Nephrostomy Tube Flushing
Yes, you can and should flush a nephrostomy tube when it becomes blocked or to maintain patency, using sterile saline with gentle manual irrigation technique.
When Flushing is Indicated
Nephrostomy tubes require flushing primarily in two clinical scenarios:
- Blockage from blood clots: When recurrent clot formation obstructs the tube, flushing with sterile saline can restore patency 1
- Routine maintenance: To prevent obstruction and maintain drainage function
Proper Flushing Technique
The key principles for safe flushing include:
- Use sterile normal saline for irrigation
- Apply gentle manual pressure - never force fluid against resistance
- Avoid overdistention of the renal collecting system, which can increase risk of sepsis or retroperitoneal contamination 2
- Ensure the catheter is self-retaining and properly positioned before attempting flush 2
Special Considerations for Clotted Tubes
For tubes blocked by blood clots that don't respond to simple saline irrigation, urokinase instillation can be used as an alternative to tube replacement. The technique involves:
- Instilling urokinase into the nephrostomy tube
- Allowing 30 minutes dwell time
- Following with manual irrigation using normal saline 1
This approach successfully declots the tube and renal pelvis while avoiding the morbidity of tube replacement or insertion of a second tube 1.
Critical Safety Warnings
Do not flush if:
- There is evidence of infection/sepsis without adequate drainage already established
- The tube appears dislodged or malpositioned
- You encounter significant resistance (may indicate tube malposition or severe obstruction)
In infected, obstructed systems, avoid unnecessary complicated or prolonged procedures 2. If a patient has obstructing stones with suspected infection, urgent drainage takes priority over any manipulation 3.
Common Pitfalls to Avoid
- Excessive pressure during flushing: Can cause pyelovenous backflow, increasing sepsis risk
- Flushing without confirming tube position: Always ensure the catheter remains in the collecting system
- Ignoring signs of infection: Fever, leukocytosis, or purulent drainage require immediate attention and culture-directed antibiotics before elective flushing 3
The evidence supports that nephrostomy tubes can be safely flushed when done with proper sterile technique and gentle pressure, making this a standard component of nephrostomy care 4.