From the Guidelines
Management of hematuria from a nephrostomy tube should prioritize a systematic approach, starting with assessment of bleeding severity, and may involve increasing fluid intake, gentle irrigation of the nephrostomy tube, and application of a nephrostomy tube clamp for mild cases, while moderate to severe cases may require tranexamic acid, urgent medical attention, and potential angiographic embolization or surgical intervention. When managing hematuria from a nephrostomy tube, it is essential to consider the potential complications associated with the procedure, such as bleeding, sepsis, and catheter displacement, as highlighted in the study by 1. Some key points to consider in the management of hematuria from a nephrostomy tube include:
- Increasing fluid intake to 2-3 liters daily to promote dilution and flushing of blood
- Gentle irrigation of the nephrostomy tube with sterile normal saline (10-20 mL) to clear blood clots, using aseptic technique and avoiding excessive pressure
- Application of a nephrostomy tube clamp for 15-30 minutes to help tamponade the bleeding site
- Administering tranexamic acid 1000 mg orally three times daily for 3-5 days to promote clotting in cases of moderate hematuria
- Monitoring vital signs, hemoglobin levels, and urine output to assess the severity of bleeding and guide further management
- Preventive measures, such as securing the nephrostomy tube properly to prevent movement, maintaining adequate hydration, and avoiding activities that create tension on the tube, can help reduce the risk of hematuria and other complications, as noted in the study by 1. In cases of severe or persistent hematuria, urgent medical attention is required, as it may indicate tube displacement, renal trauma, or underlying pathology, and may necessitate angiographic embolization or surgical intervention, as discussed in the study by 1.
From the Research
Management of Hematuria from a Nephrostomy Tube
- The management of hematuria from a nephrostomy tube can be achieved through various methods, including the use of tranexamic acid 2, which has been shown to reduce the volume of serum required for bladder irrigation and decrease the microscopic status of urine in terms of hematuria.
- Percutaneous nephrostomy is a well-established procedure for managing patients with urologic problems, including hematuria, and has a high technical success rate of 98% 3.
- The use of a gelatine-thrombin matrix for closure of the access tract without a nephrostomy tube has been shown to be a safe alternative to traditional mini-PCNL with placement of a nephrostomy tube, reducing postoperative pain and patient discomfort 4.
- Selective renal artery embolization can be used to manage traumatic hematuria, with a success rate of 94.1% in achieving immediate control of hemorrhage 5.
- Percutaneous nephrostomy with extensions of the technique can be used to manage various urinary tract problems, including hematuria, and requires careful selection of the entry site to minimize bleeding complications 6.
- Transient hematuria is a common complication of percutaneous nephrostomy, but severe bleeding that requires transfusion or intervention is uncommon 6.
- The use of tranexamic acid, selective renal artery embolization, and percutaneous nephrostomy with careful selection of the entry site can help to minimize bleeding complications and manage hematuria from a nephrostomy tube 2, 3, 5, 6.