Nephrostomy Tube

What is a nephrostomy tube for?

A nephrostomy (pronounced “neff-ROSS-toh-mee”) tube drains pee (urine) from your kidney. It’s a tube your healthcare provider places to take pee directly from your kidney and channel it into a bag (nephrostomy bag). The bag has a valve on it so you can empty it. A surgeon or radiologist inserts the tube through the skin of your lower back into your kidney. You may have one tube in just one kidney or you may have two tubes, one in each of your kidneys.

Typically, your kidney makes pee. Pee drains from your kidneys down your ureters and bladder. Your bladder is an organ that stores your pee. When your bladder is full, the pee comes out of your body through your urethra.

Many things can stop pee from flowing from your kidneys and through the rest of your urinary system. Things like blockages, infection, trauma or injury are all possible reasons why pee isn’t flowing the way it should.

A nephrostomy tube is usually temporary, but you may need one for several months or years. It depends on the reason you need it. You may have to learn to care for your nephrostomy tube and change your bag. If you need a tube for a long time, you may need to visit your provider on a regular basis so they can replace your nephrostomy tube with a new one.

Placing a nephrostomy tube is often an outpatient procedure and you’re able to go home after (unless you’re already in the hospital getting treatment for another condition). Other names for a nephrostomy tube are nephrostomy catheter or percutaneous nephrostomy.

When would you need a nephrostomy tube?

Several things can block the flow of pee from your kidney. Some of these are:

• Kidney stones.
• Kidney infection.
• Trauma or injury.
• Swelling after kidney surgery.
• Tumors.
• Scar tissue.
• Congenital condition (something you’re born with) that affects your urinary tract.
• Ureter, bladder or advanced prostate cancer.

A blockage in your kidney can become serious when your pee doesn’t empty from your body. It can cause pee to back up into your kidney and make it very swollen. This is called hydronephrosis, which could lead to kidney damage.

How should I prepare for a nephrostomy tube?

Your healthcare provider will give you specific instructions for the procedure depending on your health history and the reason you’re getting a nephrostomy tube. There may be restrictions on eating and drinking in the hours prior to the surgery. You should also let your healthcare provider know what medications you’re taking or if you have allergies.

What happens during a nephrostomy?

Your healthcare provider inserts a nephrostomy tube into your kidney through a tiny cut in the skin in your back. The tube connects to a draining bag that collects your pee. When the bag is half full, you empty it.

The specific steps for a nephrostomy include:

• You’ll change into a hospital gown and lie face down on a table (so your back is accessible).
• You may receive sedation through an IV (intravenous sedation) in your vein, which relieves pain and helps you relax. You usually receive a local anesthetic in your lower back where your provider will insert the tube. Children and some adults may receive general anesthesia, which means they’re asleep for the procedure.
• An interventional radiologist will use an ultrasound or X-ray to locate your kidney. Then, they’ll insert a needle through your skin in your back and into your kidney. They guide a wire through this needle. The tube is then put over the wire into your kidney. Some providers use fluoroscopy and contrast dye to make sure the tube is in the right spot.
• The other end of the tube (the end that’s outside of your body) is connected to a drainage bag, which will collect your pee.
• A stitch or adhesive dressing (gauze or bandages) helps keep the tube in place.

How long does a nephrostomy take?

A nephrostomy takes about one hour.

What happens after a nephrostomy?

You may stay in a recovery area for about several hours after the procedure, but can usually go home to recover. Your healthcare provider will check your blood pressure and pulse, and make sure the tube is draining properly before allowing you to leave. Some people stay overnight. It’s important to note that many people who have a nephrostomy tube placed are already in the hospital receiving treatment for another concern, like an infection, injury or kidney stones.

Here are some general tips for recovering from nephrostomy tube placement:

• You can expect pain and discomfort for several days, especially at the dressing site (where the tube comes out of your skin). This should subside over time, and you’ll be able to take pain medication to help.
• Some people find placing your hand on the tube feels better when you go climb steps or bend down.
• Your healthcare provider may tell you to limit certain activities like rough play, sudden movements or vigorous exercise for several days. These types of activities may accidentally pull your tube or knock the bag.
• You’ll need to keep the tube site clean and dry so it doesn’t become infected. This means you have to avoid bathing or swimming. Showering is fine after 48 hours, but you’ll need to change your dressing immediately after showering.
• It’s OK if you notice some pink (like grapefruit juice color) in your pee for the first 48 hours. Pee that’s bright red (like beet juice) is a reason for concern.

Is nephrostomy major surgery?

Getting a nephrostomy tube is major surgery because it affects a critical organ. The risks are low and the benefits of preventing kidney damage outweigh any risk. Your healthcare provider will discuss the procedure with you and take care to prevent any complications.

How long does a nephrostomy tube stay in?

It depends on your diagnosis and condition. Some people need to leave the tube in for a few days, while others leave it in for weeks or months. If your healthcare provider wants you to wear it for longer than a few months, they’ll need to change out the tubing periodically to prevent infection. Long-term use of a nephrostomy tube increases your risk of infection.

