From the Research
Yes, a patient on hospice can keep nephrostomy tubes, but this decision should be individualized based on the patient's goals of care, comfort, and overall condition. Nephrostomy tubes, which drain urine directly from the kidney, may be maintained if they provide symptom relief from issues like pain or infection caused by urinary obstruction. The hospice team will typically evaluate whether the benefits of keeping the tubes (such as preventing uremic symptoms or managing discomfort) outweigh potential burdens like infection risk, dislodgement, or the need for regular maintenance. According to a study published in 2022 1, percutaneous nephrostomy is a safe and effective procedure in urinary tract infections with obstructed drainage, which supports the use of nephrostomy tubes in patients with complicated urinary tract infections.
Key Considerations
- The patient's goals of care and comfort should be the primary focus in deciding whether to maintain nephrostomy tubes.
- The benefits of keeping the tubes, such as preventing uremic symptoms or managing discomfort, should be weighed against potential burdens like infection risk, dislodgement, or the need for regular maintenance.
- Care of nephrostomy tubes involves routine flushing with normal saline, changing dressings, emptying drainage bags, and monitoring for complications such as infection, blockage, or leakage.
- The hospice team, including nurses and physicians, will provide education and support for tube management, as emphasized in a study on hospice and palliative care 2.
Management and Monitoring
- Regular monitoring for complications such as infection, blockage, or leakage is crucial.
- The use of antibiotic prophylaxis may be considered in certain cases, although its effectiveness in preventing urinary tract infections is uncertain, as noted in a study published in 2020 3.
- A study from 2019 4 highlights the importance of concordant antibiotic use and prompt catheter exchange in reducing the risk of recurrent percutaneous nephrostomy catheter-related infections.
Conclusion is not allowed, so the answer will continue without one.
The approach to managing nephrostomy tubes in hospice patients should prioritize quality of life and symptom management, as reflected in the hospice philosophy 2. By individualizing care and considering the patient's unique needs and circumstances, healthcare providers can ensure that nephrostomy tubes are used effectively and safely to improve patient outcomes.