Presentation on theme: "Urinary – Nephrostomy Catheter Care"— Presentation transcript:
1Urinary – Nephrostomy Catheter Care Adapted from VNAA Procedure ManualBy Ambercare Education Department – Jan 2014
2PurposeTo 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
3Indications:Inserted into the renal pelvis to drain urine and relieve pressureIt can be inserted percutaneously using local anesthesia or via an open surgical procedure called a pyeloplastyMost common – via local anesthetic and either radiography or ultrasound for placementIt is an invasive procedure – resulting in an interruption of the skin – which of course is the body’s first line of defenseGenerally placed as a temporary method of diversion; however, it can be placed permanently
4Indications continued Complete obstruction of ureter(s)Urinary fistula (bypass)Irrigation of the renal pelvisRenal calculi (kidney stones)Kidney stones – procedure called a nephrolithotomy – a surgeon inserts a nephroscope into the kidney and uses ultrasonic lithotripsy to break up large stones (generally > 5 mm) removing large pieces via the nephroscope. The remains are excreted in the urine. A percutaneous nephrostomy tube may be placed after this procedure for continuous or intermittent irrigation to flush out stone fragments, to help dissolve the remaining renal calculi, to prevent or remove clots from the procedure, or to infuse medications that prevent infection or further breakdown of renal calculiVarious types of tubes may be used, as well as differing sizes ranging from 5 Fr to 32 Fr. The small tubes are more likely to become obstructed than the larger tubes – the nephrostomy tube is generally attached to a drainage tubing system that connects to a urine collection bagCare of the tube frequently includes irrigation or flushing at prescribed intervals to prevent clogging of the tubing with debris or to prevent clots from forming in the catheter. Routine flushing is only performed if the output drops or if the output is very purulent or bloody. Flushing tubing and dressing changes should be done sterilely.
5Potential Complications with long-term placement InfectionStone formationIntermittent hematuriaRenal hemorrhageAccidental dislodgment
7Things to ConsiderMaintaining a sterile system is of utmost importance in preventing serious consequences of kidney infectionThe catheter is either taped, sutured or a securement device is used to keep catheter securely in placeThe 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 siteIf the positioning, manipulation of tube, or irrigation does not remove an obstruction and allow flow of urine, notify physician immediatelyThe catheter is never clamped unless otherwise ordered by physician
8Things 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 neededIf excessive drainage occurs after removal, a small urostomy appliance can be placed over site until drainage is minimizedMonitor for s/sx of infection at site and document appropriatelyLabeling of tubes/dressings (date/initials, etc.) must be adhered toPatient/family education is an important aspect of the plan of care – including contacting nurse for assistance if the catheter becomes dislodged, disconnected, etc.
9Urinary Nephrostomy Equipment Sterile irrigation set (if needed)10 mL sterile syringeGauze pads (sterile 4x4s)Antimicrobial solution (wound cleanser)Drainage basin / Drainage bag / leg straps if necessaryGloves (sterile and clean) / adhesive remover padsSterile irrigation solution (Normal Saline or as prescribed) / sterile waterChux (underpad)Transparent dressing / paper or cloth tapeSterile cotton tips
10Urinary Nephrostomy Dressing Change Adhere to Standard PrecautionsExplain procedure to patientPlace 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 necessaryAnchor catheter to skin with one hand while removing tape with other hand to sure catheter is not pulled outCleanse 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
11Urinary 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 physicianPlace appropriate dressing over or around catheter site – secure in place – A transparent dressing may be applied to provide a waterproof barrier
12Urinary – 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 solutionOn (stop cock) to syringe to allow flow of urine into syringe or bagUse sterile technique, gently irrigate catheter with 5 mL of NS or ordered irrigation – never force irrigantGently allow irrigant to flow back per gravity drainage. ONLY ASPIRATE WITH PHYSICIAN’S ORDERNEVER re-install USED irrigant into tube!If unable to get a retunurse of irrigant, assess catheter for kinks; if none found, notify physicianDisgard any unused irrigating solution and collected irrigation solution from drainage basin in toilet. Cleanse and dry drainage basin; patient/caregiver education must ensue. Apply catheter strap and use a leg bag to prevent pulling on the catheter (if available); use continuous gravity drainage bag at night time; discard soiled supplies in appropriate containers;
13Document in patients record: Color and characteristics of urine (odor, sediment)Urinary outputCondition of catheter, patency of tubeAny drainage or s/sx of infection around siteCondition of skin under tape – noting blisters, rashes, etc. and interventionInterventions performedPatient’s response to procedurePatient education given and understanding of suchCommunications with physician when necessary
14Video – Mosby’s Skills See URL in link below Copy and paste URL into goggle chromeMosby’s nephrostomy video (mycnm.edu)