This information explains your nephrostomy procedure at Memorial Sloan Kettering Cancer Center (MSKCC) and describes how to care for your nephrostomy catheter.
You will have a nephrostomy catheter to relieve a blockage in your urinary system. The catheter will be inserted through your skin into your kidneys. The catheter will allow urine to drain into a bag outside your body. In some cases, it may also drain into your bladder.
This booklet tells you how:
Your urinary system works
The nephrostomy catheter will be placed
To care for your catheter at home
Your nurse will review this information with you before and after the catheter is placed.
The urinary system consists of the kidneys, ureters, bladder, and urethra. The two kidneys are the organs that produce urine. Urine collects in the renal pelvis (see Figure 1). This is the funnel shaped top of the ureter. The ureter is the tube-like structure that carries urine from the kidneys to the bladder (see Figure 1). Urine collects and remains in the bladder until there is a need to urinate. The urine then passes out of the body through the urethra. In women, the urethra is a very short structure located in front of the vagina (see Figure 2). In men, the urethra is much longer and passes through the prostate gland and the penis (see Figure 3).
Drainage of the urinary system is achieved in one of two ways. Your doctor will discuss these options with you before beginning your procedure.
Types of drainage:
Nephrostomy: This catheter is placed in the renal pelvis of your kidney. It passes through the skin and into the renal pelvis. It is placed here if the doctor cannot bypass the blockage or if your ureter has been injured. One end of the catheter forms a loop in this area. The other end of the catheter will extend from your body (Figure 4). It will be attached to an external drainage bag strapped to your leg.
Nephro-Ureterostomy. This catheter is placed if the blockage in your urinary system can be bypassed. It passes through the skin and into the renal pelvis. It is guided across the area of blockage down to the bladder. One end of the catheter will be in the bladder. The other end of the catheter will extend from your body (Figure 5). It will be attached to an external drainage bag strapped to your leg. This catheter lets urine flow in two directions. It can go out to the drainage bag or into the bladder.
If you are already in the hospital, your nurse will help you prepare.
Many patients will come in from home for the procedure. Please follow these instructions:
You may have to stop certain medications before your procedure. The card Common Medicines Containing Aspirin and Nonsteroidal Anti-Inflammatory Drugs has detailed information about these medicines.
Ask your doctor what to do if you take blood thinners such as:
If your doctor asks you to stop taking aspirin for the procedure, stop taking it 5 days before your procedure. If you have any questions, call Interventional Radiology. The number is (212) 639-2236. Ask to speak with the nurse.
Ask your doctor what to do if you take medicine for diabetes such as insulin, glucophage (Metformin®), or glipizide (Glucotrol®).
Vitamin E and Non-steroidal anti-inflammatory medicines (NSAIDs) can also increase your risk of bleeding. You will need to stop taking medicines that contain vitamin E 10 days before your procedure. You will need to stop taking NSAIDS 2 days before your procedure. Examples of NSAIDs are ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).
If you had a stroke or a heart attack, you may need to have another doctor's visit for medical clearance. This will be an important safety step for you.
Call your doctor develop any illness before your procedure. This includes a fever, cold, flu, or a sore throat.
Do not eat any solid food after midnight the night before the procedure.
Drink only clear liquids the day of your procedure.
Stop drinking liquids 2 hours before you are scheduled to arrive at the hospital for your procedure.
If you have any questions about the procedure, you may call an interventional radiology nurse between 9:00 am and 5:00 pm. The phone number is (212) 639-2236.
Pre-Procedure Telephone Call
The Admissions Center will call you the business day before your procedure. It is important that we have a phone number where we can reach you. It could be your home, office, hotel, or cell phone. If you give us your cell phone number, make sure the phone is charged and turned on. You will be told when to arrive for the procedure. We try to call between 3:00 pm and 7:00 pm. If you do not receive the call by 7:00 pm, please call (212) 639-7881.
On the day of the procedure, please be aware that many things can impact the start time of your procedure. The one before yours may last longer than expected. An emergency may need to be done in the room you are scheduled for. If there is a delay in your start time, we will let you know.
You must have a responsible adult go home with you after your procedure. We recommend that your care partner drive you home or take you in a taxi.
You may shower, but do not apply any cream or lotion.
Take any medications that your doctor or nurse told you to take with water or another clear liquid.
