Nephrostomy tube change: A guide for patients

Introduction

This leaflet is designed for patients who have been advised to have a nephrostomy tube change.

Contents

• What is a nephrostomy tube change?
• Why do I need a nephrostomy tube change?
• Who has made the decision for me to have a nephrostomy tube change?
• What are the benefits?
• What happens before the procedure?
• Who will be performing the nephrostomy tube change?
• What happens during the nephrostomy tube change?
• Will the nephrostomy tube change hurt?
• How long will the nephrostomy tube change take?
• What will happen after the nephrostomy tube change?
• What are the possible risks?
• Radiation
• Conclusion
• Privacy and dignity

What is a nephrostomy tube change?

A nephrostomy tube change is a procedure where the nephrostomy (the plastic tube in your kidney) is changed.

Why do I need a nephrostomy tube change?

The decision to place a nephrostomy had already been made and discussed with you prior to insertion.

The nephrostomy (plastic tube) can get blocked or can move. To prevent problems such as pain, infection or a leaking tube, we regularly change the tube.

Who has made the decision?

The consultant in charge of your case and the radiologist who performed the nephrostomy will have discussed the situation and come to the conclusion that the nephrostomy tube needs to be changed.

However, you will also have the opportunity for your opinion to be considered, and if, after discussion with your doctors, you do not want the procedure carried out, you can decide against it.

What are the benefits?

Having your nephrostomy tube changed regularly should prevent pain, infection or a leaking tube.

What happens before the procedure?

• Some patients are admitted to the radiology day unit. Some patients may simply walk into the operating room from the waiting room.
• A doctor will take a history from you.
• You may have a small needle put into a vein in your arm for painkillers to be given if necessary.
• You may eat a light meal before the nephrostomy tube change.
• If you have any allergies you must let your doctor know.
• If you take any medications to thin the blood (anticoagulants or antiplatelets) please let us know beforehand, as these will need to be stopped a certain length of time before the procedure.
  • Examples include: warfarin, dalteparin, enoxaparin, tinzaparin, dabigatran, rivaroxaban, apixaban, clopidogrel, ticagrelor.
  • Low dose aspirin (75mg) is safe to continue.
  • Please discuss with a doctor before stopping any medicines, as sometimes other treatment will need to be given.
• If you have previously reacted to intravenous contrast medium (the dye used for CT scans), you must also tell your doctor about this.

Who will be performing the nephrostomy tube change?

A specially trained doctor called an interventional radiologist will be performing your tube change.

Radiologists have special expertise in using x-ray equipment and interpreting the images produced. They will look at these images while carrying out the procedure.

The radiologist will be assisted by a radiographer and nurses.

What happens during the nephrostomy tube change?

You will lie on the x-ray table, generally flat on your front.

The procedure is performed under sterile conditions and the radiologist and scrub nurse will wear sterile theatre gowns and operating gloves. Antiseptic solution will be used to clean around the nephrostomy tube.

If required, local anaesthetic will be injected. Most patients don’t get any pain and so do not need local anaesthetic.

The radiologist will use x-rays to pass a wire into the nephrostomy tube, remove the old tube and then insert a new tube.

The new tube will be fixed to the skin and attached to your drainage bag.

Will the nephrostomy tube change hurt?

A nephrostomy tube change is not usually painful and is often performed without local anaesthetic.

There will be a nurse, or another member of the clinical staff, in the room looking after you. If the procedure does become uncomfortable, please let a member of staff know.

How long does the nephrostomy tube change take?

Usually a nephrostomy tube change is very quick, taking only 10 to 15 minutes.

What will happen after the nephrostomy tube change?

Some patients will go back to the radiology day unit before being discharged.

Some patients will be discharged directly from the operating room.

Nursing staff may carry out routine observations including taking your pulse and blood pressure and will also check the treatment site.

If you experience pain or sickness let the nursing staff know.

If you were told to stop any medication before the procedure, your doctor will tell you when to start them again.

What are the possible risks?

A nephrostomy tube change is a very safe procedure but as with any medical procedures there are some risks and complications.

You may see a small amount of blood in the urine (haematuria) after your tube change. This usually settles within a few hours.

On rare occasions you can get a urinary tract infection (UTI) following your tube change.

Radiation

You have been referred for an Interventional Radiology procedure to help deliver your treatment. A specialist in radiology agrees that this is the best procedure to treat your clinical condition and that the benefit of the examination is greater than the risk.

The x-ray involves a dose of ionising radiation equivalent to a few months or years of natural background radiation which we are all exposed to every day.

Ionising radiation can cause cell damage that may turn cancerous however the risk of this happening from your examination is considered low.

Depending on the length of the procedure there may also be a small risk of an excess radiation dose to the skin leading to short term and long term effects (e.g. reddening of the skin and burns).

If this happens as a result of this procedure, you will receive further advice following the procedure. The dose delivered will be kept as low as is practicable

For further information please see the CUH Imaging Page on the Public Website

Conclusion

Some of your questions about a nephrostomy tube change should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you.

This document has been adapted from one prepared by the British Society of Interventional Radiology (BSIR).

Privacy and dignity

We are committed to treating all patients with privacy and dignity in a safe, clean and comfortable environment. This means, with a few exceptions, we will care for you in same sex bays in wards with separate sanitary facilities for men and women.

In some areas, due to the nature of the equipment or specialist care involved, we may not be able to care for you in same sex bays. In these cases staff will always do their best to respect your privacy and dignity, for example with the use of curtains or, where possible, moving you next to a patient of the same sex. If you have any concerns, please speak to a member of the radiology team, ward sister or charge nurse.