Presentation is loading. Please wait.

Presentation is loading. Please wait.

Urinary – Nephrostomy Catheter Care Adapted from VNAA Procedure Manual By Ambercare Education Department – Jan 2014.

Similar presentations


Presentation on theme: "Urinary – Nephrostomy Catheter Care Adapted from VNAA Procedure Manual By Ambercare Education Department – Jan 2014."— Presentation transcript:

1 Urinary – Nephrostomy Catheter Care Adapted from VNAA Procedure Manual By Ambercare Education Department – Jan 2014

2 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

3 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

4 Indications continued  Complete obstruction of ureter(s)  Urinary fistula (bypass)  Irrigation of the renal pelvis  Renal calculi (kidney stones)

5 Potential Complications with long-term placement  Infection  Stone formation  Intermittent hematuria  Renal hemorrhage  Accidental dislodgment

6 Nephrostomy Anterior/Posterior View

7 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

8 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.

9 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

10 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

11 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

12 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  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

13 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

14 Video – Mosby’s Skills  See URL in link below


Download ppt "Urinary – Nephrostomy Catheter Care Adapted from VNAA Procedure Manual By Ambercare Education Department – Jan 2014."

Similar presentations


Ads by Google