Radiology - A guide to your Nephrostomy Exchange

Why do I need my nephrostomy tube exchanging?

Your nephrostomy tube will need to be changed at regular intervals which can vary from every few weeks to every few months. This is because the tube drains urine from the inside of the kidney and this urine often contains a gritty sediment which can block the tube. A build-up of the gritty sediment can slow down or even stop the urine from draining out. If this happens then the kidney will become infected and possibly damaged, and it could lead to you becoming unwell.

The nephrostomy tube is also a foreign body to your kidney. Your body’s natural response is to coat the tube with a protective layer which itself can become the source of infection. The longer the tube stays in the more this layer builds up. Frequent changes of the tube will reduce the chances of infections happening.

It is important to notify your consultant if your tube stops draining so that a change of tube can be arranged for you.

What does a Nephrostomy Exchange involve?

A radiologist (x-ray doctor), specialist radiographer or specialist nurse will perform the procedure for you. They will explain the procedure to you and if you have any questions, you can ask then. You will be asked to lie on the x-ray table, in a position where it is possible for us to access the tube – usually on your front.

The skin around the nephrostomy tube will be cleaned with an antiseptic solution and covered with a drape.

A soft wire will be passed into the nephrostomy tube. X-rays will be used to watch the passage of the wire. This then allows the radiologist/radiographer to remove the old nephrostomy tube, and a new tube is passed over the wire.

The new nephrostomy tube is secured in position and a dressing applied. To confirm the nephrostomy tube is in the correct position, the radiologist/radiographer will inject a small amount of x-ray dye through the tube.

What are the risks?

Changing the nephrostomy tube is a much simpler and quicker procedure than having the nephrostomy tube inserted. It is very safe but as with any medical procedure there are some risks and complications that can arise:

• Bleeding from the kidney – it is common for the urine to be bloody (pink or red) immediately after the procedure. This usually clears over the next 24-48 hours
• Infection – Urine in the kidney may become infected. This can generally be treated with antibiotics
• The tube could be partly blocked inside, and it can take a few minutes of manipulation by the operator to unblock the tube
• Very occasionally the tube has come out of the system completely so a new nephrostomy tube will need to be inserted
• The procedure uses x-rays, and the amount of radiation used is small, however if you think you may be pregnant, please inform the Radiology department before attending the appointment

Preparation

Please contact the Radiology department if you are taking any blood thinning medication.

You can continue taking your normal medication and you may eat and drink as normal.

You will arrive at the Interventional Radiology Department and a member of the Radiology team will accompany you into the angiography suite (x-ray room). A member of the team will check your details and go through a checklist with you.

If you have been asked to attend the ward, then you will be greeted by the ward staff and they will check your details and go through a checklist with you. You will then need to wait for a bed to become available.

You may be given some antibiotics before your nephrostomy exchange; this will reduce the chance of you getting an infection and will be decided by your doctor. Not all patients require regular anti-biotics, and it will be prearranged if you require this medication.

Please bring a spare stoma bag with you for after your tube is replaced.

Please inform us if you have any allergies.

Will it hurt?

It can be slightly uncomfortable when the tube is removed, but most people tolerate the procedure without any pain medication.

Will I need to fast for my procedure?

No.

What happens after the procedure?

Once the member of staff performing your procedure is happy and you are feeling well you are free to go home - this is normally about 10-20 minutes.

Should I watch out for anything after my procedure?

Call your GP for any of the following reasons after your exchange:

• If you have a temperature. If you develop back or side pain
• If your urine output stops, becomes dark or foul-smelling
• If the tube falls out or becomes dislodged - don’t attempt to re-insert it yourself. This needs to be done at the hospital

Are there alternatives to a nephrostomy exchange?

Unfortunately, there are no alternatives to having the tube exchanged. Your Consultant and Radiologist will have discussed your case and ensured this is the best treatment option for you.

Could you be pregnant?

If there is any chance you could be pregnant:

Please call 0161 206 5091 if your appointment is at Salford Royal Hospital.

Please call 0161 656 1178 if your appointment is at Royal Oldham Hospital.

Is x-ray guidance dangerous?

All x-ray machines use potentially harmful x-rays. Modern equipment is designed to keep the dose you receive as low as possible. If your doctor has asked for this test, they will have decided that the benefits from the procedure outweigh the risks from the very small dose of radiation that you receive.

What if I cannot attend my appointment?

If you have any queries about your appointment or cannot attend, then please telephone the booking office on:

0161 204 2044 or 2404 (Salford Royal Hospital) or
0161 656 1178 (Royal Oldham Hospital). Monday to Friday 8.30am to 4.00pm.

You can also email:

booking.radiology@srft.nhs.uk (Salford Royal Hospital) or
Ir.BookingsOldham@nca.nhs.uk (Royal Oldham Hospital).

Please include name, date of birth, address and hospital number (if known) in any correspondence.

I need an ambulance. How do I arrange one?

If you need an ambulance there are contact details on your appointment letter.

Please contact us if you are arriving by ambulance so we can time your appointment with your ambulance arrival. If we are not aware that you are coming by ambulance you may miss your appointment, and it may have to be rebooked.

If you need an interpreter

If you need an interpreter for your examination, please call the department so that we can try and arrange this.

Contact Details

We hope your questions have been answered by this leaflet.

If you require help or any other information regarding your appointment you can contact:

The Angiography Department, Salford Royal Hospital - 0161 206 2206/5091

Interventional Radiology, Royal Oldham Hospital - 0161 656 1178