Patient Information Nephrostomy Author:Urology Produced and designed by the Communications Team Issue date Nov 2015 - Review date Nov 2018 - Expiry date Nov 2019 Version 3 Ref no. PILCOM1604
What is a nephrostomy? A nephrostomy is a small tube inserted through the skin into the kidney to allow urine to drain. A nephrostomy is inserted when there is an obstruction which does not allow urine to drain into the bladder from the kidney. How is the tube inserted? The nephrostomy tube is inserted through your skin into the affected kidney in the x-ray department. A local anaesthetic is given in your side/back. A small needle will be inserted into your hand for pain relief to be given to you and sometimes a sedative. This procedure can also be carried out under general anaesthetic. You will be informed if you are having a local or general anaesthetic. How long will it take? Every patient s situation is different. The procedure usually takes about an hour. What happens before the insertion of the tube? for infection. If the reason for the insertion of the nephrostomy tube is due to an infected obstructed kidney, the appropriate antibiotics will be given to you. The doctor will explain the reason you need a nephrostomy tube inserted and will ask you to sign a consent form. Please make sure you are satisfi ed that you have received enough information about the procedure before you sign the consent form. You will need to wear a theatre gown. This allows the radiologist easy access to the insertion site, which is usually over the affected kidney. If you are having the procedure under general anaesthetic you will be asked to fast and allowed only water up to two hours before the procedure. If you are having the procedure under local anaesthetic and sedation, you will be asked not to eat anything for four hours beforehand, though you may be allowed water. You will need to have some routine blood tests. A urine sample will be sent to the laboratory to check 2
What happens during the procedure? You will lie on the x-ray table, fl at (or nearly fl at) on your stomach. You will have a needle put into a vein in your arm or hand for the sedative or pain relief. Once in place, this needle does not cause any pain. You will also have a monitoring device attached to your chest and fi nger, and may receive oxygen through small tubes in your nose. Your skin will be cleaned with antiseptic and then most of the rest of your body will be covered with a green theatre cloth. The radiologist will use the x-ray equipment or ultrasound to decide on the most suitable point for inserting the fi ne plastic tube (catheter), usually in your back just below your 12th rib. Then your skin will be anaesthetised with local anaesthetic and a fi ne needle inserted into the kidney. When the radiologist is sure that the needle is in a satisfactory position, a guide wire will be placed into the kidney through the needle, which enables the plastic catheter to be positioned correctly. The catheter will then be fi xed to the skin surface and attached to a drainage bag. Will it hurt? It may hurt a little for a short period of time, but your pain can be controlled with pain relief. When the local anaesthetic is injected, it will sting to start with but this soon wears off and the skin and deeper tissues should then feel numb. Later, you may be aware of the needle and then the catheter passing into the kidney. This is sometimes painful, especially if the kidney was sore to start with. There will be a nurse looking after you and if you do have pain then they can arrange for you to have more pain relief. What happens afterwards? You will be taken from the x-ray department to your ward and helped to your bed. You will need to rest on your bed for 24 hours. This is to allow the insertion site to heal suffi ciently. Your blood pressure and pulse will be taken every half an hour for two hours, then less frequently. The tube will be monitored by the nursing staff to ensure that it is draining properly. 3
There will be a dressing over the site of the tube. Please do not remove this. The doctor or nurse looking after you may remove it, but only if necessary, as removing the dressing increases the risk of infection. What complications are there? As with any medical treatment there are some risks and complications that can arise. It may not be possible to place the drainage tube satisfactorily in the kidney. If this happens, your doctor will arrange another method of overcoming the blockage, which may involve surgery. Sometimes there is a leak of urine from the kidney, resulting in a small collection of fl uid inside the abdomen. If this becomes a large collection it may require draining. What happens next? You do not need to stay in hospital while you have a nephrostomy tube. Your doctor will explain to you what further treatment is required. This may include an operation at a later date or ultrasound wave therapy if you have a stone. If you have any questions regarding the treatment you are to have, please do not hesitate to ask the nurses looking after you. Before going home you will be taught how to care for your nephrostomy tube and a district nurse will be informed of your return home. He/she will visit you at home and give you a contact number so you can call for assistance or advice. There may be slight bleeding from the kidney. On very rare occasions, this may become severe and require surgery or another procedure to stop it. Occasionally there may be an infection in the kidney, or in the space around it. This can be treated with antibiotics. 4
Living with a nephrostomy tube Listed below are some common questions asked by patients. If you have any further questions, please do not hesitate to ask the doctor or nurse. What are my restrictions? Movement may be restricted. You may find it uncomfortable to bend or stretch. Climbing the stairs may be uncomfortable. This can be overcome by holding your hand over the nephrostomy site whilst carrying out these activities. How does the kidney drain? The urine from the kidney drains into a bag attached to the end of the nephrostomy tube. You will wear a belt and the drainage bag will be attached to this. You will be sent home with extra bags and supplies will be delivered to your home after you have been discharged from hospital. 5 How do I connect the drainage bag? Changing drainage bags Drainage bag should be changed at least every 7 days. If the drainage bag becomes dirty, foul smelling, or is punctured, it should be changed sooner. Here is how you change bags. Supplies gloves for care giver drainage bag two alcohol pads tape securing straps 1. Wash your hands thoroughly with soap and water. Caregiver should wash hands and put on gloves. 2. Gather your equipment. 3. Swab the end of the drainage tubing attached to the nephrostomy tube with one of the alcohol pads. 4. Disconnect the drainage bag from the tube. Put the used bag aside. 5. Swab the end of the tube with the other alcohol pad. 6. Connect a new bag. 7. Secure the drainage bag to the belt. 8. Wash your hands with soap and water.
