Radiology - Nephrostomy Insertion

Introduction

The aim of this leaflet is to provide you with information to help you understand more about having your nephrostomy tube inserted.

It explains what is involved and the possible risks. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions.

If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.

What is a nephrostomy?

A nephrostomy is a procedure in which a fine plastic tube (catheter) is placed through the skin on your back into your kidney to drain your urine. The urine is collected in a plastic drainage bag which will be attached to your skin surface.

Why do you need a nephrostomy?

The most common reason for having a nephrostomy is blockage of the ureter. The urine from a normal kidney drains through a narrow muscular tube (the ureter) into the bladder. When the ureter becomes blocked, the kidney rapidly becomes affected, especially if infection is present. If left untreated, your kidney will become damaged. A nephrostomy drainage will relieve the symptoms of blockage and keep the kidney working.

What are the benefits and risks?

Nephrostomy insertions are very safe procedures but as with any medical procedure, there are some risks and complications that can arise.

Benefits:

• Inserting a nephrostomy tube will allow urine to flow from the kidney again and allow the kidney to function normally

Risks:

• Following a nephrostomy tube insertion, the main risk is bleeding from the kidney. It is common for the urine to be bloody immediately after the procedure. This usually clears over the next 24 to 48 hours. On rare occasions, the bleeding may be more severe and require a transfusion. Very rarely, the bleeding may require another surgical procedure to stop it
• Any procedure where the skin is penetrated carries a risk of infection. The chance of an infection occurring which is caused by having the procedure is less than one in 1000. You will be given antibiotics before the procedure as a precaution
• Sometimes there is a leak of urine from the kidney, resulting in a small collection of fluid inside the abdomen. If this becomes a large collection, it may require draining under local anaesthetic
• Very rarely, the interventional radiologist will be unable to place the drainage catheter satisfactorily in the kidney. If this happens, you may require a small operation to overcome the blockage or a repeat procedure
• The nephrostomy tube may eventually become blocked and if you notice that the volume of urine you are passing becomes much less than when they were first inserted, please contact your consultant’s secretary via the hospital switchboard

Despite these possible complications, the procedure is normally very safe and will almost certainly result in an improvement in your medical condition.

Who has made the decision?

The consultant in charge of your care and the interventional radiologist performing the procedure have discussed your case and feel that this is the best option for you. However, you will also have the opportunity for your opinion to be considered and if after discussion with your doctors, you no longer want the procedure, you can decide against it.

Are you required to make any special preparations?

A percutaneous nephrostomy is usually carried out under local anaesthetic. You may be asked not to eat for six hours before the procedure, although you may still drink clear fluid such as water until two hours before the procedure. You may receive a sedative to relieve anxiety, as well as an antibiotic and a pain-relieving drug. If you have any allergies or have previously had a reaction to the x-ray ‘dye’ (contrast agent) used in the radiology department, you must tell the radiology staff before you have the procedure.

Where will the procedure take place?

The procedure will take place in the intervention room within the radiology department. This is like an operating theatre in which x-ray equipment has been installed.

Who will see you?

You will be seen by a specially trained team led by an interventional radiologist (a doctor) and including radiology nurses and radiographers. Interventional radiologists have expertise in reading x-rays and ultrasound images and using those images to guide them in the diagnosis and treatment of some medical conditions.

What happens during the procedure?

Whilst on the hospital ward you will be asked to change into a hospital gown. A small cannula (thin tube) will be placed into a vein in your arm through which antibiotics and a pain-relieving drug will be given. You will be taken to the radiology department where the staff will introduce themselves and check your details.

The interventional radiologist will ask you to confirm that you have already had the procedure explained to you and will ask you to sign the final part of the consent form. Please feel free to ask any questions and remember that even at this stage, you can decide not to go ahead with the procedure if you so wish.

You will lie on the x-ray couch, usually flat on your stomach. You will have a monitoring device attached to your finger to check your pulse and a blood pressure cuff around your arm. You may be given oxygen through a small tube placed into your nostrils. The radiology nurse may give you further pain-relieving drugs and a sedative if you feel you need them. A nephrostomy is performed under sterile conditions and the interventional radiologist and the radiology nurse will wear sterile gowns and gloves.

Your skin will be cleaned with antiseptic, and you will be covered with sterile drapes. A small area of skin on your back will be numbed using local anaesthetic. The radiologist will use an ultrasound machine and x-ray equipment to guide them in placing a small plastic tube (nephrostomy tube) into the kidney. The nephrostomy tube will be ‘locked’ in position so that it can’t accidentally fall out. An adhesive drainage bag will be fixed to your skin to collect the urine. This bag can be emptied through a tap (or bung) at the bottom.

Will it hurt?

Unfortunately, it may hurt a little for a short period of time, but painkillers will be on hand should you need them. Local anaesthetic will sting for a short while before it takes effect. You may be aware of the nephrostomy tube passing into the kidney, and sometimes this is painful, especially if the kidney was sore to start with. Once the nephrostomy tube is in place and everything has settled down, there may be mild discomfort or none. If you do experience irritation which does not clear up after a few days, speak to your doctor as this can be treated with medication. A nephrostomy tube rarely causes pain once things have settled, usually after a couple of days, but it may feel a little uncomfortable.

How long will it take?

Every patient is different, and it is not always easy to predict; however, expect to be in the radiology department for about an hour. If both kidneys are affected, then this will take longer.

What happens afterwards?

You will move back onto your trolley and be taken back to the ward, where nursing staff will carry out routine observations such as blood pressure and pulse checks. You will stay in bed for a few hours. The drainage bag can be emptied as required and you will be able to carry on normally with the catheter and bag in place. You will probably have an overnight stay in hospital afterwards. The nursing staff on the ward will show you how to care for the bag and how to empty it. If your doctors decide that you can go home with the nephrostomy tube in, district nurses will be arranged to periodically change the bag for you. Patients with long term nephrostomies are recalled to the radiology department every three or four months to have the tube changed. Changing the tube is much quicker and simpler than having the first tube inserted and is carried out as a day case procedure.

Is there anything I should look out for?

If the nephrostomy tube stops draining, it may have become blocked. Please contact your consultant’s secretary and they will arrange for you to come into hospital to have it cleared or changed. (Telephone the hospital switchboard and ask for your consultant’s secretary).

How long will the tube stay in?

This is a question that can only be answered by the hospital doctors looking after you. It may be for a short time until a stone has passed, or it may have to stay in much longer.

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, or 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 2044/2404 (Salford Royal Hospital) or 0161 624 0420 (Royal Oldham Hospital) Monday to Friday 8.30am to 4.00pm.
 
You can also email booking.radiology@nca.nhs.uk (Salford Royal Hospital) or bookingandscheduling.outpatients@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
Tel: 0161 206 2206/5091

Interventional Radiology, Royal Oldham Hospital
Tel: 0161 656 1178