Percutaneous Nephrostomy

This leaflet tells you about the procedure known as ‘insertion of a nephrostomy tube’. It explains what is involved and what the possible risks are.

What is ‘insertion of a nephrostomy tube’?

A nephrostomy tube is inserted when there is a blockage stopping urine draining from the kidney to the bladder. It is a small tube inserted through the skin into the kidney which allows urine to drain into a collecting bag outside the body. It is important to drain urine from a blocked kidney as, if it is left untreated, progressive kidney damage or serious infection can occur.  

Who has made the decision?

The consultant in charge of your case and a radiologist will have discussed your case and feel this is the best way of treating you.  

Who will be performing the procedure?

A doctor called an interventional radiologist who has been specially trained in performing procedures using x-ray and scanning equipment.  

Where will the procedure take place?

In the X-ray Department in a ‘special procedures room’, using an ultrasound machine and x-rays.  

Is there any preparation?

A blood test called a clotting screen will be required, and certain blood thinning medications will need to be stopped prior to your appointment. The Radiology Nurses will contact you to discuss these. You should continue to take your regular medication as usual. 

You will be asked not to eat or drink for a minimum of six hours prior to the procedure. However, you can have clear fluid, for example water, black tea/coffee up until two hours before your procedure. This is to ensure we can safely administer any mediations during the procedure.  

Consent

Prior to the procedure starting the consultant radiologist will explain all the risks, benefits before asking you to sign a consent form. If you are unsure about any aspect of the treatment proposed, please do not hesitate to ask questions. 

What happens during the procedure?

If you are not already an inpatient, you will be admitted to hospital for the procedure. You may be asked to stay overnight post procedure to monitor your urine output. This will be decided by the interventional radiologist when your appointment is booked. 

After discussing the procedure and signing the consent form a needle will be put into a vein in your hand or arm so that a sedative, painkiller and/or antibiotic can be administered if required.  

You will be assisted onto the x-ray table, and you will be asked to lay flat on your stomach, with your arms in front of you, as if sun-tanning your back.  

A nurse will attach a monitor to your chest, arm and finger so your blood pressure, pulse etc. can be recorded. You will receive oxygen through small tubes in your nose.  

Your skin will be cleaned with an antiseptic solution and a sterile drape will be laid over you to help avoid infection. The interventional radiologist will use an ultrasound machine to find the best place to enter the kidney. A local anaesthetic will be injected into your skin and deeper tissues.  It will sting for a few seconds before the area goes numb.    

A fine needle will be inserted through the skin into the kidney. X-ray dye will be injected through the needle. When the interventional radiologist is sure that the needle is in a satisfactory position, a guide wire will be placed into the kidney through the needle. The nephrostomy tube is placed over the wire into the kidney and then the wire is removed, leaving the tube in the kidney allowing the urine to drain. The tube will then be fixed to the surface of the skin with a suture and dressing. A drainage bag will be attached. The urine will flow from your kidney through the tube into the bag.

How long will it take?

Every patient is different. The procedure can take between thirty minutes to one hour.

Will it hurt?

You will feel stinging as the local anaesthetic is injected.

The procedure may be slightly uncomfortable but painkillers can be administered by the monitoring nurse through the needle in your arm/hand. Once the tube is in place it should not hurt.

What happens afterwards?

You will be taken back to the ward on a bed.  Nursing staff will monitor your blood pressure, pulse, temperature etc., to make sure there are no problems. You will stay in bed for a few hours, until you have recovered.   

You may eat and drink normally once the sedation has worn off.  

The nursing staff will monitor the urine draining into the bag; this may be blood stained at first but should clear over time.  

You can carry on a normal life with the tube in situ. Remember to be careful not to catch the tube, for example when dressing, because it is possible for these tubes to be inadvertently pulled out.  The bag can be strapped to your leg for comfort and the ward staff will teach you how to empty the bag. Care should be taken when showering to avoid getting the dressings wet.  A water-resistant dressing can be supplied.  

If you are well enough, you may be allowed home later that day, or you may need to stay overnight.  

You must:  

• Have a responsible adult to collect you, as you cannot drive home or travel on public transport

• Have someone to stay with you for the first night just in case your wound bleeds or you feel unwell

• Have access to a telephone.  

How long will the tube stay in for?

This is something which you will need to discuss with your urologist or the team caring for you. It will depend on your condition and circumstances. It will be removed if treatment can relieve the blockage, for example a stent.  

Some patients are not suitable to have treatment or a stent and, in these cases, the nephrostomy will be permanent but will be changed periodically.    

What are the risks and complications?

Percutaneous Nephrostomy is a common and safe procedure but, as with any medical treatment, there are some risks and complications that can occur.    

There may be slight bleeding from the kidney, and blood staining of the urine for a day or two after the procedure is not uncommon.  On very rare occasions this may become severe and require another radiological procedure or surgical operation to stop it. This could result in damage to or loss of the kidney, but this is extremely rare.  

If urine in the blocked kidney is infected, you may get shaking, chills or fever during or soon after the insertion of the tube.  This can be treated with antibiotics.   

There is an extremely small risk of experiencing a reaction to the x-ray dye.  If you have had previous reactions to x-ray dye, then please tell the x-ray staff prior to the procedure.  

Will I need further treatment?

Your doctor may consider that further treatment is required. This depends on what is causing the blockage. If the radiologist thinks you will be suitable for further treatment he will discuss this with you and your consultant and make a plan going forward. 

Looking after a nephrostomy

You may be discharged home with the nephrostomy tube in situ. A referral will be made by the ward staff to your local district nurse to assist with the care of the tube.  

The skin around the nephrostomy tube insertion site should be kept clean and, to prevent infection, a sterile dressing (drain fixative) should be placed around the site where the tube leaves the skin.  

The nephrostomy tube will be stitched at the drain site where the tube leaves the skin. It is important that the urine bag is either strapped to your thigh, attached to a drainage system belt or pinned to your clothing with a safety pin. It is important not to leave the bag hanging as the weight of the urine and any tugging may cause the nephrostomy tube to become dislodged or fall out. The urine bag should be changed weekly.  

Ordering equipment

If it is agreed the nephrostomies will be in situ long-term then you will be enrolled on the prescription service prior to being discharged. You will be given an a ‘hospital to home bag’ prior to leaving the Interventional Radiology Suite and a member of the team will explain how the service works.  

Contact numbers

We hope that you have found this information useful. If you have any questions or are worried about anything, please contact your referring consultant or family doctor (GP). To contact your referring consultant, please call:

Dorset County Hospital on 01305 251150 and ask for the secretary of your consultant
Urology nurses on 01305 255145
Radiology sister on 01305 255276

About this leaflet

Authors: Michelle De La Haye, Radiology Sister, Dr Robert Ward, Consultant Interventional Radiologist
Written: May 2019
Updated and approved: July 2025
Review date: July 2028
Edition: 1

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk