage bag placed below the level of your kidneys. This helps prevent urine from backing up into your kidneys. You may wear a small drainage bag strapped to your leg to let you move around more easily.

  • Use a larger drainage bag at night and when you take naps during the day. This will help prevent urine from leaking out from the place where the tube enters your skin.

  • Check the catheter to be sure it is in place after you change your clothes or do other activities. Do not wear tight clothing over the tube. Place the tubing over your thigh rather than under it when you are sitting down. Be sure that nothing is pulling on the nephrostomy tube when you move around.

  • Change positions if you see little or no urine in your drainage bag. Check to see if the urine tube is twisted or bent. Be sure that you are not sitting or lying on the tube. If there are no kinks and there is little or no urine in the drainage bag, tell your PHP.

  • Flush out the tube as directed. Do this if you think the tube is blocked.

Other things to know:

  • Drink 2 to 3 liters of liquid each day unless you were told to limit liquids because of another condition. This amount is equal to about 8 to 12 (eight-ounce) cups of liquid. There should be 30 to 60 milliliters of urine draining into the bag each hour. A large amount of urine that drains over a shorter period of time should be reported. For example, 2,000 milliliters (2 liters) of urine draining out over 8 hours could be a sign of problems.

  • Keep the site covered while you shower. Tape a piece of clear adhesive plastic over the dressing to keep it dry while you shower. Do not take tub baths.

Contact your PHP if:

  • The skin around the nephrostomy tube is red, swollen, itches, or has a rash.

  • You have a fever.

  • You have lower back or hip pain.

  • There are changes in how your urine looks or smells.

  • You have large amounts of urine draining into the drainage bag over a short period of time.

  • You have little or no urine draining from the nephrostomy tube.

  • You have nausea and are vomiting.

  • The black mark on your tube has moved, or the tube is longer than when it was put in.

  • You have questions or concerns about your condition or care.

Return to the emergency department if:

  • The nephrostomy tube comes out completely.

  • There is blood, pus, or a bad smell coming from the place where the tube enters your skin.

  • Urine is leaking around the tube 10 days after the tube was placed.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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