Urinary – Nephrostomy Catheter Care

1. Urinary – Nephrostomy Catheter Care Adapted from VNAA Procedure Manual By Ambercare Education Department – Jan 2014

2. 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

3. 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

4. Indications continued • Complete obstruction of ureter(s) • Urinary fistula (bypass) • Irrigation of the renal pelvis • Renal calculi (kidney stones)

5. Potential Complications with long-term placement • Infection • Stone formation • Intermittent hematuria • Renal hemorrhage • Accidental dislodgment

6. Nephrostomy Anterior/Posterior View

7. 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

8. 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.

9. 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

10. 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

11. 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

12. Urinary – Nephrostomy Catheter Irrigation, occluded or plugged interventions (as ordered) • Most tubes are connected to a stop cock system. Tunursestop 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 retunurseof irrigant, assess catheter for kinks; if none found, notify physician

13. 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

14. Video – Mosby’s Skills • See URL in link below