What is the next step for a non-draining nephrostomy (percutaneous nephrostomy) tube?

From the Guidelines

For a non-draining nephrostomy tube, the next step is to assess for potential obstruction and restore patency. First, check for kinks in the external tubing and ensure the collection bag is positioned below the kidney level. If no external issues are found, flush the tube with 5-10 mL of sterile saline using aseptic technique and a small syringe (10 mL) to avoid excessive pressure, as recommended by general medical principles and supported by the safety and effectiveness of percutaneous nephrostomy (PCN) procedures 1. If resistance is met during flushing, stop immediately and do not force the fluid. Contact the interventional radiology team or urologist who placed the tube, as the obstruction may be due to blood clots, debris, or tube malposition requiring professional intervention, which is crucial for preventing complications such as urinary obstruction, infection, or kidney damage 1. While waiting for assistance, monitor the patient for signs of infection (fever, flank pain) or renal dysfunction. Non-draining nephrostomy tubes require prompt attention as they can lead to serious complications if left unaddressed, highlighting the importance of maintaining patency for proper renal function and prevention of complications, in line with guidelines for the management of urinary tract obstruction and urotrauma 1. Key considerations include:

• Ensuring proper positioning and function of the nephrostomy tube
• Monitoring for signs of infection or renal dysfunction
• Promptly addressing any issues with the tube to prevent complications
• Collaborating with interventional radiology or urology teams for professional intervention when needed, based on the most recent and highest quality evidence available 1.

From the Research

Next Steps for a Non-Draining Nephrostomy Tube

The next steps for a non-draining nephrostomy tube are crucial for maintaining patient health and preventing complications.

• Check the tube for kinking or blockages: Ensure that the tube is not kinked or blocked, as this can prevent drainage 2.
• Flush the tube: Flushing the tube with saline solution may help to clear any blockages and restore drainage.
• Check for urinary tract infection: Bacteriuria can occur after long-term drainage of the kidney, and routine nephrostomy tube change can cause frequent, asymptomatic bacteremia in patients with colonization of bacteria in the urinary tract 3.
• Consider imaging studies: Imaging studies such as ultrasound or CT scans may be necessary to check for any obstruction or blockage in the urinary tract.
• Consult a healthcare professional: If the tube is still not draining after trying the above steps, consult a healthcare professional for further guidance and management.

Possible Interventions

Possible interventions for a non-draining nephrostomy tube include:

• Nephrolithotripsy: A procedure to break up kidney stones that may be blocking the tube 2.
• Ureteric stent placement: A procedure to place a stent in the ureter to help drain the kidney 2.
• Ureteric dilation: A procedure to dilate the ureter to help improve drainage 2.