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1. Nephrostomy Tubes
NEPHROSTOMY

2. Nephrostomy
• 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.

3. INDICATIONS
Relief of Urinary Obstruction
• Urosepsis or possible infection
• Acute Renal failure
Urinary Diversion
• Inflammatory or malignant urinary fistula
• Trauma or iatrogenic ureteral injury
• Hemorrhagic cystitis
Access for endourological procedure
• Biopsy or treatment of urothelial lesions
• Dilating or stenting ureteral stricture
• Foreign Body Retrival

4. Contraindications
 Hemodinamically unstable
 Uncorrectable severe coagulopathy / bleeding diathesis
 Severe hyperkalaemia and/or metabolic acidosis
 Unconscious patient

5. Complication

6. Nephrostomy Tube Type
A. Malecot B. Pezzer C. Hulbert

7. Where to Puncture?
Considerations:
Anatomy – Where am I least likely to cause significant
complications
• Bleeding
• Perforation
• Pneumothorax
Next intervention
• Simple nephrostomy
• Ureteral intervention
Patient comfort

8. Bleeding
 Renal artery divides into
anterior an posterior branches
 Posterior branch supplies 30%
of the kidney
 Brodel’s Line divides the area
between the anterior and
posterior division
 RELATIVELY AVASCULAR

9. Other anatomical considerations
BOWEL
LUNG

11. POST-PROCEDURE MANAGEMENT
Administer analgesia as
prescribed
Patient should be on bed rest for
4 hours
Nephrostomy tube must be
connected to a sterile closed
drainage system and drainage
bag should be below level of
kidney at all times
Post procedure vital signs to be
monitored half hourly for 2
hours, hourly for the next 2
hours then four hourly for 24
hours.
Measure urine output hourly for
4 hours, then 4 hourly for 24
hours then progress to 8 hourly
until stable
Monitor urine for colour and
presence of sediment.
Nephrostomy tube dressing site
must be observed every hour for
four hours, 4 hourly for 24
hours, then once per shift for
bleeding and signs of infection
(pain, leakage, redness, swelling,
bleeding
Inspect nephrostomy tube to
ensure it is secure and no
kinking has occurred
All urine specimens must be
collected from nephrostomy
tube by gravity. Do not use
aspiration.

12. Nephrostomy Tube
Post-Op Nursing Management
Assess/Monitor:
 VS
 I&O
- urine output
 Urine characteristics
 Nephrostomy
- dressing
- insertion site
- drainage system
● Collect urine samples by gravity, never
aspirate

13. Nursing management / Ongoing Care of a
Nephrostomy
● A person with a urinary diversion or nephrostomy is
typically referred to an ostomy nurse.
● The catheter must never be kinked, compressed, or
clamped.
● The catheter should be checked for patency.
Irrigation of the tubing is done only if it is ordered. It
should be done with strict aseptic technique.

14. Irrigation of the tubing
● Irrigation of the tube is required if there is absence of
urine, if urine remains heavily blood stained, if patient has
persistent flank pain or suspected blockage.
● Gently and slowly instill a maximum of 5 mL of sterile
saline solution at one time using strict aseptic technique to
prevent overdistention of the kidney pelvis and renal
damage.
● Patient should lie on the side that is the opposite of the
nephrostomy tube site during irrigation.

15. Skin care and showering
● Patient may take a shower 48 hours after the catheter is
placed, but drain site must be kept dry.
● The catheter dressing and the skin around the site should
be covered with plastic wrap taped to the skin before a
shower. Site must be covered for 14 days after placement.
● After 14 days, if the site has healed, patient may shower
without the dressing and plastic wrap.

16. Dressing change / drainage bag
● Patient should be taught how to
change the dressings using sterile
technique and how frequently it should
be done.
● A gauze dressing should be changed
every other day, but a transparent
dressing is changed every 72 hours.
Either dressing should be changed if it
gets wet or the edges become loose.
● May use a single use or reusable
drainage bag.
● Empty your drainage bag as often as
needed when it is about 2/3 full.
Drain contents in a measuring
container and record. Keep track of
the amount of drainage each day.
● The bag should be closed to reduce
risk of infection.
● Change the reusable urine drainage
bag every 7 days
● Keep the drainage bag below the
level of your kidneys at all times, to
prevent a back flow of urine into the
kidneys.

17. Nephrostomy Care Procedures

18. When to contact HCP
Patient should be taught to contact their health care provider if they
experience any of these problems:
•Sudden decrease in the amount of drainage with discomfort at the
catheter site
•Blood in or around the catheter
•Fever greater than 101 degrees F
•Persistent blood in the urine
•Nausea and vomiting
•Chills
•Urine that is cloudy or has a strong odor
•Back pain
•Catheter becomes dislodged or broken or leaks

19. References
Barbaric et al. Percutaneous nephrostomy: placement under CT and fluoroscopic guidance. AJR 1997;
169(1):151-5
Campbell‐Walsh Urology Tenth Edition . Alan J. Wein, Louis R. Kavoussi, Andrew C. Novick, Alan W. Partin and
Craig A. Peters . Saunders , 2011 ; 10th revised edition
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2013). Nursing diagnosis manual: Planning, individualizing,
and documenting client care. Philadelphia: F.A. Davis Co.
Lewis, S.M., Dirksen, S.R., Heitkemper, M.M., & Bucher, L. (2014). Medical Surgical Nursing: Assessment and
Management of Clinical Problems (9th ed.). St. Louis, MO: Mosby.
Naidi, S., Lp, V., McDonald, C., & Liverpool Health Service. (2010). Management of patients with Nephrostomy
Tubes. Agency for Clinical Innovation. Retrieved May 5, 2017, from
https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0005/191066/ACI_Nephrostomy_Jan 13.pdf
Quality Improvement Guidelines for Percutaneous Nephrostomy J Vasc Interv Radiol 2003; 14:S277–S281 (SIR
website)