Do not take medicines that thin the blood unless your doctor told you to.
Do not take diuretics (medicines that make you urinate) such as furosemide (Lasix®) or hydrochlorothiazide (HCTZ).
Your medicines with you on the day of your procedure.
Only the money you need (e.g., for a newspaper or parking costs).
If you use contact lenses, wear glasses instead. If you do not have glasses, bring a container for your contact lenses.
Leave valuables and jewelry, including rings, at home.
Enter the hospital through the main entrance at 1275 York Avenue. Take the M elevators at the top of the escalator to the 2nd floor. As you step off the elevator, enter the double doors to the Pre-Surgical Center. Check in at the desk. Please arrive on time.
In the Pre-Surgical Center (PSC), you will change into a gown, robe, and slippers. An intravenous (IV) line will be started. When you are ready, you will be taken to Interventional Radiology.
The nephrostomy catheter is placed by a doctor in Interventional Radiology. You will meet the doctor at a separate visit or just before the procedure. You will be asked to sign a consent form. Tell the doctor if you are allergic to IV contrast, commonly used for computed tomography (CT) scans.
After you are positioned on the table, you will get medicine through your IV to help you relax. The skin around the area where the catheter will be inserted will be cleaned and covered with a drape. You will get an injection to numb the site.
The doctor uses fluoroscopy and ultrasound to aid in placing the catheter. Fluoroscopy is real time x-rays. It lets the doctor see the urinary system when IV contrast is injected. The contrast makes it easier to see the area. The doctor will then know what type of drainage is possible.
After the drainage catheter is inserted, a silicone disk is placed on the catheter (Figure 6). This disk allows the catheter to be secured to the skin. There are times when the catheter may be secured with a suture, in addition to the disk. The disk is held to the skin with an adhesive dressing. A black mark is placed immediately above the disk on the catheter. This mark will let you see if the catheter has moved out of place.
After the procedure, you will recover in a recovery room. You will need to stay in bed until the sedation has worn off. If you came from home, you will be able to go home after that, but a responsible adult must go with you.
The end of the catheter that is outside your body will be attached to a leg drainage bag (Figure 7). Urine will begin flowing into the bag right after the procedure. It is possible that the urine will appear bloody at first. Your nurse will check the drainage to be certain it improves.
It is important that you keep the bag strapped to your leg. That prevents the catheter from accidentally pulling out. The bag can fill up with urine and become heavy. If the bag falls, it can pull the catheter out.
Your nurse will teach you how to care for the catheter. Use this booklet at home to remind you of what you learned. At first, a visiting nurse will come to your home to help you care for the catheter. It won't be long before you feel secure doing it yourself.
Your daily routine will consist of:
Inspecting the catheter
Emptying urine from the bag
Your dressing and your drainage bag will need to be changed once a week. You will also need to change the dressing if it becomes loose, wet, or soiled. If a wet dressing is left against your skin, it may cause your skin to become reddened and sore. This makes skin breakdown more likely.
You will need help changing the dressing and drainage equipment. You will need a mirror to be able to inspect the catheter.
Inspecting Your Catheter
Inspect your catheter every day. Use a hand held mirror or a full length mirror or both.
Look at the position of the black mark. Make sure it is near the disk (Figure 6). Your nurse will show you what to look for before you leave the hospital.
Check the dressing to assure that it is secure. If the dressing is wet, soiled, or has come loose or started to lift from the skin, it needs to be changed.
Examine the skin around the catheter to see that it is in good condition. There should be no redness, areas of broken skin, or rash. Urine should not leak around the catheter.
Look at the drainage bag. Urine should be flowing freely into the bag. It should not have changed color or consistency. There should not be a large decrease in the amount of urine in the bag.
Inspect the catheter and the drainage bag for kinks in the tubing.
If you find a problem, call the nurse or fellow. The phone numbers are listed at the end of this booklet.
Changing the Uresil® Dressing
The Uresil® dressing keeps the catheter from moving out of the kidney. The disk is secured to the drainage catheter. The dressing covers the disk, which in turn holds the catheter in place.
