Post Nephrostomy Catheter Complications & Troubleshooting

Nursing interventions in nephrostomy care. Problems, possible causes, prevention techniques and suggested actions.

Nephrostomy site infection

Possible cause: Foreign body puncturing the skin.

Prevention: Monitor the patient for signs of infection, such as purulent discharge, exit-site erythema, pain/itching or an elevated temperature.Send a swab for microscopy, culture and sensitivity test, if indicated. Seek medical advice and treat the patient accordingly.

Suggested action: Maintain exit-site care. Change the dressing and check the site at least every seven days. Maintain good hand hygiene.

Pyelonephritis

Possible cause: Foreign body in the renal pelvis

Prevention: Monitor thevpatient for signs of infection, such as elevated temperature, raised inflammatory markers, purulent urine output, loin/groin pain, burning/stinging when passing urine

Suggested action: Follow nephrostomy care advice. Change the tubing and bags at least every seven days. Maintain aseptic technique.

Nephrostomy tube falls out

Possible cause: Failed drain locking mechanism. Loose retaining suture. Drain-fixation dressing has fallen off.

Prevention: Seek urgent medical assistance – nephrostomy tube will need to be replaced by a physician.

Suggested action: Check all the elements securing the nephrostomy tube are well situated. Check the locking mechanism on drain is in lock or drain position. Check the retaining suture is intact during weekly dressing changes; if broken/missing, escalate to the medical team for replacement. Correctly apply and secure drain-fixation dressing.

Nephrostomy tube stops draining

Possible cause: No urine output. Blocked tube. Kinked tube

Prevention: Check the patient’s vital signs; seek urgent medical assistance if patient is unwell. Check that the patient is well hydrated. Ensure there are no kinks in the tube that could occlude the flow of urine; straighten tube if any kinks are found. If the tube is blocked with debris, flush it with 5ml of normal saline 0.9%, using aseptic technique to unblock.

Suggested action: Monitor urine output and vital signs. Escalate concerns to medical team. Carefully secure drain and tubing to prevent kinking.

High Nephrostomy outputs

Possible cause: Diuresis from previously obstructed kidney.

Prevention: Strict fluid-balance monitoring. Weigh the patient daily. Ensure the patient is cannulated for intravenous hydration.

Suggested action: Check the patient’s vital signs; seek medical assistance if needed. Carry out strict fluid-balance monitoring. Seek medical assistance to match fluid input/output. Weigh the patient daily. Monitor blood daily.

 

Source: Dougherty and Lister (2015)

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