Nephrostomy tubes

Editorial Team / Admin · Feb 5, 2005

Hi adidas! Will attempt to answer some of your questions, perhaps over time those who work in Med-Surg will jump in to help. I have experience assisting with placement of new and change-out of long-term nephro tubes, as well as trouble-shooting problems. You may want to post your questions on the general discussion as well, as not everyone browses this section; you may get more replies. :)

Since your grandpa's tubes have been in since Oct, I must assume the tract is pretty well established. The tubes are curved into a loop a the end, inside the kidney, and secured into that loop by a string that runs the length of the tube. That loop is larger than the diameter of the tubes, so they won't just slip out of the tract, once it's established.

We usually put a small roll of 4X4s under the tube, or some sort of securing device, that keeps the tubes from kinking and interrupting the flow of urine. An outside dressing isn't really necessary if the tubes have been in awhile, -- i.e., it doesn't keep the tubes in. But, it keeps them from rubbing on clothes and bedclothes, and esthetically some folks prefer the tube's exit sites covered. I would recommend some sort of t-shirt (one of those "muscle" t-shirts would be fine) that hugs the torso, to cover the tubes at all times, to prevent their being accidently grabbed by dangerous doorknobs and table edges. We've had to replace tubes pulled out of position by just such mishaps. So, have grandpa wear the t-shirt to prevent the tubes' being available for yanking. (sometimes we've put on torso-sized burn netting, does the same thing for more $$$!!)

Inspect the site at each dressing change for signs of inflammation or infection (redness, edema, pus at the site). Inspect the urine daily as well, for signs of blood or cloudiness or foul odor, all of which could signal problems with the tubes or a kidney infection. Monitor grandpa, as well, for any fever or loss of appetite/decrease in energy/LOC level, which may indicate infection as well.

Sometimes the bags (only the bags, now, not the tubes) just wear out or get perforated, and need replacing. This can easily be done at the hospital. We always told the patients to call us first, in the Radiology dept, instead of going to the ER and sitting and sitting and sitting and sitting . . . we just needed to swap the bags out, that's all (as long as everything else = site, urine, etc -- was unchanged and looked healthy).

Most bags have an anti-reflux valve, to prevent flow of urine back into the kidney. Even if the bag has this feature (and you may not even know if it does or not), always keep the bag below the kidney. Empty the bag when 2/3 full, don't wait till it's REALLY full! If the bag is too small to accommodate the overnight output, you may ask the nurses in Radiology about getting a larger bag.

The tubes WILL need routine changing, probably every 6-8 weeks. Some pts build up "crusties" in the tubes sooner than others (one woman we monitored had them changed every 3-4 weeks, or they'd plug up). This doesn't usually take as long, nor is it as uncomfortable, as the initial placement. Replacements should be routinely scheduled by your Radiology dept (I assume that's where they were placed initially).

If one of the tubes happens to come out -- which can happen, even without doorknob trauma! -- call immediately, as there is high probability it can easily be replaced if done within 24 hours of exiting, while the track is still open!

I'm sure I've forgotten something . . . will post more if I remember it. If you have any questions, contact the nurses in the Radiology dept. You may PM me, as well, but not having seen your grandpa, well, I defer to those who have contact w/him. :)

Sounds like he has the best caregiver, which is you, someone who cares for him a lot. I think with time you'll grow more used to care of the tubes, -- what is "normal," what is not. Best to you and him! -- Diana

dspring, RN · Feb 5, 2005

I was going to reply to this thread, but I think it is safe to just say listen to Dianah.

adidas99 · Feb 5, 2005

Diana,

thank you for the info

Editorial Team / Admin · Feb 5, 2005

It was always gratifying to put the tubes in the pts with massive hydronephrosis and sky-high BUN and creat, and then watch the labs return to normal, the flank pain ease (well, except where we put the tube in, initially -- which gets better as the pt gets used to having the tubes in) . . They're not the most comfortable or attractive to have in, but are a practical solution for a way to drain that urine when there's nothing wrong with the kidneys per se, just with the drainage system.

We preferred a couple of 4X4s taped over the exit site, as they "breathe" more than tegaderm. Perhaps some benzoin on the skin might help prevent skin breakdown from multiple tape re-applying.

Yes, I'm sure grandpa prefers having you caring for him! I took care of my fragile great-grandma one summer and, while I was pretty young and naive (pre-nursing days, just out of high school!), I learned a lot about basics, never regret spending that time, and remember her fondly. :) :) -- D

adidas99 · Feb 5, 2005

Ya, i'm going with them to get the supplies

Editorial Team / Admin · Feb 6, 2005

You certainly will! We tried a couple of securing devices - some with all the bells and whistles,-- that were quite impressive and secured well. But over time, any of the securing devices lost that contact with the skin and had to be replaced (and some were VERY tenacious, making it difficult to extract the nephro tube from their clutches!) . . and if, as you say, cost IS an issue, the simplest is really the most cost-conscious: one or two 4X4s, folded into thirds and placed under the tube as close to the exit site as you can, to make a nice soft bed for the tube, so it won't kink, and then tape another 4X4 over that. Minimum of tape, whatever will hold. :) :)