Size: 215 kB 25th Aug 2014 Urinary Nephrostomy Catheter Care

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Urinary – Nephrostomy
Catheter Care
Adapted from VNAA Procedure Manual
By Ambercare Education Department – Jan 2014
Purpose
To maintain a patent catheter
providing drainage of urine from the
kidney when flow of urine through a
ureter is not possible or desirable
and to prevent infection
Indications:
 Inserted into the renal pelvis to drain urine and relieve
pressure
 It can be inserted percutaneously using local anesthesia
or via an open surgical procedure called a pyeloplasty
 Most common – via local anesthetic and either
radiography or ultrasound for placement
 It is an invasive procedure – resulting in an interruption
of the skin – which of course is the body’s first line of
defense
 Generally placed as a temporary method of diversion;
however, it can be placed permanently
Indications continued
Complete obstruction of ureter(s)
Urinary fistula (bypass)
Irrigation of the renal pelvis
Renal calculi (kidney stones)
Potential Complications with
long-term placement
 Infection
 Stone formation
 Intermittent hematuria
 Renal hemorrhage
 Accidental dislodgment
Nephrostomy Anterior/Posterior
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Things to Consider
 Maintaining a sterile system is of utmost importance in
preventing serious consequences of kidney infection
 The catheter is either taped, sutured or a securement
device is used to keep catheter securely in place
 The catheter should not be kinked or plugged to assure
continuous drainage. Bending or shaping in a “C” shape
will provide some give and help the tube not to be pulled
out.
 Prevent kinking or bending of the catheter by careful
dressing of the site
 If the positioning, manipulation of tube, or irrigation
does not remove an obstruction and allow flow of urine,
notify physician immediately
 The catheter is never clamped unless otherwise ordered
by physician
Things to consider - continued
 Removal of a nephrostomy catheter is done by the
physician; after removal a 4x4 sterile gauze dressing or
other appropriate dressing is placed over the catheter
insertion site and changed daily or as needed
 If excessive drainage occurs after removal, a small
urostomy appliance can be placed over site until drainage is
minimized
 Monitor for s/sx of infection at site and document
appropriately
 Labeling of tubes/dressings (date/initials, etc.) must be
adhered to
 Patient/family education is an important aspect of the plan
of care – including contacting nurse for assistance if the
catheter becomes dislodged, disconnected, etc.
Urinary Nephrostomy Equipment
 Sterile irrigation set (if needed)
 10 mL sterile syringe
 Gauze pads (sterile 4x4s)
 Antimicrobial solution (wound cleanser)
 Drainage basin / Drainage bag / leg straps if necessary
 Gloves (sterile and clean) / adhesive remover pads
 Sterile irrigation solution (Normal Saline or as
prescribed) / sterile water
 Chux (underpad)
 Transparent dressing / paper or cloth tape
 Sterile cotton tips
Urinary Nephrostomy Dressing
Change
 Adhere to Standard Precautions
 Explain procedure to patient
 Place patient in comfortable position (that allows access and
observation of Nephrostomy tube) – place chux under
patient (cover exposed body parts with sheet)
 Remove old dressing (care must be taken not to pull on
tube – may not be sutured in) – use adhesive remover if
necessary
 Anchor catheter to skin with one hand while removing tape
with other hand to sure catheter is not pulled out
 Cleanse around nephrostomy tube with sterile 4x4s and
sterile water (after cleansing with wound cleaner and sterile
4x4x) pat dry with sterile 4x4 – begin at the catheter site
and move outward
Urinary Nephrostomy Dressing
Change
 Inspect catheter for kinks, check for leakage of urine or
(bile if it is a biliary tube)
 Examine catheter exit site. Report s/sx of redness or
infection to physician
 Place appropriate dressing over or around catheter site –
secure in place – A transparent dressing may be applied
to provide a waterproof barrier
Urinary – Nephrostomy Catheter
Irrigation, occluded or plugged
interventions (as ordered)
 Most tubes are connected to a stop cock system.
Tunurse stop cock to the appropriate position:
 Off to drainage bag (closed) when instilling solution
 On (stop cock) to syringe to allow flow of urine into syringe
or bag
 Use sterile technique, gently irrigate catheter with 5 mL of
NS or ordered irrigation – never force irrigant
 Gently allow irrigant to flow back per gravity drainage.
ONLY ASPIRATE WITH PHYSICIAN’S ORDER
 NEVER re-install USED irrigant into tube!
 If unable to get a retunurse of irrigant, assess catheter for
kinks; if none found, notify physician
Document in patients record:
 Color and characteristics of urine (odor, sediment)
 Urinary output
 Condition of catheter, patency of tube
 Any drainage or s/sx of infection around site
 Condition of skin under tape – noting blisters, rashes,
etc. and intervention
 Interventions performed
 Patient’s response to procedure
 Patient education given and understanding of such
 Communications with physician when necessary
Video – Mosby’s
Skills
See URL in link
below
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