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Nephrostomy tube: Care at home

What is a nephrostomy?

The kidneys make urine that drains down the ureters into the bladder. When a ureter becomes blocked, the urine backs up into the kidney—which can cause kidney damage.

A nephrostomy (neh-frah-sto-mee) is an opening made in the kidney to drain the urine. In surgery, a small opening is made in the skin, and a catheter (small tube) is placed through the opening into the kidney. It is held in place with stitches. This catheter is called a nephrostomy tube.

What can I expect after surgery?

A dressing (bandage) covers the nephrostomy site to protect it and to collect any urine or other drainage that may leak around the catheter. The catheter may be connected to a drainage bag, or may drain into a diaper.

The anesthesiologist and surgeon will prescribe and explain the medicines that will be used to keep your child comfortable. See the education sheet, "Pain in infants" or "Pain in children and adolescents."

Your child will have an intravenous line (IV) to provide enough fluids. It may also be used to give medicines, such as pain relievers and antibiotics. The doctor will decide when the IV and IV medicines are no longer needed.

A pulse oximeter may be used to monitor your child's oxygen saturation while on IV pain medicines.

Quiet activity will be encouraged for the first few days after surgery.

How should I care for my child?

Caring for a nephrostomy tube may be a little scary at first. Your nurse will teach you and help you become comfortable with the procedures before you do them yourself. These are the procedures that will need to be done:

  • change dressing daily and when soiled
  • change the urine drainage bag
  • clean and care for the urine drainage bag
  • know who and when to call for help

How should I prepare my child?

Explain procedures before they are done, especially what your child will see, hear, and feel. Tell your child what is expected ahead of time, such as, "Your job is to hold still while I change your bandage." This will help your child feel more successful, and make care at home easier for both of you. Praise your child when the task is done.

How do I change the dressing?

With young children, you may need someone to help your child hold still.

  1. Prepare a clean work area by cleaning a solid surface with household disinfecting cleanser and laying a clean towel on it.
  2. Wash your hands with soap and water for at least 15 seconds, rubbing all surfaces briskly, or use an alcohol hand sanitizer.
  3. Gather and prepare supplies:
    • cotton-tipped swabs such as Q tips®
    • normal saline, or antibacterial soap and water
    • 2 gauze sponges, 4 inches by 4 inches, folded in half
    • 2 more gauze sponges, 4 inches by 4 inches, one flat and one rolled up
    • tape, cut into strips
    • waste container
  4. Hold the nephrostomy tube securely with one hand throughout the procedure. Remove the old dressing with the other.
  5. Check the old dressing for any drainage, and discard it in the waste container.
  6. Check the skin around the tube for redness, swelling, odor, or drainage.
  7. Clean the skin around the tube with normal saline or antibacterial soap. If soap is used, rinse with water. Using a fresh cotton swab for each side, wipe away from the exit site. Remove any crusting. After cleaning, dry each area with another cotton swab, wiping outward.
  8. Place the 2 folded gauze sponges along each side of the tube.
  9. To keep the tube from kinking, place the rolled gauze sponge under the tube and over the folded sponges.
  10. Place another flat gauze sponge over the tube and securely tape the entire dressing.
  11. Tape the tube to the skin, leaving a little slack in the tube for extra stability.

How do I care for the drainage bag?

Empty the bag whenever it is half full, and anytime you disconnect it from the tube. Never leave urine in the bag when it is not in use.

Before disconnecting or reconnecting the nephrostomy tube and the drainage system, scrub the connection area of the tubes. Wrap an alcohol-soaked gauze sponge around the area and rub, using friction.

Clean and sterilize the drainage bag daily. Follow these steps:

  1. Empty all urine from tubing and bag.
  2. In a basin or sink of warm water and antibacterial soap, submerge the whole drainage system, with emptying port (spout) open. Use a syringe to force the soapy water through the tubing. Let soak for 15 minutes.
  3. Rinse the bag and tube well with warm water to remove the soap.
  4. To sterilize: First mix 16 ounces (2 cups) of water with 1 tablespoon of liquid bleach. Use a pure bleach such as Hilex® or Clorox® with no fragrance or additives.
  5. Close the emptying port. Pour the bleach solution into the bag and rotate it so all surfaces are rinsed. Use a syringe to flush it through the tubing, too. Let the bag and tube soak for at least 30 minutes, up to 1 hour.
  6. Drain the bag by opening the emptying spout. Discard the bleach solution.
  7. Rinse the bag and tube again with warm water.
  8. Hang up to air-dry with all ports open.

With proper care and cleaning, drainage bags may be reused for 4 to 12 weeks. Discard a bag when it gets stiff, cracked, or hard to clean.

What else do I need to know?

Check your child's temperature as recommended by your doctor, and if your child does not feel well.

Your child should drink plenty of fluids. A nutritious diet will promote healing.

Keep the dressing dry. No tub baths until the nephrostomy tube is removed. Give sponge baths instead. If your child is old enough to take a quick shower, keep the dressing dry by covering it with plastic and taping all the edges down with waterproof tape.

Avoid kinking, twisting, or clamping the tube.

Always keep the drainage bag below the waist, so the urine can't run back towards the kidneys. A leg bag may be used when sitting in a chair or walking.

For an infant, the doctor may recommend draining the tube into a diaper. Your baby will wear a regular-sized diaper with the tube taped outside it (with some slack), and a larger diaper on top. This keeps stool from getting into the tube.

Your child will need surgery to put in a new tube about every three months, if it is needed for that long.

Who and when should I call for help?

Call the doctor right away if:

  • stitches or nephrostomy tube comes out
  • fever higher than 101º F (38.4º C)
  • change in urine's smell
  • cloudy or bloody urine
  • redness, swelling, odor, or discharge at exit site
  • urine leaks from tube enough to soak the dressing
  • pain in abdomen (belly) or back
  • vomiting for more than 4 to 6 hours
  • less or no urine coming out of the tube

Questions?

This sheet is not specific to your child, but provides general information. If you have any questions, please call your surgeon.

Children's Hospitals and Clinics of Minnesota
Patient/Family Education
2525 Chicago Avenue South
Minneapolis, MN 55404
Last reviewed 8/2015 ©Copyright

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Family Resource Center library, or visit www.childrensmn.org/educationmaterials.

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