What should I do if my nephrostomy tube falls out?

Management of Dislodged Nephrostomy Tubes

If a nephrostomy tube falls out, immediate medical attention is required - the patient should cover the site with a clean dressing and proceed to the emergency department promptly for evaluation and replacement of the tube. 1

Immediate Actions

• Apply a clean, sterile dressing over the nephrostomy site to prevent infection and collect any drainage 2
• Seek medical attention immediately - this is considered an urgent situation requiring prompt evaluation 2
• Do not attempt to reinsert the tube at home under any circumstances 2

Medical Management Protocol

Initial Assessment

• Evaluate for signs of infection (fever, flank pain, purulent drainage) 1
• Assess for significant bleeding from the nephrostomy site 1
• Determine how long the tube has been dislodged, as timing affects management approach 1

Replacement Strategy

• For recent dislodgement (within hours):

  • The tract may still be patent, allowing for potential bedside replacement by a qualified provider 2
  • Fluoroscopic guidance is strongly preferred even for recent dislodgements to ensure proper placement 1

• For delayed presentation (>24 hours):

  • The tract likely has begun to close, requiring new percutaneous access 1
  • Imaging (ultrasound or CT) should be performed to assess for hydronephrosis and guide replacement 1

Procedural Considerations

• Replacement should be performed with appropriate sterile technique 3
• Antibiotics are typically administered before nephrostomy tube replacement to prevent infection 3
• Coagulopathy should be corrected before nephrostomy tube replacement when possible 3

Alternative Management Options

If nephrostomy tube replacement is not immediately possible:

• Retrograde ureteral stent placement should be attempted if the underlying condition allows for this approach 1
• If stent placement fails and the kidney is obstructed, a new percutaneous nephrostomy tube must be placed 1

Prevention of Future Dislodgement

• Secure the nephrostomy tube properly to the skin with sutures 4
• Consider reinforcement techniques such as using a rubber drainage tube to encase the nephrostomy tube at the skin exit site 4
• Educate patients on proper tube care and movement restrictions 2
• Regular follow-up for tube changes at recommended intervals (typically every 2-3 months) 2

Potential Complications to Monitor

• Infection: Monitor for signs of fever, increased pain, or purulent drainage 1, 2
• Bleeding: Some hematuria is common after replacement but should not be severe or persistent 1
• Urine leakage: Can occur around the tube insertion site and may require additional interventions 5
• Failed access: If the collecting system cannot be accessed, urologic consultation is mandatory 1

Special Considerations

• In unstable patients with complete ureteral obstruction, prompt nephrostomy tube replacement is critical to prevent further renal damage 1
• For patients with malignant obstruction, re-evaluation of the need for continued drainage versus alternative approaches may be appropriate 1
• Patients with a history of recurrent tube dislodgement may benefit from alternative fixation methods or consideration of internal ureteral stents if feasible 4