A percutaneous nephrostomy tube drains urine from one or both kidneys to a bag outside the body via a catheter inserted through the skin. The dressing on the skin surrounding the catheter will need to be changed regularly. Patients must also empty and sterilize the external collecting bag. The nephrostomy tube itself may need to be replaced by the doctor every two to three months.
Doctors will help patients and caregivers learn how to care for the tube and collecting bag at home. In addition to caring for the tube, dressings, and collecting bag, patients must follow general care instructions. It is essential that the dressing be kept dry, so patients should avoid taking baths. Sponge baths may be taken, or the patient should tape a plastic wrap over the dressing before showering. The collecting bag must always be positioned below the patient's waist, or the urine may flow backward. Nephrostomy tubes should be regularly checked to ensure that there is no twisting or kinking.
Collecting bags must be drained and sterilized when they are no more than one-half or two-thirds full. The patient should detach the collecting bag from the nephrostomy tube and empty it into the toilet, and then it should be fully submerged into a sink with hot water and antibacterial soap. The patient should use a syringe to introduce the soapy water through the spout and into the tubing.
After soaking the bag for 15 minutes, the bag and its attached tube should be thoroughly rinsed. To sterilize the bag, the patient should mix a spoonful of bleach with two cups of water and pour it into the bag and attached tubing. After soaking it for about an hour in the bleach mixture, the patient may rinse it thoroughly and allow it to air-dry with the spout open. Before attaching another collecting bag to the nephrostomy tube, the patient should sterilize the connection area of the tube by rubbing it vigorously with a sterile gauze soaked in rubbing alcohol.
The patient's doctor will tell him how often to change the dressing around the tube, but usually it is recommended that a new dressing be applied once daily for the first two weeks. Following this, it may need changing twice weekly or more often if it gets wet. Before changing the dressing, patients must thoroughly wash their hands and put on sterile gloves. A clean towel may be used as a work surface on which to place the supplies.
One hand should be used to firmly hold the nephrostomy tube in place so that it does not pull out while the patient carefully removes the old dressing. Then, the patient should examine the dressing and the skin for signs of unusual drainage, swelling, or odor, which should be reported to the doctor promptly if noticed. The gloves should be disposed of along with the old dressing, and patients should put on new sterile gloves. Saline solution should be used to cleanse the area of skin and the patient should use sterile cotton swabs to wipe the skin in the direction away from the tube site.
Two folded gauze sponges should be placed on either side of the nephrostomy tube, with another rolled gauze sponge over these, but under the tube. The patient may then place a flat gauze sponge over the tube. Strips of medical tape may be used to secure the dressing. Some doctors may give different directions to patients if they are using a different type of dressing.