Have you recently got a nephrostomy insertion tube into your kidney? And you have so many questions on what life is going to be like after the insertion. Wondering how to sleep with a nephrostomy bag, can you swim or shower with a nephrostomy tube.
Based on my experience as an interventional diagnostic radiographer, I take x-rays and see so many insertions and exchanges in adults.
I see patients with so many questions about the procedure. Even after being reassured by the doctor, still curious about life after the nephrostomy insertion.
I am addressing in this blog the most frequently asked questions from online users about life after a nephrostomy insertion.
I draw on my experience as an interventional radiographer and research from scientific studies to answer your questions (all references at the end of the article).
Enjoy reading! 😃
(Have any questions, remarks. Or experience to share? Feel free to use the comments section at the end of the article.!💁
Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links
▶️ What is a nephrostomy tube insertion?
Before delving into your questions about life after a nephrostomy insertion, let’s briefly review some anatomy. (Truly just a tiny bit, I promise.)
Our urinary system is made up of different parts:
🟢The kidneys(two)
🟢Ureters
🟢The bladder
🟢Urethra
The work of the kidneys is to filter your blood to remove waste products that changes into urine.
This urine is carried from each kidney through a fine tube called the ureter to the bladder where it is stored until you feel like passing it out.
When all these body parts cannot coordinate to help pass urine in a normal way then that’s when a nephrostomy insertion procedure comes in to rescue the situation!
▶️Why do you usually need a nephrostomy insertion?
Usually there are so many reasons why you may need a nephrostomy insertion. Here I will highlight a few reasons why you might need one.
🔵Kidney stones
🔵Cancer growth
🔵Strictures narrowing.
🔵Ureteral or bladder leaks due to various causes.
The urinary system can get blocked by stones, cancer growth or strictures which blocks urine from flowing smoothly from the kidney to the bladder.
Urinary system showing blockage of stones in the kidney and ureter
▶️Is a nephrostomy tube placement a major surgery? What to expect?
A nephrostomy tube will be inserted into the kidney through your back and connected to an external drainage pouch. Nephrostomy insertion is a very simple procedure requiring general anaesthesia.
I would not call it a major procedure because I have seen so many done with in 30 minutes with no complications ,the doctor will directly puncture thought the skin to established a temporary drainage pathway
In normal cases urine is supposed to flow straight from the kidney through the ureter to the bladder.
But because the whole system is blocked, urine will be forced to collect in the kidneys.
To preserve your kidney from infection and other complications a nephrostomy insertion is recommended until the problem is managed.
Image below shows a nephrostomy tube inserted into the kidney and a bag is attached outside to help drain the urine.
Image source: National Institute of Diabetes and Digestive and Kidney Diseases
Some urine can still go through your bladder as normal. Remember if your other kidney is working, it will still filter urine as normal.
Also, you can have nephrostomy insertion in both kidneys if need be and two tubes will be attached to help filter urine from your kidneys.
After placement has been achieved, you will need a routine exchange of the nephrostomy catheter to prevent obstruction related to mineral deposition and layers to prevent a risk for sepsis.
Routine nephrostomy exchange here in the United kingdom are typically performed at 1-to-3-month intervals to prevent blockage. Your doctor will tell you when often your tube can be changed.
However I have seen patients refuse to come for their routine exchanges and they have not been changed for over a year and still in good working condition.
▶️What are some of the frequently asked questions after a nephrostomy insertion?
In summary there so many questions that frequently arise among patients I have looked after a nephrostomy insertion, some of these stand out:
▶️ ️Now ,What are the possible complications following a nephrostomy insertion?
What is more important to remember? The list of possible complications during and after the insertion, or the fact that these complications are relatively rare.
Most people I have seen under my care recover without any complications after an insertion. Let’s be optimistic: You will likely be part of this group!
Although the technical success of nephrostomy tube placement is reported up to 99%, complications occur in up to 6% of patients (Lewis.,2004)
The most described complications consist of:
🔷Infection.
🔷Haemorrhage.
🔷Catheter related structural problems including misplacement and dislodgement.
