Nephrostomy
Tubes
Urology department
01935 384 394
01935 384 227
yeovilhospital.nhs.uk
What is a nephrostomy?
A nephrostomy is a small tube inserted through the skin into the
kidney to allow urine to drain. A nephrostomy tube is required
when there is a blockage which does not allow urine to drain
into the bladder from the kidney.
How is the tube inserted?
This procedure is usually carried out under a local anaesthetic.
The nephrostomy tube is inserted through your skin into the
affected kidney in the x-ray department. Sometimes it may be
performed under CT guidance. This will be made clear to you at
your appointment.
A local anaesthetic is given at the site of entry which is your
side/back. You are likely to have a small needle (cannula)
inserted into your hand, this allows painkillers and or a sedative
to be given to you.
You will be informed if you are having a local or general
anaesthetic. It is rare to need this procedure under a general
anaesthetic.
How long will it take?
Every patient’s situation is different. It may all be done in 20
minutes, or it may take up to 90 minutes. As a rough guide
expect about an hour.
What happens before the procedure?
You may need to have some routine blood tests done and a
urine sample taken to check for infection. In some cases the
reason for the insertion of the nephrostomy tube is due to an
infected blocked kidney and you may be given antibiotics at this
stage.
The doctor will explain the reason you need a nephrostomy tube
inserted and will ask you to sign a consent form.
Make sure you are satisfied that you have received enough
information about the procedure and been given ample
opportunity to ask any questions, before you sign the consent
form.
You will need to wear a theatre gown. This allows the radiologist
easy access to the insertion site.
If you are having the procedure under local anaesthetic, you
will be asked not to eat anything for four hours beforehand,
although you may be allowed water.
What happens during the procedure?
You will lie on the x-ray table, usually on your side. You need
to have a needle put into a vein in your arm or hand so the
radiologist can give you a sedative or painkillers. You will also
have a monitoring device attached to your chest and finger, and
will probably receive oxygen through small tubes in your nose.
The radiologist will keep everything as sterile as possible, and
may wear a theatre gown and gloves. Your skin will be cleaned
with antiseptic and then most of the rest of your body will be
covered with a sterile sheet.
The radiologist will use the x-ray equipment or the ultrasound
machine to decide on the most suitable point for inserting the
fine plastic tube (catheter), usually in your back just below
your 12th rib. Then your skin will be anaesthetised with local
anaesthetic and a fine needle inserted into the kidney.
When the radiologist is sure that the needle is in the correct
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 fixed to the skin surface with
a special dressing. It will then be attached to a drainage bag.
Will it hurt?
Unfortunately it may be uncomfortable for a short period of time,
but any pain you have can be controlled with painkillers. 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, and sometimes this is 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 painkillers through the
needle in your arm/hand. Once in place the catheter should not
hurt at all.
What happens afterwards?
You will be taken on a trolley from the x-ray department to the
ward. You will need to rest on your bed for 24 hours. This is to
allow the insertion site to heal sufficiently. 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. There will be a dressing over the site of the
tube which should not be removed by yourself but by the doctor
or nurse looking after you and only if it is deemed necessary.
This is because removing the dressing increases the risk of
infection.
What are the possible complications?
As with any medical treatment there are some risks and
complications that can arise. The biggest problem is being
unable 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.
Occasionally there may be an infection in the kidney, or in the
space around it. This can be treated with antibiotics.
There may be slight bleeding from the kidney. On very rare
occasions, this may become severe and you may require a
surgical operation or another radiological procedure to stop it.
What happens next?
You do not necessarily need to stay in hospital whilst 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 Lithotripsy (ESWL) 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.
Prior to 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
assistance, support and advice.
Living with a nephrostomy tube
You may encounter some problems at home but these can be
easily overcome. Listed below are some common questions
asked by patients. If you have a question not answered, 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 also be uncomfortable.
his 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. During the day a ‘leg bag’ will
be attached which is under your clothing strapped to your leg.
During the night a bigger drainage bag may be required.
 How do I connect the drainage bag?
You will be shown how to do this whilst you are on the ward.
Please do not be afraid to ask if you are unsure of anything. It
is important that you are confident 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.
 What should I do if I notice blood in the bag?
A small amount of blood in the bag is not unusual following the
procedure, however if it persists of you are concerned about
the volume of blood, contact your GP. Excessive blood in the
urine can indicate an infection. See your GP and take with you
a sample of urine from the bag. Increase your fluid intake from
two litres a day to three 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 fluid intake.
 Can I prevent an infection occurring?
Not all infections can be prevented. You need to drink about
two litres a day, increasing to three litres if you already have an
infection. Ensure you wash your hands thoroughly before and
after changing your drainage bags. Keep the drainage bag
closed at all times except when emptying it. Empty the drainage
bag only when necessary and not before.
Depending on your type of dressing it may need changing once
a week or more often if it is soiled.
Cranberry juice may assist in the prevention of infections. If you
wish, you can have a glass of cranberry juice daily.
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. If you have not drunk enough, try drinking half a litre of
fluid. If no urine drains after these checks, contact your GP.
 Will I have pain?
You may feel some discomfort. Painkillers like 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?
Yes. If you have two kidneys the other one will work in the
normal way, hence allowing you to pass urine the normal way. If
you have two nephrostomy tubes you may pass the normal way
although this 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. 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 ‘What happens
if I have an infection?’
 Can I eat and drink normally?
You can eat and drink like you normally do. You need to ensure
that your fluid intake is at least 2 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 may be better. You will have to find a
position that suits you.
 Can I exercise?
Gentle exercise is fine. More strenuous exercise may cause you
pain or discomfort so should therefore be avoided.
 When can I return to work?
This depends on the type of work you do. Light housework or
office work is fine. Heavy labouring, lifting or scrubbing floors
may not be. You need to ask about your particular job.
 Can I have sexual intercourse?
There are no restrictions on your sexual activities. You may have
to find 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.
 Can I drive?
If you are comfortable whilst driving then there are no
restrictions. You should check with your own doctor and inform
your insurance company.
 Can I go out and about?
Yes. If you normally do your own shopping then you can
continue to do so. Some people have concerns of the tube
getting knocked and this stops them from going to crowded
areas. Again, if you are careful you needn’t avoid going out.
Knowing where the public toilets are situated when you are out
and about can alleviate fears of 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 fill 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 to where.
It may also depend on how confident you feel with 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 will also need to check with your insurance
company before you go.
 Where do I get further supplies?
Your GP surgery and/or your district nurse will arrange for your
supplies.
What happens on discharge from hospital?
A district nurse will be organised by the ward staff to visit you at
home. He/she may visit you 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
management you require. Any medication that you require will
be given to you and if you require a repeat prescription, your
GP will provide you with this.
An outpatient appointment may be sent to your home address.
It is important for these appointments to be kept so that the
hospital doctor can monitor your progress and plan further
treatment.
If you would like this leaflet in another
format or in a different language,
please ask a member of staff.
Yeovil District Hospital
NHS Foundation Trust
Higher Kingston
Yeovil
Somerset
BA21 4AT
Ref: 18-16-122 np
Review: 06/18