A nephrostomy tube is a drainage tube placed into the kidney to drain urine directly from the kidney. The word "nephrostomy" comes from two Latin root words for "kidney" (nephr) and "new opening" (stomy).

Normally, as urine is produced in the kidney, it drains downward through a tube called the ureter and is stored in the bladder until urination occurs. In some instances, when the urine is made in the kidney, it cannot reach the bladder or cannot be eliminated from the bladder. This obstruction of urine flow can be caused by stones, infection, a congenital malformation (an abnormality that a child has from birth), swelling after kidney surgery, or trauma.

A nephrostomy tube can be placed during a surgical procedure in the operating room by a surgeon or it may be placed in the Interventional Radiology Department by a radiologist. It may be done under general anesthesia or with conscious sedation. Your child will recover in the post anesthesia care unit (PACU) after the placement of the nephrostomy tube.  

A nephrostomy tube is placed on a temporary basis only. It may remain in place for a few days, weeks or months. If it needs to stay for a relatively long period of time, a new one may be placed at intervals.

The nephrostomy tube should drain urine continuously when it is connected to a drainage bag. The tube can become clogged and cause urine not to drain. If this happens, the tube will need to be flushed through with a sterile antibiotic solution, sterile water, or sterile saline.

Nephrostomy Tube Care

The drainage system should be treated very carefully to prevent bacteria and other germs from entering the system. If any germs get into the tubing, they can easily cause a kidney infection. The drainage bag should not be allowed to drag on the floor. If the bag should accidentally be cut or begin to leak, it must be changed. It is not acceptable to place the drainage bag in a plastic bag if it leaks.

Changing the Nephrostomy Tube Dressing

One of two cleansing substances may be used to clean the skin around the nephrostomy tube. Our preferred choice is chlorhexidine.

You will need to remove the dressing where the tube enters your child's side, clean the area, and replace the dressing one to three times each week. If your child is young, you may want to have someone help to keep your child lying still during the procedure.

If using chlorhexidine:

1. Wash your hands with soap and water.
2. Prepare your supplies by placing them on a nearby clean surface. You will need a Tegaderm bandage, one chlorhexidine swab and a split 2x2 gauze.
3. After you've gathered your supplies, remove and discard the old Tegaderm bandage and dressing. You may choose to wear sterile or nonsterile gloves.
4. Wash your hands after removing the soiled dressings.
5. Open the chlorhexidine and use a back and forth scrubbing motion that follows a circular pattern around the exit site for 30 seconds. Allow the skin to air dry for 60 seconds.
6. Place the split 2x2 gauze around the tube.
7. Apply the Tegaderm on top of the 2x2 and over the tube.

If urine leaks around the tube and causes the dressing to become wet, you will need to change the dressing right away. You should also call your child's doctor and let him/her know about the leak. 

Changing Tube Dressing Placed in Radiology

1. Wash your hands with soap and water.
2. Prepare your new supplies by placing them on a nearby clean surface. You will need Tegaderm, 3 betadine swabs (or a chlorhexidine swab) and a StayFix device.
3. After you've gathered your supplies, remove and discard the old Tegaderm dressing and StayFix device. You may choose to wear sterile or non-sterile gloves.
4. Wash your hands after removing the soiled dressings.
5. Open the betadine swabs (or chlorhexidine swab) and clean the tube site in a circular fashion starting with the skin closest to the tube and moving outwards. Repeat with each swab. Let the chlorhexidine air dry for 60 seconds.
6. Apply the new StayFix device.
7. Apply the Tegaderm on top of the StayFix device.

Bathing

While the nephrostomy tube is in place, your child will not be able to take a bath. Instead, you will need to give your child sponge baths. Showers are allowed as long as the tube is secured with plastic wrap. Do not let the water pound on the tubing. Change the dressing after you shower. Swimming is not allowed as long as the tube is in place.

Emptying the Bag

The drainage bag must be emptied when it becomes half full. Be careful not to touch the spout to the container into which it is being drained. Also, do not touch the spout with your hands.

Tips

• Keep the drainage system below the level of the bladder so urine does not back up.
• If a leg bag is worn, it will need to be emptied frequently because it is very small.
• Be sure that there are no kinks or bends in the tubing. The tube will not drain if kinks or bends are present.
• Change the drainage bag if it becomes dirty or foul smelling, or if a hole is punctured in the bag or in the tubing. Contact your child's doctor if you need a new bag.

Call Your Child's Doctor

• If the urine changes color, smells foul or becomes bloody
• If there is urine leakage around the catheter and the dressing becomes wet
• If your child has pain in the back, sides or abdomen
• If your child has a fever that is greater than 101.5°F (38.6°C)
• If your child is vomiting
• If urine drainage stops for two hours
• If the skin around the tube becomes raw, irritated or develops a rash
• If the skin around the tube hurts
• If there is more than a tiny amount of yellow or green drainage at the tube site