Percutaneous Nephrostomy Home Guide

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.

During the procedure, the nephrostomy tube is inserted in the right or left side of your lower back and is connected to an external drainage bag.

After you have a nephrostomy tube placed, urine will collect in the drainage bag outside of your body. You will need to empty and change the drainage bag as needed. You will also need to take steps to care for the area where the nephrostomy tube was inserted (tube insertion site).

How do I care for my nephrostomy tube?

• Always keep your tubing, the leg bag, or the bedside drainage bag below the level of your kidney so that your urine drains freely.
• Avoid activities that would cause bending or pulling of your tubing. Ask your health care provider what activities are safe for you.
• 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 gently wrap an elastic bandage over the tubing. This will help keep the tubing in place and prevent it from kinking. Make sure there is no tension on the tubing so it does not become dislodged.
• At night, you may want to connect your nephrostomy tube or the leg bag to a larger bedside drainage bag.

How do I empty the drainage bag?

Empty the leg bag or bedside drainage bag whenever it becomes ⅔ full. Also empty it before you go to sleep. Most drainage bags have a drain at the bottom that allows urine to be emptied. Follow these basic steps:

1. Hold the drainage bag over a toilet or collection container. Use a measuring container if your health care provider told you to measure your urine.
2. Open the drain of the bag and allow the urine to drain out.
3. After all the urine has drained from the drainage bag, close the drain fully.
4. Flush the urine down the toilet. If a collection container was used, rinse the container.

How do I change the dressing around the nephrostomy tube?

Change your dressing and clean your tube exit site as told by your health care provider. You may need to change the dressing every day for the first 2 weeks after having a nephrostomy tube inserted. After the first 2 weeks, you may be told to change the dressing two times a week.

Supplies needed:

• Mild soap and water.
• Split gauze pads, 4 × 4 inches (10 x 10 cm).
• Gauze pads, 4 × 4 inches (10 x 10 cm).
• Paper tape.

How to change the dressing:

Because of the location of your nephrostomy tube, you may need help from another person to complete dressing changes. Follow these basic steps:

1. Wash hands with soap and water.
2. Gently remove the tape and dressing from around the nephrostomy tube. Be careful not to pull on the tube while removing the dressing. Avoid using scissors because they may damage the tube.
3. Wash the skin around the tube with mild soap and water, rinse well, and pat the skin dry with a clean cloth.
4. Check the skin around the drain for redness, swelling, pus, warmth, or a bad smell.
5. If the drain was sutured to the skin, check the suture to verify that it is still anchored in the skin.
6. Place two split gauze pads in and around the tube exit site. Do not apply ointments or alcohol to the site.
7. Place a gauze pad on top of the split gauze pad.
8. Coil the tube on top of the gauze. The tubing should rest on the gauze, not on the skin.
9. Place tape around each edge of the gauze pad.
10. Secure the nephrostomy tubing. Make sure that the tube does not kink or become pinched. The tubing should rest on the gauze pad, not on the skin.
11. Dispose of used supplies properly.

How do I flush my nephrostomy tube?

Use a saline syringe to rinse out (flush) your nephrostomy tube as told by your health care provider. Flushing is easier if a three-way stopcock is placed between the tube and the drainage bag. One connection of the stopcock connects to your tube, the second connects to the drainage bag, and the third is usually covered with a cap. The lever on the stopcock points to the direction on the stopcock that is closed to flow. Normally, the lever points in the direction of the cap to allow urine to drain from the tube to the drainage bag.

Supplies needed:

• Rubbing alcohol wipe.
• 10 mL 0.9% saline syringe.

How to flush the tube:

1. Move the lever of the three-way stopcock so it points toward the drainage bag.
2. Clean the cap with a rubbing alcohol wipe.
3. Screw the tip of a 10 mL 0.9% saline syringe onto the cap.
4. Using the syringe plunger, slowly push the 10 mL 0.9% saline in the syringe over 5–10 seconds. If resistance is met or pain occurs while pushing, stop pushing the saline.
5. Remove the syringe from the cap.
6. Return the stopcock lever to the usual position, pointing in the direction of the cap.
7. Dispose of used supplies properly.

How do I replace the drainage bag?

Replace the drainage bag, three-way stopcock, and any extension tubing as told by your health care provider. Make sure you always have an extra drainage bag and connecting tubing available.

1. Empty urine from your drainage bag.
2. Gather a new drainage bag, three-way stopcock, and any extension tubing.
3. Remove the drainage bag, three-way stopcock, and any extension tubing from the nephrostomy tube.
4. Attach the new leg bag or bedside drainage bag, three-way stopcock, and any extension tubing to the nephrostomy tube.
5. Dispose of the used drainage bag, three-way stopcock, and any extension.

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.