What is an exchange of a nephrostomy tube?
You will already have had a tube inserted through the skin into one or both of your kidneys, which drains urine into a bag. This procedure is called a nephrostomy. This tube requires changing every 3 months and this is referred to as ‘exchange of nephrostomy’.
Why do I need an exchange of nephrostomy?
Nephrostomy tubes are routinely changed to prevent infections and blockages. Your doctor will decide how frequently this needs to be done.
What to tell the doctor
- If you have any allergies.
- If you have had a previous reaction to intravenous contrast medium (the dye used for some X-rays and CT scanning).
- If you are taking medication to prevent blood clots. Below is a list of some of the medications which are used to thin the blood and help to prevent blood clots.
If you are currently taking any of these medications, please contact your referring doctor or the radiology department on 0161 918 2346 as soon as possible, as these may need to be stopped prior to your procedure. Failure to do so may result in your procedure being postponed.
Who has made the decision?
Your doctor and the interventional radiologist (specialist doctor) who will do the procedure, will have carefully considered your case and feel that this is in your best interests. However, if following discussion with your doctors you do not wish to have the procedure, you can decide against it.
Who will be doing the exchange of nephrostomy tube?
An interventional radiologist will carry out the procedure. They have special expertise in using X-ray and scanning equipment to do procedures, and also in interpreting the images produced. They need to look at these images while carrying out the procedure. Interventional radiologists are the best trained people to replace the tube correctly.
Where will the procedure take place?
The exchange of a nephrostomy tube procedure will take place in the procedure room in the radiology department on the Integrated Procedures Unit (IPU). This room is adapted for specialised procedures.
How do I prepare for an exchange of a nephrostomy tube?
You can eat and drink as normal. Take all your medications as you normally would. Please bring a list of your normal medications with you.
When you arrive at the department, you will be seen by the admissions team who will ask about your medical history and any allergies you may have. They will also put a cannula into one of your veins in case any medications are required during your procedure.
Please inform the team if you have any allergies to medicines, or have had a reaction to intravenous contrast medium (the dye used for kidney X-rays and CT scanning). The procedure is performed by an interventional radiologist and you will have an opportunity to speak with them about the nephrostomy exchange before proceeding.
What actually happens during the exchange of nephrostomy tube?
You will lie on the X-ray table. You will be asked to lie on your front, back or side depending on the easiest route of access to your tube. We will give you some antibiotics through your cannula to help prevent any infections caused by changing your tube.
The radiologist needs to keep everything sterile and will wear a theatre gown and gloves. The skin around the site will be swabbed with antiseptic and then most of the rest of your body will be covered with theatre towels. The radiologist will inject some dye down the tube and will look at the X-rays to check that the present tube is in the correct position.
A guide wire will then be placed through the existing tube into the kidney. The radiologist will then pull the tube out, leaving the guide wire in place. This allows a new tube to be inserted over the wire and into the correct place in your kidney. Once the tube is secured in place, the guide wire is removed. The outer tube is then covered with an adhesive bag to collect the urine.
Will it hurt?
An exchange of nephrostomy tube is usually a relatively pain-free procedure. It is normally performed without local anaesthetic. However, if you experience discomfort, it may be possible for the interventional radiologist to give local anaesthetic and/or the nurse to give you a painkiller.
How long will it take?
The procedure usually takes around 30 minutes as well as some preparation time. The radiologist will ensure that your new nephrostomy tube is working well before planning your discharge.
What will happen after my procedure?
When your procedure is finished, the doctor will assess you and you may be required to stay in the recovery area of the Integrated Procedures Unit for a short period to monitor your observations and ensure your nephrostomy is functioning well. The nursing team will prepare you for discharge soon after.
What are the benefits of the procedure?
Nephrostomy tubes are routinely changed every 3 months, or in some cases earlier. This is to prevent infections and blockage of the tube.
Are there any risks or complications?
Exchange of a nephrostomy tube is a safe procedure, and it is rare that complications occur. Despite this, the complications that could possibly arise are infection, bleeding and pain. It is not unusual to have lightly blood-stained urine for 24 hours. These potential complications will be discussed with you when you come for the procedure.
If you notice that your nephrostomy tube stops draining, please call The Christie Hotline immediately on 0161 446 3658 for advice. If there is a blockage with your nephrostomy tube, you may need to be admitted to hospital for further assessment.
This is available from the radiology department on the phone numbers below or from the following websites: