Percutaneous insertion of a nephrostomy tube

What is this?

The procedure involves insertion of a small tube into the kidney (usually under local anaesthetic) which then allows urine to drain from the kidney into a collecting bag outside the body.

What alternatives are there?

No treatment (observation only) or insertion of an internal stent under general anaesthetic.

What to expect before procedure

You will usually be admitted on the day of your surgery unless the tube insertion is being performed during an emergency admission. If your admission is not an emergency, you will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 4 hours before surgery and, immediately before the procedure, you will be given an injection of antibiotics to prevent infection. If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium (the dye used for kidney X-rays and CT scan), you must tell your doctor about this.

What happens during the procedure?

You will lie on an X-ray table, generally flat on your stomach, or nearly flat. You may need to have a needle put into a vein in your arm so that the radiologist can give you a sedative or painkillers. The procedure will be performed by a specially-trained doctor called a radiologist. The radiologist will use either X-rays or ultrasound to decide on the most suitable point for inserting the fine catheter. You skin will then be anaesthetised with local anaesthetic and a fine needle inserted into the kidney. Once the radiologist is sure that the needle is in a satisfactory position, a guidewire is placed into the kidney, through the needle, which then enables the plastic catheter to be positioned correctly. The catheter is fixed to the skin of your back and attached to a drainage bag. The procedure will normally take 20 minutes or so but, occasionally, it may take longer.

After the procedure

Once you return to the ward, the nurses will perform some routine observations of your pulse, temperature and blood pressure. You will generally stay in bed for a few hours until you feel comfortable. You should avoid making sudden movements, once you are mobile, to ensure that the tube does not get pulled or become displaced. The bag needs to be emptied fairly frequently so that it does not become too heavy. The nurses will monitor your urine output carefully during this period.

Potential side effects