Nephrostomy Insertion
Date issued: November 2024
For review: November 2026
Ref: B-526/LD/Radiology/Nephrostomy Insertion
PDF: Nephrostomy Insertion.pdf [pdf] 215KB
This leaflet tells you about having a nephrostomy insertion. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to an Interventional Radiologist for this procedure. Before the procedure you will need to sign a consent form, if one hasn’t previously been completed. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or Interventional Radiologist, you do not want this examination then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then they will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the radiologist and referring clinician will be acting in your best interests.
What is a nephrostomy?
A nephrostomy is a procedure in which a fine plastic tube (catheter) is placed through the skin into your kidney to drain your urine. The urine is collected in an attached drainage bag.
Why do you need a nephrostomy?
The most common reason for having a nephrostomy is blockage of the ureter. The urine from a normal kidney drains through a narrow muscular tube (the ureter) into the bladder. When the ureter becomes blocked, the kidney rapidly becomes affected, especially if infection is present. If left untreated, your kidney may become damaged. A nephrostomy drainage will relieve the symptoms of blockage and keep the kidney working.
Are there any risks?
Nephrostomy is a very safe procedure, but as with any medical procedure there are some risks and complications that can arise.
The main risk is bleeding from the kidney. It is common for the urine to be bloody immediately after the procedure. This usually clears over the next 24–48hrs.
On rare occasions, the bleeding may be more severe and require a transfusion. Very rarely the bleeding may require another surgical operation or radiological procedure to stop it.
The urine in the kidney may be infected. This can generally be treated satisfactorily with antibiotics, but occasionally you can feel unwell after the procedure.
Sometimes there is a leak of urine from the kidney, resulting in a small collection of fluid inside the abdomen. If this becomes a large collection, it may require draining under local anaesthetic.
Very rarely, the Interventional Radiologist will be unable to place the drainage catheter satisfactorily in the kidney. If this happens, you may require a small operation to overcome the blockage or a repeat procedure.
The nephrostomy tube can occasionally become blocked. This will require another appointment with us for a tube change.
Despite these possible complications, the procedure is normally very safe and will almost certainly result in a great improvement in your medical condition.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an X-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Are you required to make any special preparations?
A nephrostomy is usually carried out as an inpatient procedure under local anaesthetic. You may eat and drink as normal unless sedation has been discussed beforehand with the referring team/radiologist.
If you are taking warfarin, rivaroxaban, apixaban, ticagrelor (anticoagulants) this will be stopped before the procedure and you may require admission to hospital to give you an alternative.
You may receive a sedative to relieve anxiety, as well as an antibiotic.
A small cannula (thin tube) may be placed into a vein in your arm. You may require a fluid drip to help your kidney function before the nephrostomy insertion.
If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
Who will you see?
A specially trained team led by an Interventional Radiologist within the radiology department. Interventional Radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
If you are having the procedure as a day case, then you will be admitted to a ward. You will be asked to get undressed and put on a hospital gown. A small cannula (thin tube) will be placed into a vein in your arm. You may require a fluid drip to help your kidney function before the procedure.
Our porters will collect you and bring you to the interventional radiology suite which is located within X-ray East. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during the procedure?
You will lie on the X-ray table, nearly flat on your stomach. Occasionally a pillow is placed under your stomach. You will have monitoring devices attached to your chest and finger and may be given oxygen.
A nephrostomy is performed under sterile conditions and the Interventional Radiologist and radiology nurse will wear sterile gowns and gloves to carry out the procedure.
Your skin will be swabbed with antiseptic, and you will be covered with sterile drapes. The skin overlying the puncture site will be numbed with local anaesthetic. The Interventional Radiologist will use an ultrasound probe and the X-ray equipment to place a fine needle accurately into the kidney. When happy with the position, a guide wire will be inserted to allow the small plastic tube (catheter) to be placed.
This catheter will then be fixed to the skin surface and attached to a drainage bag.
Will it hurt?
Unfortunately, it may hurt a little for a very short period of time, but any pain you have should be controlled with painkillers or a sedative. When the local anaesthetic is injected, it will sting for a short while, but this soon wears off. Later, you may be aware of the needle and the catheter passing into the kidney, and sometimes this is painful, especially if the kidney was sore to start with. Generally, placing the catheter in the kidney only takes a short time, and once in place it should not hurt at all.
How long will it take?
Every patient is different, and it is not always easy to predict; however, expect to be in the radiology department for about an hour.
What happens afterwards?
You will be taken back to your ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site. You will generally stay in bed for a few hours, until you have recovered.
The nephrostomy catheter remains in place in your body for the time being and will be attached to a collection bag. You will be able to carry on a normal life with the catheter in place, but you must be careful not to dislodge the tube. The bag needs to be emptied fairly frequently, so that it does not become too heavy, but the nurses may wish to measure the amount in it each time.
How long will the tube stay in?
This is a question that can only be answered by the doctors looking after you. It may only need to stay in a short time. For example, while a stone passes naturally, or it may need to stay in for a much longer period, to allow a more permanent solution for the blockage to be organised, such as a ureteric stent (a small tube from the kidney to the bladder).
Other Risks
A nephrostomy insertion is a safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
Finally
Some of your questions 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. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 430838 - IR Co-ordinator
01752 432063 – Bookings Clerk
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Monday to Saturday (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