These complications could result into:
🔹Tube blockage leading to decreased urine output or peri-tube leakage of urine.
🔹Flank pain.
🔹Fever /sepsis.
🔹Blood in the urine.
🔹Dislodgement /malposition of the tube.
🔹Infection.
Nevertheless, this still applies to a minority of people . When this happens, you will have to see your doctor immediately for treatment.
Here’s what a research team, who systematically examined the question, concluded:
Complications from a nephrostomy insertion are very rare. A study done on Ten of 318 (3.1%) cases sustained a major complication: five had sepsis alone, two haemorrhage (one with sepsis as well) and three patients had a major pelvic injury (one with sepsis as well). (Lewis & Patel.2004)
Nephrostomy procedures are generally safe, during my years of practice I have seen few complications after the insertion. The patient usually starts to feel better once the urine starts draining.
▶️How long do you keep a nephrostomy tube in your kidney?
Many people (and you probably are one of them) wonder if this tube will be a permanent solution to your urinary problem.
It is different for each patient, some patients we see, the tube remains in place for a few days, some weeks, months, and years or even permanent.
Reason being each patient has a different diagnosis why the tube is needed!
⏯️If treatment can relieve the blockage with another alternative for example with a stent then the tube will be removed.
⏯️If your urinary body parts start working well then you do not need a tube.
⏯️When your kidney stones are removed and no urine blockage.
However, some patients who are not suitable to have any other treatment or a stent. In these cases the nephrostomy will stay in permanently.
To keep the tube working and avoid any infection or blockages a routine nephrostomy exchange is typically performed.
Here in the United Kingdom exchanges are routinely exchanged at 1-to-3-month intervals. Your doctor will tell you when often your tube can be changed.
To put your heart at rest, the 3 monthly exchanges are quick and less painful, you do not need anaesthetic. I have seen patients with no pain at all and some feel a little bit of pain.
Caution! Pain to some people could be low-intensity yet intense for others. We are different.! But you should not feel pain during exchanges, If you ever do, usually you will be given painkillers.
The truth is the patients I speak to after they have had their insertion do confess, that having a tube and urine bag hanging outside from their kidney can sometimes be mentally draining.
They are anxious about what people will say, can they enjoy swimming again, how to sleep, without pulling the tube out.
It is ok to feel this way because having a nephropathy tubes can change your quality of life because you are learning to live with it.
But remember life is full of all other positive things and one thing you should always remind yourself is to be grateful that you are alive, and this bag is a temporary measure to help with your treatment.
▶️How do you sleep after a nephrostomy?
Many nephrostomy insertion patients often ask me: ‘Can I sleep on my side, won’t that risk pulling on the tube to come out?’’
Rest assured: no position risks damaging the nephrostomy tube. It is ok laying on the side of the nephrostomy tube, you cannot pull on it because it is a locking pigtail kind of tube that is secure inside your kidney.
However, in my years of practice I have seen a few patients come into intervention where a nephrostomy tube has fallen out.
There are few studies about the causes, in some studies it is believed that tube displacement is commonly found in long-time patients.
Also, some factors associated with the different types of catheters used could increase the risk of involuntary displacement, such as being a first event. In addition, pigtail type nephrostomies tend toward accidental dislodgement earlier than Foley ones. (Navarrete 2020.)
The truth is having a bag hanging at the side of your back can be uncomfortable. The fear of pulling the tube out could affect your sleep.
I did ask one of the radiologists this question. To my surprise I was told it is one of these things that happen with no explanation though it is not common.
Getting used to sleeping with the tube will take time but try to find the most comfortable position of sleeping that suits you.
If you have two tubes on both sides, try to place the urine bag in a good position to allow the connections to be in the curve of the waist to avoid discomfort and make sleep better.
▶️Can you bathe or shower with a nephrostomy tube?
After you have had your tube inserted, it is advisable to shower or bathe after 48 hours.
During these 48 hours, it is very important to protect the skin where the tube is with a plaster wrap during showering to let it heal.
After 14 days you may shower without any protection for the tube because at this time the skin is healed and dry, the rate of infection is low.
