HHC Health & Home Care Clinical Policy And

HHC HEALTH & HOME CARE Section: 5-20
Genitourinary: Nephrostomy Catheter Care __RN
PURPOSE:
To maintain a patent catheter providing drainage of
urine from the kidney when flow of urine through a ureter
is not possible or desirable.
CONSIDERATIONS:
1. Maintaining a sterile system is of utmost importance
in preventing serious consequences of kidney
infection.
2. The catheter is either taped or sutured securely into
place.
3. The catheter should not be kinked, bent, or plugged
to assure continuous drainage. If a patient is
positioned on his back, apply enough dressings
under the catheter to prevent kinking or bending. If
the positioning, manipulation of tube or irrigation
does not remove an obstruction, notify physician
immediately.
4. The catheter is never clamped unless otherwise
ordered by a physician.
5. Removal of a nephrostomy catheter is be done by
the physician. A 4x4 sterile gauze dressing is
placed over the catheter insertion site after tube is
removed.
EQUIPMENT:
Sterile irrigation set:
Solution container
Asepto syringe
Gauze pads
Antimicrobial solution
Drainage basin
Gloves
Sterile irrigation solution (normal saline)
Waterproof, absorbent underpad
Impervious trash bag
Sterile gauze dressing: 2x2s, 4x4s, ABDs, Sop-Wik
Drain Sponges
Leg drainage bag with catheter strap for long term or
permanent nephrostomy
Stabilizing device (if nephrostomy not sutured in place)
Antiseptic wipes
Nail polish remover pads
250 cc pour bottle of sterile water
Sterile cotton applicators
Transparent dressing (optional)
Paper tape/transpore tape
Gloves – sterile and clean
PROCEDURE:
1. Adhere to Universal Precautions.
2. Explain procedure to patient.
3. Place patient in a position of comfort that allows
observation and access to the nephrostomy
catheter. Protect the area beneath the patient with
a waterproof, absorbent underpad and cover the
patient's lower body with a drape (towel, sheet) to
prevent exposure.
4. General care (to be performed at least every two
days or as needed):
a. Adhere to Standard Precautions.
b. Peel off old dressing carefully from the outmost
part to inner most part.
c. Anchor the catheter to skin with one hand while
removing tape with the other hand to ensure
catheter is not pulled out.
d. Cleanse around nephrostomy tube with
antiseptic wipes, beginning at the catheter site
and moving outward. Repeat cleansing.
Cleanse outside of the disc (closet to skin),
beginning at the insertion site and moving
outward.
e. If there is residual adhesive on the skin, it can
be removed with nail polish remover pads.
Pour a small amount of water on 4x4 gauze to
thoroughly wash nail polish remover from the
skin.
f. Inspect catheter for kinks, check for leakage of
urine or bile from catheter.
g. Examine catheter exit site. Report signs of
redness or infection to physician as needed.
h. Place gauze dressing around catheter and tape
in place. A transparent dressing may be
applied to provide a waterproof barrier.
5. Plugged catheter, irrigate if ordered by physician:
a. Using sterile technique, gently irrigate catheter
with 5cc normal saline using a syringe without
the needle, never forcing the irrigant. (See
Genitourinary, Irrigation of Indwelling Foley
Catheter, No. 5.12.)
b. Gently aspirate irrigant instilled or allow irrigant
to flow back per gravity drainage. Only aspirate
with physician's order.
c. Discard any unused irrigating solution and
collected irrigation solution from drainage basin
in toilet.
d. Cleanse and dry drainage basin.
e. Instruct patient/caregivers regarding preparation
of sterile equipment and container, if disposable
equipment is not used.
6. Instruct patient to:
a. Apply catheter strap and use a leg bag for
daytime drainage.
b. Use continuous gravity drainage bag at night
time.
7. Discard soiled supplies in appropriate containers.
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