Nephrostomy Tube Placement

What it is, why it is placed, how to prepare, and how to care for it

What is it?

A nephrostomy tube is a thin, flexible catheter placed through the skin of the lower back into the kidney. It lets urine drain from the kidney into a bag outside the body when urine cannot pass normally down the ureter to the bladder.

The procedure is called percutaneous nephrostomy. “Percutaneous” means through the skin. An interventional radiologist places the tube using ultrasound and live X-ray guidance. The tube tip coils inside the kidney. The other end is secured to the skin and connected to a drainage bag.

You may have a tube in one kidney, or one tube in each kidney. It may stay in for days, weeks, or longer, depending on why it was placed. If it stays in for more than a few weeks, it is usually exchanged on a schedule to prevent clogging.

Why do I need it?

A nephrostomy tube is used when the ureter is blocked, leaking, or when urine needs to be diverted to protect the kidney. Draining the kidney can relieve pressure, protect kidney function, and help treat infection. Common reasons include:

A kidney stone, tumor, scar, blood clot, or other blockage in the ureter
Infection trapped behind a blockage (an infected, swollen kidney)
Injury, recent surgery, or swelling that keeps urine from reaching the bladder
A urine leak, or the need to protect a kidney while another treatment, such as stone removal, is planned

You will still make urine. Most of it leaves through the tube into the bag. Some urine may still pass the usual way, especially if only one kidney has a tube.

How do I prepare?

Tell the team about blood thinners, antiplatelet drugs, diabetes medicine, and every other medicine and supplement you take. Some may be held. Do not stop any medicine unless you are told to.
Report allergies to contrast dye, numbing medicine, latex, or adhesives. We often give antibiotics before the procedure.
Eating and labs. If sedation is planned, you will usually be asked not to eat for several hours beforehand. They may check blood counts, clotting studies, and kidney function.
Arrange a ride home. You should not drive after sedation. Wear loose clothing that is easy to change. Ask how long the tube is expected to stay in, and who to call with questions.

How is it placed?

You change into a gown and usually lie face down so the team can reach your back. Monitors track your heart rate, blood pressure, and oxygen. The skin is cleaned, and the doctor injects numbing medicine. Most people also receive sedation through an IV to help them relax. Children and some adults may receive general anesthesia.
Ultrasound and live X-ray locate the kidney. A thin needle is placed through a small opening in the back into the kidney’s collecting system.
The physician passes a guidewire through the needle. The path is gently widened, and the nephrostomy tube is advanced over the wire. The tip coils inside the kidney to keep it in place.
Contrast dye may be injected to confirm the tube is in the right place and to see the level of the blockage. Sometimes a longer tube, called a nephroureteral catheter, is placed so urine can also drain internally toward the bladder. Your team will tell you which tube you have.
The tube is stitched or secured to the skin, covered with a dressing, and connected to a drainage bag. The procedure often takes 30 to 90 minutes. You are watched in recovery. Many people go home the same day. Some stay overnight.

What are the care instructions?

Clean hands. Wash your hands, or use alcohol sanitizer, before and after you touch the tube, the bag, or the dressing.
Keep the site clean and dry. Change the dressing at least twice a week, and any time it is wet, loose, or soiled. Your team will show you how and give you supplies.
You may usually shower after 48 hours. Cover the site, then change the dressing right after. Do not bathe, swim, or use a hot tub while the tube is in place.
The bag. Empty the bag when it is about half full. Do not let it get nearly full. Always keep the bag below the level of the kidney so urine drains by gravity. Do not place the drainage bag inside another bag. Change the bag if it leaks.
The tube. Do not kink, pull, or clamp the tube unless you were taught to. Secure it so it does not tug when you walk, bend, or sleep. Try not to lie on the same side as the tube.
Urine and fluids. Pink urine for a day or two is common. Drink fluids as directed, unless you are on a fluid limit. Flush the tube only if your team has taught you how, and stop if flushing causes pain.
Activity and exchanges. Avoid heavy lifting and vigorous activity for several days, and do not pull on the tube. If the tube stays in longer than a few weeks, it is usually exchanged about every 2 to 3 months. Do not remove it yourself.

What do I watch out for?

Call your care team right away if:

The tube comes out, slips, or the stitch breaks. Do not try to push it back in. Cover the site with a clean dressing and call.
Urine stops draining, the bag stays empty for several hours, the tube is kinked and will not straighten, or urine is leaking around the skin.
Urine turns bright red, or you see large clots, after the first day or two. Light pink urine early on can be normal.
You have a fever over 101°F (38.3°C), shaking chills, vomiting, or worsening back or side pain.
The site is red, swollen, or draining pus, or the urine is cloudy or smells foul.
You feel dizzy or faint, or you have chest pain or trouble breathing. Seek emergency care.