Stephen J. Schueler, M.D.

Overview Home Care warning signs

Nephrostomy Home Care

Home care for a nephrostomy includes cleaning the site and managing urine drainage bags. Since all nephrostomy tubes eventually become clogged, the doctor must replace the nephrostomy tube every 2 to 3 weeks.

Nurses who are specially trained in nephrostomy care, train patients who need to care for them. Basic nephrostomy training includes information on site cleaning, nephrostomy tube care, and management of various problems. Too much tension on the nephrostomy tube may cause the tube to be pulled out prematurely.

The stoma, or opening in the skin, may be raised or flush with the skin. The inside of a stoma is normally warm, moist and pink. Stomas tend to shrink in size over time and are not painful to touch.

Nephrostomy tubes must be carefully managed in the first week after the surgery, as the stoma edges heal. The stoma must be kept clean and covered with gauze. Skin irritation may occur from allergic reactions, minor skin infection, an irritation from tape. When skin irritation occurs, gently clean the surrounding skin.

Cleaning the stoma
You should gently clean the site and change the dressing once a day. Careful cleaning reduces the risk for infection. You may require help from another person, since the nephrostomy is placed in your back.

To clean the stoma:

  • Wash your hands. If another person is helping you, then he or she must wear gloves.
  • Remove the dressing.
  • Gently wash the area where the tube enters your body with soap and water.
  • Apply hydrogen peroxide with a cotton swab to the skin around the stoma.
  • Dry the area gently.
  • Apply a new dressing as directed by the nephrostomy nurse:
    • Cover the site with sterile gauze.
    • Secure the tube with tape.
  • During the first 2 weeks after the nephrostomy is inserted, protect the site with a waterproof dressing while showering. After two weeks, the site may be cleaned in the shower.
  • Do not take a tub bath while you have a nephrostomy.

Flushing the nephrostomy tube
In order to flush the nephrostomy tube, follow the directions from the nephrostomy care nurse. You must flush the tube every day.

To flush the nephrostomy tube:
  • Wash your hands.
  • Wear gloves.
  • Clean the flushing port on the stopcock with alcohol.
  • Position the stopcock so that noting can flow into the bag.
  • Draw 5 cc of sterile saline into the syringe.
  • Inject the saline into the flushing port on the stopcock.
  • Position the stopcock so that urine flows from the tube, into the bag.

Urine drainage bags
The drainage bag must be positioned to hang below the kidney, so that gravity allows the urine to collect in the bag. Empty the urine bag when it becomes 2/3 full.

To empty the bag:
  • Wash your hands.
  • Stand or sit near a toilet.
  • Hang the bag over a measuring container.
  • Keep track of the amount of urine you pass every day.
  • Open the clamp on the bottom of the bag to drain the urine.
  • Drain the urine form the bag into the toilet.
  • Close the clamp.
  • Clean the end of the bag with alcohol.
  • Dry the end of the drainage tube with tissue.
  • Wash your hands.

Changing the drainage bag:
  • Drain the urine from the bag into the toilet as directed above.
  • Wash your hands.
  • Clean the connection between the bag and the nephrostomy tube with alcohol.
  • Stop the flow of urine into the bag by closing the stopcock.
  • Remove the bag from the stopcock.
  • Attach the clean bag to the stopcock. Open the stopcock so that urine can flow into the bag again
  • Wash your hands.

Managing the bag when you go to bed:
  • When you get into bed, arrange the tubing so that it does not kink or loop.
  • Hang the bag on the side of your bed. Be sure to keep the bag below the level of your kidney at all times.
  • In the morning, wash your hands and empty the night bag into the toilet.
  • Clean the tip of the leg bag with an alcohol swab.
  • Pinch off the catheter, and re-connect the leg bag.
  • Wash your hands again.

Cleaning a drainage bag:
  • Wash your hands.
  • Close the stopcock.
  • Disconnect the bag form the stopcock and attach it to a clean bag.
  • Open the stopcock.
  • Fill the original bag with one-half cup (100 ml) of cleaning solution:
    • 2 parts vinegar to 3 parts water, OR
    • 1 tablespoon (15 ml) of liquid chlorine bleach to one-half cup of water
  • Close the bag and shake it.
  • Allow the bag to sit for 20 minutes.
  • Empty the bag.
  • Hang the bag upside-down and allow it to dry.

Additional tips
  • Drink 4-6 glasses of water a day to keep your kidneys and bladder flushed out.
  • You may shower, but do not take a tub bath.
  • Remember to take any prescribed medications and keep scheduled appointments.
  • Do not allow the nephrostomy tube to twist or kink.

Nephrostomy Warning Signs

Notify your doctor if you have a nephrostomy and you have any of the following:

  • You develop pain in your back, side, or flank.
  • You develop a temperature of 100.4 degrees or higher.
  • You develop shaking chills.
  • You develop worsening pain around the stoma.
  • Urine stops draining from the nephrostomy tube.
  • You develop increasing amounts of blood in the urine.
  • You develop new blood clots in your urine.
  • You see blood draining from around the outside of the nephrostomy.
  • You see yellow or green mucus draining from around the outside of the nephrostomy.
  • You urine becomes very cloudy.
  • You develop worsening abdominal pain.
  • You develop worsening back pain.
  • The nephrostomy is leaking.
  • The nephrostomy tube breaks

Last Updated: Apr 12, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Nephrostomy References
  1. Fitzgerald J. Hospital and home care of sutureless percutaneous catheters. Ostomy Wound Manage. 1989 Winter;25:42, 45-9. [2610817]
  2. Guidos B. Preparing the patient for home care of the percutaneous nephrostomy tube. J Enterostomal Ther. 1988 Sep-Oct;15(5):187-90. [3170934]
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