From the Guidelines
To flush a nephrostomy tube, normal saline irrigation should be used, as it is isotonic and isoosmolar, and does not lead to significant electrolyte abnormalities when absorbed, as recommended by the American Urological Association/Endourological Society guideline 1. When flushing a nephrostomy tube, it is essential to follow proper technique to maintain tube patency and prevent complications.
- Gather sterile supplies, including a 10ml syringe, sterile normal saline, alcohol swabs, and clean gloves.
- Wash your hands thoroughly and put on gloves.
- Clean the connection port with an alcohol swab and allow it to dry.
- Disconnect the drainage bag from the nephrostomy tube, keeping the end sterile.
- Draw up 5-10ml of normal saline into the syringe.
- Gently insert the syringe into the nephrostomy tube port and slowly inject the saline, avoiding excessive pressure, as recommended for PCNL and URS procedures 1. The frequency of flushing should be once or twice daily or as directed by your healthcare provider, to prevent blockage from sediment or debris and ensure proper urine drainage.
- Monitor for signs of complications such as pain, bleeding, fever, or cloudy urine, which should prompt immediate medical attention. It is crucial to follow your specific healthcare provider's instructions, as they may vary based on your individual situation, and always use normal saline for irrigation, as it is the standard solution for PCNL and URS, according to the guideline 1.
From the Research
Flushing a Nephrostomy Tube
To flush a nephrostomy tube, the following steps can be taken:
- Use sterile water or isotonic saline solution as the irrigation fluid, as both have been shown to be safe and effective 2
- The irrigation fluid can be instilled into the collecting system using a ureteral catheter, with 10 mL of betadine solution and gentamicin in normal saline (80 mg/3L) as the irrigant fluid 3
- The tube should be flushed regularly to prevent blockage and infection, with the frequency of flushing depending on the individual patient's needs and the specific type of tube being used
- Patients with nephrostomy tubes should be monitored for signs of infection, such as fever, chills, and hematuria, and treated promptly if any of these symptoms occur 4, 5, 6
Potential Complications
Potential complications of flushing a nephrostomy tube include:
- Infection, which can be treated with antibiotics 3, 4, 5, 6
- Blockage of the tube, which can be prevented by regular flushing 6
- Hemorrhage, which can occur in some patients, especially those with malignant obstruction 6
- Dislodgement or migration of the tube, which can cause obstructive signs and symptoms 4
Management of Complications
If any complications occur, the following steps can be taken:
- Obtain laboratory testing and advanced imaging, such as ultrasound and computed tomography, to evaluate the patient's condition 4
- Consult with a specialist, such as a urologist or radiologist, to determine the best course of treatment 4
- Treat any infections promptly with antibiotics, and monitor the patient's condition closely 3, 4, 5, 6