Urinary – Nephrostomy Catheter CareAdapted from VNAA Procedure Manual

By Ambercare Education Department – Jan 2014

Purpose

To maintain a patent catheter providing drainage of urine from the kidney when flow of urine through a ureter is not possible or desirable and to prevent infection

Indications:

Inserted into the renal pelvis to drain urine and relieve pressure

It can be inserted percutaneously using local anesthesia or via an open surgical procedure called a pyeloplasty

Most common – via local anesthetic and either radiography or ultrasound for placement

It is an invasive procedure – resulting in an interruption of the skin – which of course is the body’s first line of defense

Generally placed as a temporary method of diversion; however, it can be placed permanently

Indications continued

Complete obstruction of ureter(s)Urinary fistula (bypass)Irrigation of the renal pelvisRenal calculi (kidney stones)

Potential Complications with long-term placement

Infection

Stone formation

Intermittent hematuria

Renal hemorrhage

Accidental dislodgment

Nephrostomy Anterior/Posterior View

Things to Consider Maintaining a sterile system is of utmost importance in

preventing serious consequences of kidney infection

The catheter is either taped, sutured or a securement device is used to keep catheter securely in place

The catheter should not be kinked or plugged to assure continuous drainage. Bending or shaping in a “C” shape will provide some give and help the tube not to be pulled out.

Prevent kinking or bending of the catheter by careful dressing of the site

If the positioning, manipulation of tube, or irrigation does not remove an obstruction and allow flow of urine, notify physician immediately

The catheter is never clamped unless otherwise ordered by physician

Things to consider - continued

Removal of a nephrostomy catheter is done by the physician; after removal a 4x4 sterile gauze dressing or other appropriate dressing is placed over the catheter insertion site and changed daily or as needed

If excessive drainage occurs after removal, a small urostomy appliance can be placed over site until drainage is minimized

Monitor for s/sx of infection at site and document appropriately

Labeling of tubes/dressings (date/initials, etc.) must be adhered to

Patient/family education is an important aspect of the plan of care – including contacting nurse for assistance if the catheter becomes dislodged, disconnected, etc.

Urinary Nephrostomy Equipment

Sterile irrigation set (if needed)

10 mL sterile syringe

Gauze pads (sterile 4x4s)

Antimicrobial solution (wound cleanser)

Drainage basin / Drainage bag / leg straps if necessary

Gloves (sterile and clean) / adhesive remover pads

Sterile irrigation solution (Normal Saline or as prescribed) / sterile water

Chux (underpad)

Transparent dressing / paper or cloth tape

Sterile cotton tips

Urinary Nephrostomy Dressing Change Adhere to Standard Precautions

Explain procedure to patient

Place patient in comfortable position (that allows access and observation of Nephrostomy tube) – place chux under patient (cover exposed body parts with sheet)

Remove old dressing (care must be taken not to pull on tube – may not be sutured in) – use adhesive remover if necessary

Anchor catheter to skin with one hand while removing tape with other hand to sure catheter is not pulled out

Cleanse around nephrostomy tube with sterile 4x4s and sterile water (after cleansing with wound cleaner and sterile 4x4x) pat dry with sterile 4x4 – begin at the catheter site and move outward

Urinary Nephrostomy Dressing Change

Inspect catheter for kinks, check for leakage of urine or (bile if it is a biliary tube)

Examine catheter exit site. Report s/sx of redness or infection to physician

Place appropriate dressing over or around catheter site – secure in place – A transparent dressing may be applied to provide a waterproof barrier

Urinary – Nephrostomy Catheter Irrigation, occluded or plugged interventions (as ordered) Most tubes are connected to a stop cock system.

Tunurse stop cock to the appropriate position: Off to drainage bag (closed) when instilling solution

On (stop cock) to syringe to allow flow of urine into syringe or bag

Use sterile technique, gently irrigate catheter with 5 mL of NS or ordered irrigation – never force irrigant

Gently allow irrigant to flow back per gravity drainage. ONLY ASPIRATE WITH PHYSICIAN’S ORDER

NEVER re-install USED irrigant into tube!

If unable to get a retunurse of irrigant, assess catheter for kinks; if none found, notify physician

Document in patients record:

Color and characteristics of urine (odor, sediment)

Urinary output

Condition of catheter, patency of tube

Any drainage or s/sx of infection around site

Condition of skin under tape – noting blisters, rashes, etc. and intervention

Interventions performed

Patient’s response to procedure

Patient education given and understanding of such

Communications with physician when necessary

Video – Mosby’s Skills

See URL in link below