Percutaneous Urinary Procedures - Discharge

You had a procedure to drain urine from your kidney or to get rid of kidney stones. This article gives you advice on what to expect after the procedure and steps you should take to care for yourself.

When You're in the Hospital

You had percutaneous (through the skin) urinary procedures to help drain urine from your kidney and get rid of kidney stones.

If you had a percutaneous nephrostomy, the health care provider inserted a small, flexible catheter (tube) through your skin into your kidney to drain your urine.

If you also had percutaneous nephrostolithotomy (or nephrolithotomy), the provider passed a small medical instrument through your skin into your kidney. This was done to break up or remove kidney stones.

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What to Expect at Home

You may have some pain in your back for the first week after the catheter was inserted into the kidney. Over-the-counter pain medicine such as Tylenol may help with the pain. Other pain medicines, such as aspirin or ibuprofen (Advil) can also help, but your provider may not recommend that you take these medicines because they can increase your risk of bleeding.

You may have some clear-to-light yellow drainage around the catheter insertion site for the first 1 to 3 days. This is normal.

A tube that comes from your kidney will pass through the skin on your back. This helps the urine flow from your kidney into a bag that is attached to your leg. You may see some blood in the bag at first. This is normal and should clear over time.

Caring for Your Tubes and Catheters

Proper care of your nephrostomy catheter is important so you do not get an infection.

During the day, you may use a small urinary bag that is attachesd to your leg.
Use a larger drainage bag at night.
Always keep the urinary bag below the level of your kidneys.
Empty the bag before it is completely full.
Wash your drainage bag once a week using a solution of half white vinegar and half water. Rinse it well with water and allow it to air dry.

Drink plenty of liquids (2 to 3 liters) every day, unless your provider tells you not to do so.

Avoid any activity that causes a pulling sensation, pain around the catheter, or kinking in the catheter. DO NOT swim when you have this catheter.

Your provider will recommend that you take sponge baths so that your dressing stays dry. You may take a shower if you wrap the dressing with plastic wrap and replace the dressing if it gets damp. DO NOT soak in a bathtub or hot tub.

Dressing Changes

Your provider will show you how to place a new dressing.

Change your dressing every 2 to 3 days for the first week. Change it more often if it gets dirty, wet, or becomes loose. After the first week, change your dressing once a week, or more often as needed.

You will need some supplies when you change your dressing. These include: Telfa (the dressing material), Tegaderm (the clear plastic tape that holds the plastic ring in place), scissors, split gauze sponges, 4-inch x 4-inch (10 cm x 10 cm) gauze sponges, tape, connecting tube, hydrogen peroxide, and warm water (plus a clean container to mix them in), and a drainage bag (if needed).

Always wash your hands well with soap and water before you remove the old dressing. Wash them again before you put on the new dressing.

Be careful when you take off the old dressing:

DO NOT pull on the drainage catheter.
Keep the plastic ring against your skin.
Check to see that the sutures (stitches) or the device that holds your catheter against your skin is secure.

When the old dressing is off, gently clean the skin around your catheter. Use a cotton swab soaked with a solution of half hydrogen peroxide and half warm water. Pat it dry with a clean cloth.

Look at the skin around your catheter for any increase in redness, tenderness, or drainage. Call your provider if you notice these changes.

Place a clean dressing the way your provider showed you.

If possible, have family or a friend change the dressing for you. This makes the process easier.

When to Call the Doctor

Call your provider if you have any of these symptoms:

Pain in your back or side that will not go away or is getting worse
Blood in your urine after the first few days
Fever and chills
Vomiting
Urine that smells bad or looks cloudy
Worsening redness or pain of the skin around the tube

Also call if:

The plastic ring is pulling away from your skin.
The catheter has pulled out.
The catheter stops draining urine into the bag.
The catheter is kinked.
Your skin under the tape is irritated.
Urine is leaking around the catheter or plastic ring.
You have redness, swelling, or pain where the catheter comes out of your skin.
There is more drainage than usual on your dressings.
The drainage is bloody or contains pus.

References

Bushinsky DA. Nephrolithiasis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 126.

Wolf JS. Percutaneous approaches to the upper urinary tract collecting system. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 8.