Removing the tube

When it's time to remove the tube, you'll have an appointment with an interventional radiologist. In the procedure room, they'll put a wire down the tube, take an image and then remove the tube and the wire. They'll use a local anesthetic at the point where the tube meets your skin to numb the area. Then, they’ll pull the nephrostomy tube out and place a bandage or gauze on top.

Just as when the tube was placed, you’ll need to follow your provider’s instructions for how to take care of your skin. You’ll need to avoid strenuous exercise, bathing and swimming for at least a few days.

What are the benefits of nephrostomy?

Kidneys are an essential organ in your urinary system. They’re responsible for filtering your blood, turning waste into pee (urine) and performing other critical tasks. If your kidneys aren’t able to empty waste, the waste can back up and cause kidney damage. This means your kidneys won’t be able to do their job as well and will stop working.

A nephrostomy is one of the ways healthcare providers can remove pee from your kidney when it isn’t flowing correctly. This preserves your kidney function and protects it from damage or infection (from pee backing up and without clearing bacteria). Having a tube can be potentially life-saving because kidney damage can lead to kidney disease.

What are the risks or complications of a nephrostomy tube?

The procedure is safe and low risk. Possible complications can include:

• Bleeding.
• Infection.
• Injury to your kidney, bladder or ureters.
• Allergic reaction to the contrast dye (if used).
• The nephrostomy tube falling out.

It’s normal to feel pain where the tube exits your body. If your pain doesn’t improve after a few days, contact your healthcare provider. It’s also normal if you notice light pink pee in your bag.

What’s the outlook for living with a nephrostomy tube?

Having a nephrostomy tube can affect your life in many ways. Some people may feel embarrassed about people knowing they have one. It can also feel like a burden to care for your tube and replace your bags.

But know that there are resources to help you cope. Lean on your family, friends and healthcare providers for help, too. And remember, this is a potentially life-saving treatment that’s usually temporary.

How do I care for a nephrostomy tube?

Your healthcare provider will go over how to care for your nephrostomy tube. They’ll walk you through the process so you can take care of your tube at home. This is extremely important as it can prevent bacteria from getting into the tubes and causing an infection.

Caring for your tube involves inspecting your tubes, changing out the dressing and emptying your nephrostomy bag.

Please be sure to use clean hands while caring for your tube. Wash your hands (or use an alcohol-based sanitizer) before and after you touch any parts of the nephrostomy tube, drainage bag or your dressing.

Tube inspection

When you inspect your nephrostomy tube, you should check for:

• Links or bends in the tubing. The tube won’t drain into the bag if it’s bent or kinked.
• Infection, swelling or redness where the tube meets your skin.
• Blood in the pee in your nephrostomy bag.
• Wet, dirty or loose dressings where the tube meets your skin. Your dressings should be clean and dry at all times.

Flushing the tube

Another factor in caring for your tube is flushing it. Flushing your tubing prevents it from clogging, which prevents pee from draining into your bag. Your healthcare provider will give you instructions on when and how to do this. It generally involves injecting a sterile solution into the port that connects your drainage bag to your tubing.

Emptying your nephrostomy bag

Your healthcare provider will give you extra drainage bags and instruct you on how to empty or change out your drainage bag. Depending on the size of your bag, you may need to empty it every two to three hours. Here are some tips for changing out your bag:

• Your bag must always be lower than your kidneys so it can drain correctly.
• Change the bag if you notice a leak or hole. Don’t put the drainage bag in another bag.
• Empty the drainage bag when it’s about half full. Don’t wait until it’s almost full.

Changing your dressing (bandage)

You’ll need to change out the dressing where the tube meets your skin and replace it at least twice per week or anytime you shower or the area gets wet or dirty. This may require getting help from a friend, partner or someone else in your home.

Your healthcare provider will teach you how to change the gauze dressing and keep the area clean. They’ll provide supplies you can take home.

Can you still pee with a nephrostomy tube?

You’ll still pee with a nephrostomy tube, but most of it will go through the tube and into the bag, and not out of your urethra. But you can still pass some pee in the usual way, especially if you only have a nephrostomy tube for one kidney and not both.

When should I call my healthcare provider?

Contact your healthcare provider if you have any concerns about your nephrostomy tube or feel that something isn’t working as it should. For example, if it seems like your pee isn’t flowing into the bag or you think your tubing is kinked.

You should contact your healthcare provider if you notice any of the following:

• Bright red blood (beet juice color) in your pee. Pink pee (grapefruit juice color) is normal in the days just after tube placement.
• Pus or yellowish fluid draining from the tube or in your nephrostomy bag.
• Pee leaking from the tube or around the nephrostomy site on your skin.
• You have a fever of over 101 degrees Fahrenheit (38.3 degrees Celsius) for longer than 24 hours.
• Severe pain that doesn’t get better with pain medications.

A note from Cleveland Clinic

A nephrostomy tube lets pee leave your kidney when a condition or injury prevents it from happening on its own. This tube is usually temporary and your provider will remove it once your kidneys are functioning well again. There are some cases where you may live with one for years. Taking care of your tubing to prevent infection is important. It’s normal to feel uncomfortable or embarrassed about having your pee drain out of your body in this way, but know that your provider is doing it to keep you healthy and safe. Don’t be ashamed to talk to your provider about your feelings and concerns.