The dressing, the ureteral connecting tube, and the leg bag will need to be changed once a week. The dressing may need to be changed more often if it gets wet, soiled, pulls away from the skin, or loosens. Although you will need the assistance of your trained helper to do the dressing and equipment changes, you can assemble the equipment yourself. Begin by washing your hands. Then gather the following equipment to change the dressing and the drainage system:
For the dressing change:
1 Uresil® adhesive dressing
3MTM No Sting Barrier Film
Adhesive remover wipe
1 alcohol wipe
Mild soap and a cup of water
Scissors to cut Telfa®
Alcohol wipe to clean scissors
For the leg bag change:
Leg drainage bag with Velcro straps
Ureteral connecting tube
Micropore® Paper tape (2 inches wide)
Scissors to cut tape and bag
Alcohol wipe to clean scissors
Catheter fastener, such as UC Strip®
Sit or lie comfortably. At this point, your trained helper should take over. To the person doing the dressing change:
Wash your hands and put on non-sterile gloves.
Remove the old dressing. Hold the silicone disk in place using one hand to prevent tension or pulling on the catheter. Locate the slit in the Uresil® dressing. From this spot, slowly and gently peel the adhesive away from the skin while holding the disk (Figure 8). Apply adhesive remover along the dressing edge if the patient has sensitive skin. It may minimize the discomfort.
Loosen and remove the catheter fastener.
Dispose of the old dressing.
Use a gauze pad moistened with soap and water to clean the skin around and under the disk. Then clean the top and bottom sides of the silicone disk itself. Always hold one side of the disk firmly on the skin while cleaning under the other side.
Rinse and dry the skin and the silicone disk with fresh gauze and water.
Wipe the top side of the silicone disk with an alcohol wipe. This removes any soap residue.
Check the drainage catheter. The black ink mark should be just above the disk nipple (Figure 6).
Inspect the insertion site under the silicone disk. Always hold one side of the disk firmly on the skin while tilting up the other side. Call the nurse or fellow if you see any:
Leakage of urine
You may notice new tissue growing around the insertion site. This is harmless, but it can be removed by your doctor if it is painful.
Apply the 3M® No Sting Barrier Film to the skin around the silicone disk. Then apply more to the top of the disk where the dressing will be placed. This protects your skin and helps the adhesive stick better.
Clean the scissor blades with an alcohol wipe. Trim a piece of Telfa® to 2 inches by 2 inches. Cut a slit in it (Figure 9). Slide it under the disk, around the catheter (Figure 10). The slit should point towards your feet. This will prevent moisture build up under the disk.
Open the slit and place the Uresil® dressing around the catheter. Place the dressing over the flat part of the disk, but under the disk's nipple (Figure 11). The slit in the dressing should point towards your feet.
The Uresil® dressing has 3 pieces of backing. Start at one of the lower corners of the largest piece and slowly peel the backing paper away. As you peel away the paper, press the adhesive to the skin. This step will require practice. If the dressing does not adhere properly, remove the Uresil® dressing and Telfa® and restart at step 12.
Remove the other 2 pieces of backing paper one at a time. Press the adhesive to the skin. Overlap the slit edges of the dressing to make the dressing more secure. (Figure 11) Remove your gloves and discard them in the waste container. Wash your hands.
Changing the Leg Drainage Bag
Assemble the ureteral connecting tube and leg bag
Cut a 4-inch piece of tape and fold down the short sides a half an inch. Set aside (Figure 12).
Open the packages containing the ureteral connecting tube and the leg bag. Close the outlet valve at the bottom of the bag. You will hear a snap (Figure 13).
Clean the scissors with an alcohol wipe.
Pick up the bag by the corrugated tubing, but do not touch the connector. Notice the ripples in the tubing are interrupted by smooth areas. Count 2-4 smooth areas up from the bag and cut the tubing at the outer edge of the smooth area. While cutting, hold both the tubing and the bag (Figure 14).
Attach the connector to the tubing on the leg bag (Figure 15).
Remove the cap on the connector and insert the connector into the ureteral connecting tube's wide end (Figure 16). Wrap the area with the cut piece of tape to prevent disconnecting.
Remove the Velcro straps from the packaging. Place the wider strap through the top button holes. Place the narrow strap through the bottom button holes. Cut the straps to fit legs snugly, but they should not be tight (Figure 17).
Empty the drainage bag in the toilet. Disconnect it from your leg.
Put on a pair of gloves.
Put a towel or gauze under the point of connection between the ureteral connecting tube and the catheter.