You will be shown how to do this before you leave hospital. Please tell us if you are unsure of anything. It is important that you are confi dent about everything before you go home. If you would like someone else to be shown as well as yourself, please ask a member of staff looking after you to do this. What type of dressing is there over the site? There can be different types of dressings. A dry padding type can be used. The bigger and thicker the dressing the more comfortable it is. A small dressing is likely to curl up and will not give you much support. Another kind of dressing is a fi tted flange. This is a piece of dressing stuck to your skin around the site of the tube. It is fi tted with a cover to hold the drainage bag in place. The type of dressing depends on the type and size of the nephrostomy tube. The district nurse will change this accordingly. What happens if the tube comes out? The nephrostomy tube is stitched in place and is coiled under the dressing. If, for any reason the tube comes out, you need to contact your GP/A&E immediately. If you have any worries about the tube contact the ward, your doctor, district nurse or the specialist nurse. What should I do if I notice blood in the bag? Blood in your urine can indicate an infection. See your GP and take with you a sample of urine from the bag. Increase your fl uid intake from 2-3 litres a day for a week or ten days. What happens if I have an infection? Your GP will treat the infection with antibiotics. You will also need to increase your fl uid intake.. 6
Can I prevent an infection occurring? You can prevent some infections from occurring. You need to drink about two litres a day or three litres if you already have an infection. Ensure you wash your hands thoroughly before changing your drainage bags and after. Keep the drainage bag closed at all times except when emptying. Empty the drainage bag only when necessary and not before. Depending on your type of dressing it may need changing more frequently. Cranberry juice is known to assist in the prevention of infections. If you wish, you can have a glass of cranberry juice daily. Do not drink more than two glasses a day as this reduces the potential of preventing infection. What happens if the bag does not drain? If the tube does not drain any urine for more than an hour, you need to check the tube has not got any kinks in it. You need to check the tube tap is open and has not been accidentally turned. Try drinking half a litre of fluid and if no urine drains after these checks, contact your GP. Will I have pain? You may have some discomfort. Pain relief such as paracetamol can be taken to relieve this. If you experience severe pain you need to see your GP urgently. Will I pass urine in the normal way? If you have one nephrostomy tube and two kidneys, the other kidney will continue to work in the normal way and you will pass urine the normal way. If you have two nephrostomy tubes you may pass urine the normal way although it is unlikely as the tubes will drain the kidneys. Can I get an infection in the good kidney? Yes, this is possible. You may notice symptoms of frequently going to the toilet, burning or stinging when passing urine. You may have a fever and feel generally unwell. If these symptoms occur, you need to take a sample of urine passed in the normal way to your GP. 7
The infection, if there is one in the good kidney, is not caused by having the nephrostomy tube in the other kidney. Follow the advice previously given in What happens if I have an infection? Can I eat and drink normally? Yes. You can eat and drink like you normally do. You need to ensure that your fl uid intake is at least two litres a day. Will my sleep be affected? Lying on the side of the nephrostomy tube can be painful so lying on the other side is better. You will have to fi nd a position that suits you. Do not let the tube stop you from sleeping. Can I exercise? Gentle exercise is fi ne. More strenuous exercise may cause you pain and so should be avoided. When can I go back to work? This depends on your job. Light housework or offi ce work is fi ne. Heavy labouring or scrubbing fl oors may not be. You need to ask your nurse about your particular job. Can I have sexual intercourse? There are no restrictions on your sexual activities. You may have to fi nd another position. You may have some fear of dislodging the tube but remember, if you are careful, there should be no reason why the tube will come out. It is stitched in place. Having a cuddle with someone makes you feel better and the nephrostomy tube should not get in the way of this. Can I drive? If you are comfortable while driving then there are no restrictions. You should inform your insurance company and explain to them that your doctor has stated that it is okay to drive. Can I go out and about? Yes. If you normally do your own shopping then you can continue to do so. Some people have a fear of being knocked on the tube and this stops them from going to crowded areas. Again, if you are careful you can avoid this without avoiding going out. Knowing where the toilets are situated when you are out and 8
about can alleviate worries about the drainage bag getting over-full and leaking or bursting. You will in time also develop an idea of how fast the bag takes to fi ll and this will help you to plan your trips. Can I go on holiday? This depends on the reason you have the nephrostomy tube. It also depends on how long you are going for and where to. It may also depend on how confident you are with looking after your nephrostomy tube. If you have a holiday booked you may want to check out the medical facilities. Check with your doctor before leaving hospital. You may also need to check with your insurance company before you go. Where do I get further supplies? From your GP surgery and/or your district nurse. What happens on discharge from hospital? A district nurse will be organised by the hospital staff to visit you at home. He/she may visit regularly to change your dressings or may visit once and leave a contact number in case you need help or advice. In some cases it may be arranged for you to attend your GP surgery where the practice nurse will change your dressings. You will be given a letter to take to your GP to inform them about the treatment you received in hospital and the ongoing care you need. Any medication that you require will be given to you and if you require a repeat prescription your GP will provide this. An outpatient appointment will be sent to your home address. It is important to keep these appointments so that the hospital doctor can monitor your progress and plan further treatment. 9
Contact details Urology Department 01268 524900 ext 8491 10
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Not to be photocopied Basildon University Hospital Nethermayne Basildon Essex SS16 5NL 01268 524900 Minicom 01268 593190 Patient Advice and Liaison Service (PALS) 01268 394440 E pals@btuh.nhs.uk W www.basildonandthurrock.nhs.uk The Trust will not tolerate aggression, intimidation or violence directed towards its staff. This is a smokefree Trust. Smoking is not allowed in any of our hospital buildings or grounds. This information can be provided in a different language or format (for example, large print or audio version) on request.