Nephrostomy Tube Care

GENERAL INFORMATION:

What is a percutaneous nephrostomy tube? A percutaneous (per-ku-TA-ne-us) nephrostomy (ne-FROS-to-me) tube is a catheter (plastic tube) that is inserted through your skin into your kidney. The nephrostomy tube is placed to drain urine from your body into a collecting bag outside your body. You may need one nephrostomy tube, or two tubes if you need one for each of your kidneys.

Why might I need a percutaneous nephrostomy tube? You may need a percutaneous nephrostomy tube when something is blocking the normal path that your urine takes to leave your body. Urine from your kidneys passes through thin, narrow tubes called ureters. Your ureters are connected to your bladder where urine is stored for a time before you urinate. If your ureters get blocked by stones or blood clots, urine stays in your kidneys and will cause problems. The nephrostomy tube is put in to drain your urine directly from your kidneys. You may need this tube if you have pelvic tumors, damage to the urinary system, prostate cancer, or other conditions.

How do I clean the skin around the nephrostomy tube and change the bandage? Since the nephrostomy tube comes out of a hole made in your back, you will not be able to care for it by yourself. Ask for help caring for your nephrostomy tube. Ask your caregiver how you should clean your skin, and what skin barriers and attachment devices you should use. The following are general directions for caring for the nephrostomy tube:

• Gather the following items:
  
  
  • Disposable (single use) under-pad, and a clean washcloth.
    
    
  • Plain soap (without lotions or perfumes), warm water, and hand cleaner.
    
    
  • Sterile (new) gauze bandages.
    
    
  • Clean medical gloves.
    
    
  • Clear adhesive dressing or medical tape.
    
    
  • Skin barrier. 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.
    
    
  • Tube attachment device.
    
    
  • Protective skin film.
    
    
  • Hydrogen peroxide (if ordered by a caregiver).
    
    
  • Saline solution (if ordered by a caregiver).
    
    
  • Medicine for your skin (if ordered by a caregiver).
    
    
  • Trash bag.
  
  

• Remove the old bandage, and look at the tube entry site:
  
  
  • Have the patient lie on his side with the nephrostomy tube entry site facing up. Place the under-pad where it will catch drainage as you are working with the nephrostomy tube.
    
    
  • Wash your hands using soap or a hand cleaner. Put on clean gloves.
    
    
  • Gently remove the old bandage and skin barrier. Do this by supporting (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. Throw the bandage and skin barrier away in a trash bag.
    
    
  • Look for problems such as skin redness and swelling. Report any skin changes to the patient's caregivers.
  
  

• Clean the area:
  
  
  • Hold the tube in place to keep it from being pulled out while you are cleaning around it.
    
    
  • Wet a gauze bandage with soap and water, or hydrogen peroxide if your caregiver has told you to. Beginning at the entry site, wipe the skin in circles, moving away from the entry site of the tube. Remove blood and any other material with the gauze. Do this as often as needed. Use a new bandage each time you wipe, moving away from the tube entry site.
    
    
  • Wet a new gauze bandage with water, or saline solution if your caregiver has told you to. Beginning at the entry site, wipe the skin in circles, moving away from the entry site of the tube. Use a new bandage each time you wipe, moving away from the tube entry site.
    
    
  • Gently pat the skin with a clean washcloth to dry it. Put medicine on the skin if a caregiver has told you to.
  
  
• Apply the skin barrier and bandages:
  
  
  • Place the skin barrier around the nephrostomy tube. Make sure the skin barrier is not be touching stitches that may be holding the tube in place. Put a protective skin film over the skin barrier if caregivers have told you to.
    
    
  • Roll up a bandage to make it thick, and wrap it around the place where the tube enters the patients skin. Place it to support the tube, and stop it from kinking or bending if the patient lies on his back. Tape the bandage in place, and apply more bandages if caregivers have told you to.
    
    
  • An attachment device may be placed over the bandages to help keep the nephrostomy tube in place.
    
    
  • Bring the tubing forward to the front of the patient's body, and tape it to his skin. Do not stretch the tube tight, as this may pull the nephrostomy tube out.

