What is Percutaneous Nephrostomy

Percutaneous nephrostomy is a procedure to insert a flexible tube into your kidney so that urine can leave your body. This procedure may be done if a medical condition prevents urine from leaving your kidney in the usual way.

Urine is normally carried from the kidneys to the bladder through narrow tubes called ureters. A ureter can become blocked because of conditions such as kidney stones, tumors, infection, or blood clots.

The nephrostomy tube will be inserted through your back. After the procedure, the tube will remain in place, and urine will drain from the kidney into a drainage bag outside your body. Draining the urine will relieve pressure and help prevent infection that could damage the kidney. Often, this procedure allows your health care provider to identify the cause of the blockage and plan appropriate treatment.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes used in the procedure.
• Damage to other structures or organs.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.
• You may have blood tests to see how well your kidneys and liver are working and to see how well your blood can clot.
• Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins. You may be given medicines through this IV tube to help prevent nausea and pain.
• You will be positioned on your abdomen.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic) where the nephrostomy tube will be inserted.
• The nephrostomy tube, which is thin and flexible, will be inserted into a needle.
• The needle will be inserted into your body and guided to your kidney. An imaging method that uses X-ray images (fluoroscopy) will be used to help guide the needle to the kidney.
• A dye will be injected through the nephrostomy tube. Then, X-ray images that highlight your kidney will be taken.
• Next, the needle will be removed, but the nephrostomy tube will be left in your kidney. The tube may be secured to your skin with stitches (sutures).
• A drainage bag will be attached to the nephrostomy tube. Urine will be able to drain from your kidney to this drainage bag outside your body.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will need to remain lying down for several hours.
• You will be taught how to care for the nephrostomy tube and the drainage bag.
• Do not drive for 24 hours if you were given a sedative.

Percutaneous Nephrostomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Some soreness where the nephrostomy tube was inserted (tube insertion site).
• Blood-tinged drainage from the nephrostomy tube for the first 24 hours.

Follow these instructions at home:

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid activities that may cause the nephrostomy tubing to bend.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. Cover the nephrostomy tube dressing with a watertight covering when you take a shower.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative).

Care of the tube insertion site

• Follow instructions from your health care provider about how to take care of your tube insertion site. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider. Be careful not to pull on the tube while removing the dressing.
  • When you change the dressing, wash the skin around the tube, rinse well, and pat the skin dry.
• Check the tube insertion area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Care of the nephrostomy tube and drainage bag

• Always keep the tubing, the leg bag, or the bedside drainage bags below the level of the kidney so that your urine drains freely.
• When connecting your nephrostomy tube to a drainage bag, make sure that there are no kinks in the tubing and that your urine is draining freely. You may want to use an elastic bandage to wrap any exposed tubing that goes from the nephrostomy tube to any of the connecting tubes.
• At night, you may want to connect your nephrostomy tube or the leg bag to a larger bedside drainage bag.
• Follow instructions from your health care provider about how to empty or change the drainage bag.
• Empty the drainage bag when it becomes ⅔ full.
• Replace the drainage bag and any extension tubing that is connected to your nephrostomy tube every 3 weeks or as often as told by your health care provider. Your health care provider will explain how to change the drainage bag and extension tubing.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have problems with any of the valves or tubing.
• You have persistent pain or soreness in your back.
• You have more redness, swelling, or pain around your tube insertion site.
• You have more fluid or blood coming from your tube insertion site.
• Your tube insertion site feels warm to the touch.
• You have pus or a bad smell coming from your tube insertion site.
• You have increased urine output or you feel burning when urinating.

Get help right away if:

• You have pain in your abdomen during the first week.
• You have chest pain or have trouble breathing.
• You have a new appearance of blood in your urine.
• You have a fever or chills.
• You have back pain that is not relieved by your medicine.
• You have decreased urine output.
• Your nephrostomy tube comes out.