Nephrostomy Tube Insertion

WHAT YOU SHOULD KNOW:

• 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 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. When 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.
  
  
• You may need one nephrostomy tube, or two tubes if you need one for each of your kidneys. To place a percutaneous nephrostomy tube, a tunnel is made from your lower back through and into your kidney. Through this tunnel, the tube is placed and left in to drain urine from your kidney into a drainage bag. A nephrostomy tube can relive symptoms such as pain and fullness, and can help prevent damage to your kidney.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

You may have an allergy to the anesthesia medicine. You may get an infection or bleed more than expected. Nerves, tissues and other parts of your kidney may be damaged. Your bowel or lung may be hurt during the procedure. Air, fluids, blood, or urine may get into your abdomen (stomach). The catheter may move out of place, get blocked, or not work as it should. Caregivers will watch you closely for these problems. If you do not have the procedure, pain and other symptoms may get worse, and you may have long-term damage to your kidney. Call your caregiver if you are worried about your procedure, medicine or care.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is connected to tubing and liquid.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Anesthesia: This medicine is given to make you comfortable. You may not feel discomfort, pressure, or pain. An adult will need to drive you home and should stay with you for 24 hours. Ask your caregiver if you can drive or use machinery within 24 hours. Also ask if and when you can drink alcohol or use over-the-counter medicine. You may not want to make important decisions until 24 hours have passed.

During your procedure:

• You are lying on your stomach for this procedure. A caregiver cleans your skin where the nephrostomy tube will be inserted, and clean sheets are used to cover you. You may be awake, very sleepy, or fully asleep during this procedure. Imaging tests, such as ultrasonography or fluoroscopy, help caregivers during the procedure. These imaging tests are special types of x-rays that show your kidneys on a screen. A needle is used to puncture (make a hole) in your skin. If you are awake, your caregiver may ask you to hold your breath while the needle is being put in. The needle is pushed deeper until it reaches your kidney. When the needle reaches your kidney, small amounts of urine are collected and sent for tests.
  
  
• Dye, a special gas, or air may be put into the area during your procedure. A guide wire may be used with another catheter to dilate (widen) the area where the needle passed. A nephrostomy tube is inserted and pushed slowly until it reaches your kidney. The tube is secured in place inside or outside your body. This may be done with stitches, an attachment device, or the tube may have a balloon on the end that is placed in your kidney. When the balloon is filled, it will help hold the tube in place. The tube is connected to a drainage bag outside your body. Bandages are used to cover the area.

After your procedure:

• You are taken to a room where you can rest. Caregivers will check on you often. Your heart rate, blood pressure, and temperature are watched closely. The urine drainage bag is also checked from time to time for blood. It is normal to have some blood in your urine for 1 or 2 days after you have a nephrostomy tube placed. The amount of urine in the bag is also checked to make sure that the tube is draining all of the urine from your kidney. When caregivers see that you are OK, you may be allowed to go home. If you are staying in the hospital, you will be taken to your hospital room.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Nephrostography: This is a test that will be done to check for any problems after your procedure.