Pick up the new ureteral connecting tube attached to the bag. Twist off the small cap. Figure 18
While still holding the new bag set in your hand, untwist the catheter from the old ureteral connecting tubing.
Quickly attach the new bag with a twisting motion to minimize leaking.
Secure the new tubing to the side of the abdomen with a catheter fastener.
Remove the backing from the center of the catheter fastener to expose the adhesive (Figure 19).
Place the center section of the adhesive onto the drainage bag tubing about 2 to 4 inches down from where the catheter connects to the ureteral connecting tube.
Press the adhesive around the catheter (Figure 20). The remaining adhesive will stick together.
Select a position for the catheter fastener. The catheter fastener and drainage bag tubing should be lower than the catheter insertion site. Rest the tubing on the side of the abdomen on the selected site. There should be no pull or tension on the catheter. There should be a gentle bowing of the catheter.
Remove the backing paper from each side of the catheter fastener, one at a time. Smooth the adhesive onto the abdomen. The catheter fastener will prevent pulling, tension, or kinking of the drainage catheter and tubing (Figure 21).
Attach the leg bag to either the calf or the thigh. Check to make sure all connections are tight and the leg bag is closed.
Discard the old bag.
Remove your gloves and wash your hands.
Connecting to a Night Bag
You will be shown how to connect your leg bag to a night bag. The night bag holds a large volume so you will not have to empty your bag while you sleep.
Clean the drainage end of the leg bag thoroughly with alcohol pads on the outside and as much as possible on the inside.
Holding the bag, allow the alcohol to dry for 2 minutes.
Pick up the night bag with the other hand. Remove the cap from the end of the tubing. Insert the drainage bag into the leg bag (Figure 22). Open the outlet valve to allow urine to flow from the leg bag into the night bag. For extra safety, secure the connection between the two bags with paper tape.
Never connect the night bag to the ureteral connecting tubing. The weight of the leg bag can pull the catheter out of your body if it falls.
Cleaning the Night Bag
You may reuse the night drainage bag after cleaning it properly. To clean the equipment:
Wash your hands.
Gather the following supplies:
Cold water and mild detergent
Large basin-size container for soaking items
Put on the gloves.
Empty the urine from the night bag.
Rinse the bag with cool running water. Never use hot water because it can damage the bag.
Wash the bag with mild detergent.
Rinse the bag with cool water until no signs of the detergent remain.
Soak the bag for 15 minutes in a solution of 1 part white vinegar and 3 parts water.
The catheter can usually be covered by clothing. You may go to work and exercise with the catheter in place. Avoid movements that involve aggressive stretching from side to side or continual bending. These could dislodge the catheter. You may not swim with your catheter. Speak to the radiologist if you have a warm weather vacation planned so that you can be taught what to do in this situation.
You may take showers. Remove the leg bag and empty it. Tape the drainage bag to your abdomen. AquaGuard® is a one time use waterproof cover. Each time you shower, cover the catheter dressing with a new AquaGuard® to protect it from getting wet. The edges of the AquaGuard® have peelable tape. Fold over a corner of each side of the tape (see Figure 23). Hold the AquaGuard® with the arrows pointing towards your head. Peel off the top strip and place the top edge of the AquaGuard® above the dressing. Smooth it down. Then grab a folded corner and peel down one side, smoothing as you go. Do the bottom and remaining side the same way. The edges will stick to each other if it does not fit smoothly around the dressing. Do not let the tape on the AquaGuard® touch the catheter dressing. It can lift your catheter dressing when you remove the AquaGuard® after showering.
If you do not have an AquaGuard®, tape plastic wrap or a gallon sized bag over the dressing to keep it dry (Figure 24).
If the dressing gets wet, you will need to change it. Wet dressings are the major cause of skin problems. A hand held shower can help direct the water away from the dressing.
Keep the tubing secured to your body with a catheter fastener at all times. When you are getting dressed, take care not to tug on the catheter. Do not allow the tubing to become kinked by clothing such as pantyhose or a belt. Try not to lie on your catheter when you sleep. This will prevent kinking of the catheter. Always have the bag attached to your leg.
A Visiting Nurse Service referral will be made for you before you leave the hospital. This nurse will assist you and your helper until you can manage the catheter care on your own.
Inspect the urine frequently. It should be flowing freely into the bag. It should always look the same. If there is a decrease in amount, or if the urine's color or sediments change, you may not be drinking enough fluids.