▶️Can you swim with a nephrostomy tube?
You WILL NOT be able to swim if the nephrostomy tube is still in your kidney. Reason being the tube can easily get infected or dislodge because of the pressure in the water..
▶️Can you drink alcohol with a nephrostomy tube?
Great news! You can eat and drink normally after the insertion and there are no restrictions from drinking alcohol after a nephrostomy insertion. It is only advisable to avoid alcohol for at least two weeks after the operation.
Drinking alcohol should be moderate!
Take ‼️ caution especially if your health problem is about liver because it can compromise kidney function.
You should also drink lots of water as well because it is good for your general health!
▶️Can you fly with a nephrostomy bag?
You can go on holiday and travel abroad with a nephrostomy, but it is important that you ask a nurse or doctor to ensure you are fit to travel.
You should also be in position to know how to empty and take care of the bag away from home.
▶️How do you care for a nephrostomy bag
The nephrostomy tube will be stitched in place and will exit the skin from the side of your body.
The tube will be attached to a drainage bag which is worn under your clothing and can either be strapped to the thigh or secured to the clothing with a safety pin.
It is important NOT to leave a bag hanging as the weight of the urine and any tugging may cause the nephrostomy tube to fall out.
🟠The dressing around the tube should be changed twice a week, especially if it becomes wet.
🟠The drainage bag should be changed weekly 7 (days) along with the connection tube.
🟠You may wear a small drainage bag strapped to your leg to let you move around more easily. Use a larger drainage bag at night and when you take naps during the day. This will help prevent urine from leaking out from the place where the tube enters your skin.
🟠You should flush your nephrostomy tube two to three times a week. To prevent urine from more often crystallising and clogging the tube.
🟠 If the tube becomes clogged, urine will not be able to drain from your kidney into the nephrostomy bag, which could result in an infection.
In case of any concerns, where you think the tube is not draining well or it has fallen out or you notice blood in the urine! Please do not insist on contacting your doctor.
The Good News is! Coping at home can be manageable and there should be limited restrictions preventing you from enjoying your day-to-day activities.
I hope this article has provided you with some answers to your questions? Questions or comments? See you in the comments!
📚Source:
Roven SJ, Rosen RJ. Percutaneous nephrostomy and maintenance of nephrostomy drainage. Urology. 1984 May;23(5 Spec No):25-8. doi: 10.1016/0090-4295(84)90238-3. PMID: 6719676.
Huang SY, Engstrom BI, Lungren MP, Kim CY. Management of dysfunctional catheters and tubes inserted by interventional radiology. Semin Intervent Radiol. 2015 Jun;32(2):67-77. doi: 10.1055/s-0035-1549371. PMID: 26038615; PMCID: PMC4447882.
Lewis S, Patel U. Major complications after percutaneous nephrostomy-lessons from a department audit. Clin Radiol. 2004 Feb;59(2):171-9. doi: 10.1016/s0009-9260(03)00336-2. PMID: 14746788.
Riddell AM, Charig MJ. A survey of current practice in out of hours percutaneous nephrostomy insertion in the United Kingdom. Clin Radiol. 2002 Dec;57(12):1067-9. doi: 10.1053/crad.2002.1081. Erratum in: Clin Radiol. 2003 Apr;58(4):339. PMID: 12475529.
Nariculam J, Murphy DG, Jenner C, Sellars N, Gwyther S, Gordon SG, Swinn MJ. Nephrostomy insertion for patients with bilateral ureteric obstruction caused by prostate cancer. Br J Radiol. 2009 Jul;82(979):571-6. doi: 10.1259/bjr/38306763. Epub 2009 Jan 19. PMID: 19153185.
Panache-Navarrete J, Tonazzi-Zorrilla R, Martínez-Jabaloyas JM. Dislodgement in Long-Term Patients with Nephrostomy Tube: Risk Factors and Comparative Analysis Between Two Catheter Designs. J Endourol. 2020 Feb;34(2):227-232. doi: 10.1089/end.2019.0655. Epub 2020 Jan 28. PMID: 31880962.
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.https://www.niddk.nih.gov/news/media-library/11237