CARING FOR NEPHROSTOMY TUBES

By: Helen S. Salgado, RN, MAN

Purpose

Allows urine to drain from the kidney to a drainage bag when the ureters are obstructed by tumors, calculi, strictures, or fistulas.

Equipment:

Clean drainage bag and connecting tubeDisposable glovesAlcohol swabsSterile gauze pads

Equipment:

Sterile saline solutionAdhesive tapeBath basin with soap and water

Equipment:

Paper bag for disposal of soiled dressingMild detergent and vinegar (for ongoing care)

Assessment:

Continuous flow of urineDoctor’s order for dressing changeClient’s knowledge of the procedure

Assessment:

Rise in temperature, purulent discharge at insertion site, malodorous urine, flank pain, integrity of skin around the insertion site.

Assessment:

Appearance of urineClient’s cognitive status, vision, and manual dexterityCaregiver’s reliability to care for the tube

Special consideration:

Tubes come out

notify health care provider*The tract closes quickly

in 2 to 3 hours.

Special consideration:

Drainage bag lower than the nephrostomy tube -enhances gravitational flow.Never irrigate the nephrostomy tube unless ordered.

ImplementationAction Rationale

1. Explain the procedure to client.2. Perform hand hygiene.

1.Decreases anxiety

2. Avoids transfer of microorganisms

Implementation

Action Rationale

3. Organize equipment within reach.4. Put on disposable gloves.

3.Promotes efficiency

4.Minimizes exposure to client’s body secretions

ImplementationAction Rationale

5.Disconnect the nephros-tomy tube from the used tubing and drainage bag. Clean end of the nephrostomy tube with an alcohol swab.

5. Reduces microorganism transfer .

ImplementationAction Rationale

6. Attach the ends of the nephrostomy tube and the connecting tube securely. Don’t touch the ends of the tubes.7. Check the tubing for kinks.

6. Maintains sterility of system

Implementation

Action Rationale

8. Change the dressing daily according to doctor’s order. Put soiled dressing in paper bag for disposal.

8. Removes medium for microorganism growth  

Implementation

Action Rationale

9. Gently wash around the nephrostomy tube.

9.Decreases microorganisms around the nephrostomy tube.

Implementation

Action Rationale

10. Inspect the skin around the tube. Note color and character of any drainage.

10. Redness or white, yellow, or green drainage may indicate infection; drainage that smells like urine may indicate tube displacement; either condition should be reported to the doctor immediately.

ImplementationAction Rationale

11. Fold several gauze pads in half and place around the base of the nephrostomy tube. Secure the pads with tape. Cover the nephrostomy tube entry site with a dry sterile 4 x 4 & tape securely.

11. Protects the skin and is more comfortable for the client 

ImplementationAction Rationale

12. Bring all the tubing forward, and tape securely to the body. 

13. Keep separate output records for each kidney, if both have tubes.

12. Allows the client to turn without obstructing urine flow or dislodging the tube from the kidney 13. Promotes more accurate assessment of kidney function

Implementation

Action Rationale

14. Irrigate the tube gently with 5 mL of sterile warm saline solution, if ordered. Alert doctor immediately if tube is not patent.

14.Determines patency   

ImplementationAction Rationale

15. Wash the used bag and connecting tube with a weak detergent daily. Rinse with plain water and hang on clothes hanger to air dry.

 15. A biodegradable or chlorine product may erode the bag.

Implementation

Action Rationale

17. Perform hand hygiene after procedure is complete and equipment stored.

 17. Reduces microorganism transfer

Documentation

The following should be noted on the client’s chart:

Teaching doneFunctional limitations that

interfere with performance of procedure

DocumentationClient tolerance of procedureCondition of insertion siteQuality and quantity of urinary

outputPlans for future visitsDischarge planning

Thank you!