Nephrostomy

 

 

 

What is a nephrostomy tube?

 

A nephrostomy is a small tube which is inserted into the kidney from the outside through your skin. The purpose of the tube is to act as an external drain for a kidney which has its internal system blocked for one reason or another (for example due to a stone).  The tube will be connected to a plastic bag into which it will drain.

 

How to prepare for the procedure

 

This procedure is usually performed in an urgent or semi-urgent setting and you will usually already have been admitted to hospital prior to the procedure.

 

It is important to disclose with the doctors taking caring of you whether you are on certain medications (especially blood thinners like Warfarin or Aspirin) prior to the procedure as these may need to be temporarily stopped and then re-started after the intervention.

 

What does the procedure involve?

 

The procedure will take place within an interventional suite. You will initially be taken to the Recovery Area (adjacent to the operating room) where you will be asked to change into a surgical gown. Your belongings will be kept in a safe room. You will then be asked to wait within this room until you are called from the operating theatre, at which point you will be taken theatre by a theatre nurse on a stretcher.

 

A small tube (or cannula) will be inserted into your hand or arm (if this has not been done already) – this will allow the team to give you antibiotics before the procedure to minimize the risk of infection.

You will be placed face-down (or almost completely face-down) on the operating table. The kidney(s) requiring the nephrostomy will be scanned using an ultrasound machine initially. The area involved will then be thoroughly scrubbed and draped. The radiologist performing the procedure will then proceed to give you some local anaesthetic in the skin and deeper down towards the kidney – this should dull all subsequent pain though you may still feel some pushing and pulling sensations.

 

A hollow needle is then passed through the anaesthetized area at your flank and advanced until it enters the problematic kidney (all the while being visualized using the ultrasound machine). Once the needle is in position, a guidewire is passed through the needle and then the needle is removed. The nephrostomy tube is then passed over this wire until it lies in position within the kidney. A few X-rays will be taken at the same time to confirm the correct position of this tube in the kidney – the radiologist will also inject a few milliliters of contrast material through the tube itself to better visualize its exact location within the kidney.

 

Once its position is confirmed, the tube will be secured to your skin using a small suture and a drainage bag is attached to the open end of the tube.

 

The whole procedure usually lasts around 20 minutes.

 

What happens after the procedure?

 

You will be initially taken back to the Recovery Area where you will be monitored for an amount of time following the procedure to ensure you remain well.

 

Eventually once you are deemed well enough, you will be taken back to the ward where you were admitted to rest. Your parameters and general condition will be continuously monitored.

 

The length of your hospital stay and the amount of time you will need with the tube in place depends on the reason why the tube was inserted, and the doctor taking care of you will be able to offer from information in this regard.

 

What are the risks of this procedure?

 

Every procedure carries a small number of risks which might or might not occur. In the case of nephrostomy tube insertions, the following might be seen:

 

• Discomfort at insertion site (usually short-lived and resolves after a few days).

• Bleeding (at the site where the needle entered the kidney).

• Infection (of the kidney being treated).

• Blockage of the tube (this may happen immediately or after several days following the procedure).

• Leakage of urine around the drainage tube (this results in a collection of urine around the kidney within the abdomen. If large, this collection may need to be surgically removed).

 

What should I keep in mind if I am going home with the tube still in place?

 

The following points should be kept in mind to ensure optimal post-procedural care:

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• Avoid lying down on the procedure site. If possible, try to sleep on the opposite side of where the tube is fixed.

• Try to keep the area where the tube is coming out as dry and clean as possible. You may bathe or shower normally 48 hours following the procedure, but always try to keep the area as dry as possible. After 14 days, you may wet the area but try to avoid swimming while the tube is in position.

• If you experience a high temperature, back pain, redness or swelling around the tube, leakage of urine from the drainage site, poor (or absent) drainage or if your tube falls out, you should contact your doctor immediately.

 

Compiled by Dr. Simon Gatt