Patient education: Percutaneous nephrostomy (The Basics)

What is percutaneous nephrostomy? — Percutaneous nephrostomy is a procedure where a doctor places a small tube or "catheter" through the skin on the back into the kidney.

Normally, urine drains from the kidneys through the ureters, into the bladder, then out of the body through the urethra (figure 1). With a percutaneous nephrostomy, the tube instead lets the urine drain from the kidney into a collection bag (figure 2). The other kidney will continue to drain normally into the bladder.

You might have a nephrostomy tube for a few days to a few months, or indefinitely. This depends on why the tube was placed.

Why do I need a percutaneous nephrostomy? — Some diseases can block the normal flow of urine through the ureters. This causes urine to back up, which can damage the kidneys and cause infection.

You might need this procedure if:

●You have a blockage in the kidneys or anywhere in your urinary tract.

●You have a severe kidney infection with a blockage.

●You have a large kidney stone.

●Your bladder or ureters are injured.

How do I prepare for percutaneous nephrostomy? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get imaging tests to show where the blockage is. (Imaging tests create pictures of the inside of the body.)

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding or clotting problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during percutaneous nephrostomy? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia that might be used for percutaneous nephrostomy include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain.

•Moderate sedation – This type of anesthesia involves medicines given through your IV to help with pain. You might also get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will give you a shot in the skin of your back to numb the area. Then, they will use an ultrasound or special X-rays to create pictures of your kidney.

●The doctor will use the ultrasound, X-rays, or both to place the needle in the correct area of your kidney. They might also inject dye to help see your kidneys better.

●The doctor will push a thin wire through the needle and into your kidney. The tube is threaded over the wire and left in place to drain urine from your kidney.

●The doctor might put stitches around the tube to hold it in place. Then, they connect the tube to a drainage bag and cover the area around the tube with clean bandages.

●The procedure usually takes 30 to 60 minutes.

What happens after percutaneous nephrostomy? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off.

Some people can go home after a short time, and others need to stay in the hospital. Before you go home, you will learn how to take care of the nephrostomy tube.

What are the risks of percutaneous nephrostomy? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Bleeding, or blood in your urine

●Infection

●Injury to other organs

●Problems with kidney function

●The nephrostomy tube being pulled out

●The nephrostomy tube getting blocked

What follow-up care do I need? — The doctor will want to see you again after surgery to check on your progress. Go to these appointments.

What else should I know?

●You might have some clear to light yellow drainage around the drain tube wound for a few days. This is normal. It is also normal to see some blood in the urine drain bag for a few days.

●You can take a shower after 48 hours or when your doctor tells you to. Keep your wound dry when you shower. Wrap the tube and drain bag with plastic before you shower. Do this each time you shower and until the wound fully heals. You can wash your healed wound with mild soap and water during showers.

●Do not soak in a tub or hot tub or swim while the nephrostomy tube is in place.

●The doctor might need to change the nephrostomy tube if it will be in place for a long time. They will want to change the tube every 8 to 12 weeks. This will make sure that the tube continues to work properly.

More on this topic

Patient education: How to care for a nephrostomy tube (The Basics)
Patient education: Kidney stones in adults (The Basics)
Patient education: Kidney stones in children (The Basics)
Patient education: Hydronephrosis in adults (The Basics)
Patient education: Hydronephrosis in babies (The Basics)

Patient education: Kidney stones in adults (Beyond the Basics)
Patient education: Kidney stones in children (Beyond the Basics)