​A nephrostomy is an artificial opening created between the kidney and the skin which allows for direct drainage of urine from the upper part of the urinary system (renal pelvis) when normal flow from the kidney down the ureter to the bladder is impeded. Usually a nephrostomy tube is placed through this opening and is connected to a drainage bag for ease of care.

The nephrostomy tube provides permanent or temporary urinary drainage following a procedure or to relieve ureteric obstruction. It may be inserted by open surgery in the operating theatre or under image guidance by the radiologist.

Why does your child need a nephrostomy tube?

• Temporary drainage of the kidney (a few days) after an interventional procedure through the kidney e.g. ante grade stent insertion or removal of renal calculi).
• Long-term decompression of an obstructed system (weeks to months) to relieve ureteric obstruction and improve renal function.

Before the procedure or operation

You will be given information to prepare your child before the procedure or operation. Inform your doctor if your child is on medication (especially blood thinning medication e.g. warfarin) .These should usually be stopped seven to ten days before surgery as they increase the risk of bleeding. The doctor will inform you when to stop and restart the medication. Blood and urine samples will be taken for investigation.

After the procedure or operation

A dressing will be covering the site of the tube which will be checked by the nursing staff. There may be blood draining from the tube which is normal and will decrease in a few days. Your child should drink good amount of fluid to flush the blood from the kidneys unless otherwise advised. Your child may be required to stay in the hospital for two to three days. Your child may be discharged with the tube attached to a drainage bag.

How to care for your nephrostomy tube

Education on caring for the tube will be provided to you or a family member of your choice before leaving the hospital to go home. Ask your doctor what is the recommended amount of fluids to drink daily and the minimal amount of urine you should expect to pass daily. Make sure you are provided with drainage bags and given information about how to obtain more supplies.

All patients discharged with a nephrostomy tube will be referred to the outpatient Children’s Surgery Centre. Follow-up visits at the outpatient Children’s Surgery Centre will be scheduled for change of dressing.

Specific care for your tube

Refer to information leaflet on Caring of urinary drainage tubes or catheters

Dressing around the tube

• Dressing should be changed 24 hours after insertion, and thereafter on a weekly basis, or more frequently if it becomes soiled, damp or loose.
  • Gauze dressings should be replaced every day.
  • Transparent dressings should be replaced every seven days.
• During dressing change, check skin condition of catheter exit site for:
  • Inflammation
  • Erythema
  • Skin breakdown
  • Discharges

If any of above is noted, please inform the Children’s Surgery Centre nurses or your doctor.

Note: Change of dressing and change of drainage bag will be done at Children’s Surgery Centre every week.

Changing your drainage bag in event of displacement

Refer to information leaflet on Caring of urinary drainage tubes or catheters

• Wash your hands well.
• Clean the tubing at the connection point with alcohol swab.
• Be careful not to touch the tubing where it fits together.
• Gently pinch with your fingers the soft nephrostomy tubing to prevent any leakage.
• Connect to a new drainage bag.
• Make sure your bag is below the level of your kidneys to prevent urine going back into the kidney.

Bathing

While the nephrostomy tube is in place, your child will not be able to take a bath. Instead, you will need to give your child sponge baths. Showers are allowed as long as the tube is secured with plastic wrap. Do not let the water pound on the tubing. A change of dressing is required if the dressing gets wet after shower.

Swimming is not allowed as long as the tube is in place.

Irrigation of nephrostomy tube

Your doctor will order flushing of nephrostomy tube if there is absence of urine, if urine remains heavily blood stained, if the patient has persistent flank pain or there is suspected blockage.

• Do not aspirate or force, if resistance occurs, ask the patient to lie down on their back and then again on their side.
• Do not flush greater than 5mls of sterile normal saline.
• Observe for continuous urine flow and signs of infection.

Note: A Medical Officer (MO) or a Speciality Care Nurse can perform irrigation of the nephrostomy tube

When to visit the doctor

Please call the Children’s Surgery Centre Nurse at 6394-8036 if problems happen such as:

• Urine changes colour smells foul or becomes bloody.
• Urine leakage around the catheter and the dressing becomes wet.
• Child has pain in the back, sides or abdomen.
• Child is having fever or vomiting.
• Urine drainage stops.
• Skin around the tube becomes raw, irritated or develops a rash and skin around the tube hurts.
• Discharges around the tube.

If the nephrostomy tube falls out, it is essential that it be replaced quickly as the insertion site may begin to close. You will need to seek immediate medical attention at the Children’s Emergency, Children’s Tower, Basement 1.