What should be done if a nephrostomy tube slides out?

Management of Dislodged Nephrostomy Tubes

If a nephrostomy tube slides out, the patient should immediately cover the site with a clean dressing and seek emergency medical attention for evaluation and tube replacement. 1

Immediate Assessment and Actions

• Evaluate how long the tube has been dislodged, as timing significantly affects the management approach 1
• Assess for signs of infection (fever, flank pain, purulent drainage) and significant bleeding from the nephrostomy site 1
• Check for signs of urinary obstruction or hydronephrosis that may require urgent intervention 1, 2

Management Algorithm Based on Time Since Dislodgement

If Dislodged <24 Hours:

• The nephrostomy tract may still be patent, allowing for direct replacement of the tube 1
• Replacement should be performed under imaging guidance (ultrasound or fluoroscopy) to ensure proper positioning 2
• Confirm intracollecting system location after replacement by injecting contrast material via the catheter 3

If Dislodged >24 Hours:

• The tract has likely begun to close, requiring new percutaneous access 1
• Imaging (ultrasound or CT) should be performed to assess for hydronephrosis and guide replacement 1
• Consider alternative approaches based on the underlying condition:
  • Attempt retrograde ureteral stent placement if the underlying condition allows 1, 4
  • If stent placement fails and the kidney is obstructed, a new percutaneous nephrostomy tube must be placed 4, 1

Special Considerations

• For unstable patients with complete ureteral obstruction, prompt nephrostomy tube replacement is critical to prevent further renal damage 1
• In patients with infected, obstructed systems, avoid unnecessary complicated or prolonged procedures that may increase risk of sepsis 3
• Use only self-retaining drainage catheters (like pigtail or Foley catheters) to minimize the risk of future dislodgement 3
• Foley-type nephrostomy tubes may have longer retention times compared to pigtail catheters (60.9 days vs. 20.3 days until dislodgement) 5

Potential Complications to Monitor After Replacement

• Monitor for signs of infection such as fever, increased pain, or purulent drainage 1
• Some hematuria is common after replacement but should not be severe or persistent 1
• Watch for signs of sepsis, especially if the system was infected and obstructed prior to tube dislodgement 3
• Be alert for potential injury to adjacent organs during replacement procedures 3

Prevention Strategies for Future Dislodgements

• Consider reinforcement techniques for the nephrostomy tube, such as using a rubber drainage tube segment to encase and secure the nephrostomy tube 6
• First-time nephrostomy tube placements have a higher risk of accidental dislodgement compared to subsequent replacements (OR 1.95) 5
• Ensure tubes are placed by experienced practitioners when possible, as tubes placed by less experienced providers have higher dislodgement rates 5
• Proper patient education about tube care and movement restrictions can help prevent accidental dislodgement 2