Patient education: How to care for a nephrostomy tube (The Basics)

What is a nephrostomy tube? — A nephrostomy tube is a thin tube that goes through the skin on the back into 1 of the kidneys. The tube is also called a "catheter." It lets the urine drain from that kidney into a collection bag (figure 1).

The other kidney will continue to drain normally into the bladder if it does not have a nephrostomy tube.

How do I care for myself at home? — Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

Before you go home, your doctor or nurse will talk to you about the nephrostomy tube and how to care for it. This includes taking care of your skin around the tube, the tube itself, and the drainage system that collects your urine. They will also make sure that you have the supplies you need. Having a nephrostomy tube increases your risk of infection. This is why it's so important to take care of it.

You might need a family member or friend to help you care for the nephrostomy tube. Some people have a home health nurse come to their home to help with this.

How do I take care of my skin around the nephrostomy tube? — Keeping your skin clean and changing the dressing regularly can help prevent infection. Clean your skin and replace the dressing around the tube every 2 to 7 days. Always change the dressing right away if it is wet, loose, or dirty.

●Gather the supplies, and place them on a clean workspace. You need 2 pairs of clean gloves, a small bag for trash, soap or other cleanser, cotton swabs or washcloths, split gauze dressings, medical tape, and antibacterial ointment if your doctor gave you this.

●Always wash your hands well with soap and water before touching the tube. Put on clean gloves.

●Hold the tube with 1 hand as your take off the old dressing. Do not use scissors or sharp tools. They could cut the tube. Do not pull on the tube when taking off the dressing. Throw away the gloves and old dressing.

●Check your skin where the tube enters for swelling, drainage, or redness.

●Wash your hands again, and put on clean gloves.

●Wet a clean cotton swab or washcloth with cleanser or soap and water. Work in a circular motion, moving outward from the tube to clean your skin. Clean the entire area that will be under the dressing, about a 3-inch (7.5-cm) square. Let the cleaned area air dry for at least 30 seconds.

●Repeat this step 2 more times with a clean swab or washcloth, and remove any crusted material around the tube. Do not to remove the stitch that secures the tube to the skin. Rinse the area with clean water if you are using soap.

●Allow the area to air dry, or pat dry with clean gauze. Do not fan the area.

●Apply any medicine as instructed by your doctor.

●Place a sterile split gauze around the tube. Avoid touching the gauze where it touches the skin or tube. Place a second gauze pad over the first one. Tape the edges to secure the gauze.

●Remove the gloves.

●Wash your hands with soap and water.

How do I take care of the nephrostomy tube?

●Keep the tube and drainage system secure.

●Do not pull on the tube or catch the drainage tubing on anything as you move around.

●Keep the drainage bag below your bladder.

●Keep the tubing free of kinks or loops.

How do I take care of the drainage system? — The drainage system is usually made up of a urine collection bag and tubing that attaches to the nephrostomy tube. In some cases, the tubing is a part of the bag. In others, the tubing is a separate piece. Your doctor will tell you if it is safe for you to clean and reuse the drainage tubing and urine collection bag, or if you need to use new ones each time.

Some tips for taking care of the drainage system:

●Empty the urine collection bag when it is half full. Wash your hands. Empty the urine into the toilet or into a clean container if your doctor asked you to measure it. Use the container only for urine. Do not let the drainage spout touch the container, floor, or other surface when emptying the bag.

●Change the bag and drainage tubing every 2 to 4 weeks, or if it leaks. You might need a new bag if the old one becomes too stiff.

●To change the bag and drainage tubing:

•Wash your hands well with soap and water, and empty the drainage bag. Wash your hands again.

•Gather the supplies, and place them on a clean workspace. You need a clean bag with drainage tubing, alcohol swabs, and clean gloves.

•Put on clean gloves.

•Use alcohol swabs to clean where the nephrostomy tube and drainage tubing meet. If you are reusing a drainage system, also use alcohol swabs to clean the end of the drainage tubing where it will connect with the nephrostomy tube.

•Disconnect the nephrostomy tube from the old drainage system. Attach the nephrostomy tube to the new or cleaned drainage tubing. Do not touch the end of either tube.

•Follow your doctor's instructions on the best way to clean the inside of the drainage system, if you are able to reuse it. Examples of cleaning solutions for the drainage system include:

-Warm, soapy water

-Vinegar and water, made with 1 cup (240 mL) vinegar and 3 cups (720 mL) water

-Bleach and water, made with 1 tablespoon (15 mL) unscented bleach and 1/2 cup (120 mL) water

Swish the solution all around the inside of the bag, and allow it to soak for 30 minutes. Drain, and rinse well with clean water. Hang the bag with the drainage spout open to air dry.

•Wash your hands again.

What else should I know?

●If your other kidney is working normally, you will still need to urinate the regular way in addition to collecting urine in the bag. That's because the kidney without the nephrostomy tube in it will continue to drain urine into your bladder. Some people with nephrostomy tubes in both kidneys do not need to urinate from their bladder at all, but others do.

●If you cannot see any urine in your urine collection bag, try changing your position. If there is still no urine in your bag after 6 hours, call your doctor right away.

●The doctor might need to change the nephrostomy tube if it will be in place for a long time. They will want to do this every 8 to 12 weeks. This will make sure that the tube continues to function.

When should I call the doctor? — Call your doctor or nurse for advice if you have any symptoms of a urinary tract infection ("UTI"). These might include:

●Fever of 100.4°F (38°C) or higher, or chills

●The need to urinate more often

●The need to urinate right away or in a hurry

●Blood in your urine

You should also call if:

●You have very bad pain in your back, shoulder, or belly.

●Your urine is dark or coffee colored, has bits of anything solid in it, or looks like pus.

●The nephrostomy tube starts to leak, breaks, or falls out.

●There is no urine in the drainage bag for more than 6 hours.

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