How often do I need to change the bandage, skin barrier and tube attachment device? The bandage around the tube should be changed at least every seven days. Bolsters, skin barriers and tube attachment devices also need to be changed every seven 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.

What kind of urine drainage bag should I use? 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 caregivers when and how it should be cleaned. The following are general directions for cleaning a reusable urine drainage bag:

• Drain urine out of the drainage bag when it is one-half to two-thirds full. Open the spout at the bottom of the bag to empty the urine into the toilet. Ask caregivers if you need to measure and write down how much urine is in the bag before you empty it.
  
  
• 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 special solution such as phosphoric acid to clean the bag. You may need to use bleach, or laundry or dishwasher detergent. Ask caregivers what you should use to clean the urine drainage bag. Use a plastic syringe (without a needle) to gently force the cleaning solution into the drainage bag as you clean it.
  
  
• Ask caregivers if you should leave the cleaning solution in the bag for a time before draining it out. When it's time to drain the bag, drain the cleaning solution out through the spout at the bottom.
  
  
• Ask caregivers what you should use to rinse the urine drainage bag. After rinsing the bag, empty it and hang it up to air dry before using it again. Throw reusable bags away after using them for one week.

What can I do to prevent problems with my nephrostomy tube?

• Wash your hands with soap and water, and use new medical gloves before changing the bandages around the nephrostomy tube. Do not touch the side of the bandage that is placed over or around the tube.
  
  
• Change bandages, skin barriers and attachment devices as often as your caregiver tells you to. Throw away or clean your drainage bag as you are told to by your caregiver.
  
  
• Wipe the connecting ends of the drainage bag with alcohol or iodine before reconnecting the bag to the tube. This may help prevent infection.
  
  
• Keep the tube taped to your skin and connected to a drainage bag. The drainage bag must stay below the level of your kidneys (lower back). 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 changing your clothes or doing 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 there is no tension (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 your caregiver has taught you, irrigate (flush) the tube. Do this if you think the tube is blocked. Ask caregivers if you should irrigate the tube and do it only if you have been taught how.

What else should I know about having a nephrostomy tube? Drink 2 to 3 liters of liquid each day unless you cannot because of another condition. You should drink at least 8 (eight-ounce) cups of liquid, including three glasses of cranberry juice. This amount should make you have about two liters of urine in your drainage bag over 24 hours (one full day). You may shower when you have a clear adhesive dressing in place. A piece of plastic can be taped over the dressing while showering. Do not take tub baths.

When should I call my caregiver?

• You have any signs of infection. These signs include fever, chills, or hip or back pain. Other signs include changes in how your urine looks or smells and skin redness or pus around the tube. Feeling more tired than usual, behavior changes, and muscle weakness may also be signs of infection.
  
  
• You have urine color changes. Although color changes may be caused by medicines or foods, call your caregiver to report urine color changes. During the first two days, your urine should be a pink or amber color. Call your caregiver if you often see bright red drainage coming out of your nephrostomy tube.
  
  
• There is very little or no urine in your drainage bag over time. There should be 30 to 60 milliliters of urine draining into the bag each hour. If there is a decrease in urine, check for kinks in the tubing. If there are no kinks and there is little or no urine in the drainage bag, call your caregiver.
  
  
• There is a large amount of urine in your drainage bag over a short period of time. A large amount of urine that drains over a shorter period of time should be reported. For example, 2000 milliliters (2 liters) over urine draining out over eight hours could be a sign of problems.
  
  
• The tube has moved out of the place where it goes into your skin. Tell caregivers if you see that the tube has come 2 or 3 inches out of the entry site. Do not try to insert the tube back inside by yourself.

When should I seek care immediately? Call 911 or get to the nearest emergency room if:

• The tube comes out. Cover the area with a new bandage while calling your caregiver. The tunnel that was made for the tube closes within 1 to 3 hours so get help right away.
  
  
• Leaking urine around the place where the tube enters your skin after 10 days. Leaking urine around the tube should stop 10 days after you have the tube put in. If it does not, the tube could be blocked.
  
  
• The tube is out of position. There may be a black mark on the tube to mark the place where the tube enters your skin. Have someone check to see that the black mark is next to your skin. If it is further down the tube, the tube has moved and your caregiver needs to put it back in.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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