Percutaneous Nephrostomy Drainage

What is percutaneous nephrostomy drainage?

Percutaneous nephrostomy drainage is a procedure that drains urine from the kidney. A catheter is placed through the skin in the back into the kidney to allow drainage of the urine either through a drainage bag or if the catheter is inserted through to the bladder, then the urine can drain past any obstruction in the kidney or ureter and into the bladder.

Why do I need percutaneous nephrostomy drainage?

Usually, the goal is to relieve a blockage of the kidney or ureter. The ureter drains the urine from the kidney to the bladder. Stones or a tumor may cause a narrowing or stricture, blocking the flow of urine from the kidney to the bladder. A percutaneous nephrostomy provides relief by diverting the obstructed urine to the outside of the body. A nephrostomy may also be performed to help prepare you for another procedure, such as a kidney stone removal.

How is percutaneous nephrostomy drainage performed?

Prior to your procedure you will be asked to undergo the following tests or procedures to evaluate your condition:

History and Physical Examination
Blood tests
Imaging (CT, MRI, MRA)

The procedure is performed in the interventional radiology suite. First, the nurse will give you a sedative through the intravenous line, which will be placed in your arm. You will feel relaxed and sleepy, but you will be awake throughout the procedure. The Interventional Radiologist will numb an area of your back with a local anesthetic. After you are given a local anesthetic, the Interventional Radiologist will insert a small needle into your kidney. Through this needle, contrast (x-ray dye) will be injected to see your kidney and the catheter, or drainage tube, will be placed into the kidney. The catheter will remain in place to drain urine into a drainage bag. The catheter is secured to your back to hold it in place. A dressing is then applied to the catheter entry site.

What will happen after the percutaneous nephrostomy drainage?

After the procedure, you will return to your hospital room for bed rest. Your nurse will check the catheter. The urine will drain outside your body into a drainage bag for several days. If there is a very tight blockage in the ureter, the Interventional Radiologist may have initially placed the drainage catheter in the kidney above the blockage site. If this is the case, then you will return to the interventional radiology suite after 2 or 3 days and the Interventional Radiologist will pass the catheter through the blockage and into the bladder. Once the end of the catheter is in the bladder the drainage bag can replaced by a cap and the urine will drain internally.

You should keep the skin around your nephrostomy catheter clean and dry. You can take a shower, but you should tape plastic wrap or a plastic bag around the bandage. Clean the tube site daily with hydrogen peroxide and allow the skin to dry. Apply a sterile gauze dressing and attach with paper tape. The catheter should be flushed once a day in order to clean any debris out of the holes in the catheter. Flush with 10 ml of saline. Push the saline in towards the catheter (not the drainage bag). Flush slowly in only. Do not pull back fluid into the syringe. By pulling the solution back into the syringe, you may pull the debris back into the catheter.

Problems you should be aware of:

1. If the skin around the catheter becomes red and sore, you may have a skin infection. Apply some antibiotic ointment to the skin when you change the bandage. If it does not clear in two days, call your primary care doctor.
2. If you develop a fever greater than 100° fahrenheit or back pain you should call your primary care doctor immediately.
3. If your catheter begins to leak around the skin site onto the bandage, it needs to be changed. If this occurs at night, call the office the following morning for an appointment at (305) 932-7800. If your catheter has been capped and you have a drainage bag in storage, connect the catheter to external drainage.
4. If your catheter falls out, call the office immediately at (305) 932-7800. Usually, a catheter that has fallen out can be easily replaced with a new catheter if performed within 24 hours.