LECTURE 9 (Nephrostomy) Flashcards
What is a Nephrostomy?
A tube that lets urine drain from the kidney through an opening in the skin on the back and the urine drains through the tube into a bag outside the patient’s body
What is a Nephrostomy tube?
A pigtail drain inserted under fluoroscopic, ultrasonographic or computed tomography (CT) guidance with local anaesthetic
What are the indications for a Nephrostomy tube?
- Relief of urinary obstruction
- Urinary diversion
- Following a ureteral injury, ureteral fissure or fistula
- Access for therapeutic interventions (e.g stone/foreign body removal, delivery of medications)
- Diagnostic testing
What are the contraindications for a Nephrostomy tube?
- Coagulation conditions that increase the tendency to bleed
- Anticoagulant use
What is the cause, action and prevention of Nephrostomy wound site infection?
CAUSE:
foreign body puncturing the skin
ACTION:
- monitor patient for signs of infection
- send swab for MC&S
PREVENTION:
- maintain good exit site
- change dressing and check site every 7 days
- ensure good hand hygiene
What is the cause, action and prevention of the Nephrostomy tube falling out?
CAUSE:
- locking mechanism on drain has failed
- retaining suture has become loose
- drain fixation dressing has fallen off
ACTION:
- seek urgent medical assistance
- nephrostomy tube will need to be replaced
PREVENTION:
- check locking mechanism on drain is in ‘lock’ or ‘drain’ position
- check retaining suture is intact during weekly dressing changes
- be careful to correctly apply and secure the drain fixation dressing
What is the cause, action and prevention if the Nephrostomy tube stops draining?
CAUSE:
- no urine output
- blocked tube
- kinked tube
ACTION:
- check vital signs
- ensure there are no kinks in tube that have occluded flow of urine + straighten tube
- if blocked with debris, flush with 5ml NaCl using aseptic technique to unblock
PREVENTION:
- monitor urine output + vital signs
