Nephrostomy Care Guidance

A percutaneous nephrostomy tube is inserted to allow urine to drain from an obstructed kidney. The tubes are designed to be able to stay in place for a period of 3 months. The referring hospital team should contact the patient before the end of the 3 months to arrange for the tube to be exchanged or removed. If any unexpected complications arise while the catheter is in situ, or the patient is not contacted regarding catheter removal/exchange, the referring hospital team should be contacted for an appointment.

Dressing changes

Most nephrostomy tubes used across the NHS have a locking system to hold it in place in the pelvis of the kidney.  This locking system means that the tube should not move out of the kidney. However, care should be taken during bag & dressing changes to avoid dislodgement and the tube should be checked for signs of movement each time the bag & dressing is changed.

Drainage bag changes

The drainage bag should be emptied when ⅓ to ½ full – four to five times per day. The drainage bag should be changed twice weekly. At night, a larger volume (2L) night drainage bag should be attached to ensure a comfortable night’s sleep.

Potential complications

Occasionally, post catheter insertion complications can arise. Below is a set of interventions that should be carried out & recorded by the nurses caring for a patient with a long-term nephrostomy to reduce the chances of complications.

You can download our community nursing care bundle to print here:

Nephrostomy care guidance

Weekly Dressing Change Guidance

Equipment you will need:

  • Dressing change pack if available, OR:
  • Suitable skin preparation to clean the wound such as ChloraPrep® or Clinell® 2% CHG wipe
  • Disposable gloves
  • Paper towel
  • Clean work surface or sterile drape
  • Sterile catheter securement dressing, e.g. Drain-Guard
  • Surgical tape, e.g. Micropore® (optional)
  • Adhesive removal spray (optional)
  • Barrier film spray (optional)

Steps to follow:

  1. Using ANTT, open all packets, using the open packaging as the sterile field or drop the packet contents onto a sterile drape without touching
  2. Wash hands according to NICE guidance, dry with clean paper towel & put on gloves or apply alcohol gel to hands
  3. To remove the old dressing, unpeel the top cover of the dressing to expose catheter tubing. Lift the catheter away from the dressing & secure with a piece of surgical tape to avoid migration
  4. To help with removal, gently roll up the edges of the dressing (consider using an adhesive removal spray to facilitate easy removal)
  5. Stretch the dressing outwards from the edges with one hand, using the other to gently hold the dressing steady. Keep stretching in small amounts around the edge of the dressing to break the adhesive seal until it is no longer stuck to the skin
  6. Assess the wound when you have uncovered the exit site, checking for signs of infection. Note any foul-smelling odour, drainage (colour & consistency) and the surrounding skin integrity. Check retaining suture is in place & no signs of catheter dislodgement.
  7. Clean the wound using Chloraprep® or Clinell® wipe (if unavailable, use water for cleansing (i.e. boiled cool tap water). Start closest to the exit site & cleanse outwards.
  8. Wait for skin prep to dry before applying dressing (consider using a barrier cream or spray on the skin surrounding exit site to protect skin and help with dressing adhesion; again wait to dry before applying dressing).
  9. Apply the new dressing according to manufacturers IFUs. Drain-Guard IFUs can be downloaded here. Warming the dressing in hands prior to application helps adhesion to skin. Do not apply on wet skin.
  10. Keep the dressing clean and dry. Change the dressing if it gets wet or gets soiled with blood or drainage (consider using a film dressing such as Tegaderm Film as a secondary waterproof cover). Report any unusual changes in the wound. Follow troubleshooting guidance.

Drainage Bag Change Guidance

Equipment you will need:

  • Sterile drainage bag & clean waist strap
  • Clinell® 2% CHG wipe
  • Disposable gloves
  • Paper towel
  • Blunt, disposable clamp

Steps to follow:

  1. Using ANTT, open all packets, using the open packaging as the sterile field or drop the packet contents onto a sterile drape without touching
  2. Wash hands according to NICE guidance, dry with clean paper towel & put on gloves or apply alcohol gel to hands
  3. Clamp the nephrostomy catheter, unscrew the drainage bag from the catheter hub & dispose in a yellow waste bag
  4. Scrub the hub of the nephrostomy catheter for 30 seconds with the Clinell 2% CHG wipe and allow to dry
  5. Attach the new drainage bag, taking care to maintain a non-touch technique. Unclamp the catheter, check urine output & make sure the catheter is not occluded.

Flushing Guidance

Equipment you will need:

  • Someone who has been taught to perform this procedure
  • Disposable gloves
  • Clean paper towel
  • 9% Sodium Chloride
  • 10ml luer-lock syringe
  • Sterile gauze
  • Clinell® 2% CHG wipe
  • Blunt disposable clamps
  • Sterile drainage bag

Steps to follow:

  1. Check the tube and bag for kinks & twists, ensuring there is no mechanical obstructions. If there is a mechanical obstruction that can be easily resolved, the flush will not be necessary. Ensure a needle free device has not been attached obstructing the flow of urine
  2. Using ANTT, open all packets, using the open packaging as the sterile field or drop the packet contents onto a sterile drape without touching
  3. Wash hands according to NICE guidance, dry with clean paper towel & put on gloves or apply alcohol gel to hands
  4. Clamp the nephrostomy catheter, unscrew the drainage bag from the catheter hub & dispose in a yellow waste bag
  5. Scrub the hub of the nephrostomy catheter for 30 seconds with the Clinell 2% CHG wipe and allow to dry
  6. Fill the 10ml syringe with saline and attach to the luer-lock hub of the catheter being careful to maintain ANTT
  7. Gently apply even pressure, instilling the saline into the nephrostomy tube. Gentle aspiration of the tube may dislodge the blockage, however excessive force may cause bleeding
  8. Unclamp the catheter & check the problem has been resolved; allow saline or urine to flow out of the tube. If there is no urine output after 24hrs, arrange an appointment with referring hospital team
  9. Attach the new drainage bag, taking care to maintain a non-touch technique
  10. Continue to monitor urine output. If the nephrostomy is prone to blocking on a regular basis then it may be appropriate to flush the tube prophylactically twice a week.

For managing complications, please refer to our troubleshooting guide:

References:

Nephrostomy care guidance Information adapted from:

https://www.royalmarsden.nhs.uk/welcome-patient-procedures-portal/nephrostomy-care

The Christie NHS Foundation Trust, Guidelines for Management of Nephrostomy Tubes: advice for district nurses, V5, 2018 https://www.christie.nhs.uk/media/2266/legacymedia-2402-221.pdf

Martin R. Baker H (2019) Nursing Care & Management of patients with a nephrostomy. Nursing Times (Online); 115:11, 40-43 https://cdn.ps.emap.com/wp-content/uploads/sites/3/2019/10/191016-Nursing-care-and-management-of-patients-with-a-nephrostomy.pdf