What is a nephrostomy tube?
A nephrostomy tube is a small flexible tube placed through the lower back into the kidney to drain urine. A nephrostomy tube is inserted when there is an obstruction to the normal flow of urine.
Most nephrostomy tubes are placed in the body using image guidance by interventional radiologists.
Risks of a nephrostomy tube insertion
Nephrostomy tube insertion is usually a low-risk procedure. The risk may increase depending on your child’s condition, age and health.
The risks of a nephrostomy tube include:
- pain and discomfort
- infection
- bleeding, including blood in urine
- kidney damage
- urinary leakage into the abdomen instead of the tube
- loss of a kidney (very, very rare)
Visiting the interventional radiologist before the procedure
Your child may have a clinic visit with the interventional radiologist before the procedure. During the visit you should expect:
- A health assessment to make sure your child is healthy and that it is safe to have sedation or general anaesthesia and to go ahead with the procedure.
- An overview of the procedure, and a review of the consent form with an interventional radiologist.
- In some cases, an ultrasound of the kidneys.
- Blood work, if needed.
Giving consent before the procedure
Before the procedure, the interventional radiologist will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks, and will help you weigh any benefits against the risks. It is important that you understand all of these potential risks and benefits of the nephrostomy tube insertion and that all of your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.
How to prepare your child for the procedure
Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
If your child becomes ill within two days before the procedure
It is important that your child is healthy on the day of the procedure. If your child starts to feel unwell or has a fever within two days before the nephrostomy tube insertion, let your doctor know. Your child’s procedure may need to be rebooked.
Food, drink and medicines before the procedure
- Your child’s stomach must be empty before sedation or general anaesthetic.
- If your child has special needs during fasting, talk to your doctor to make a plan.
- Your child can take their regular morning medicine with a sip of water two hours before the procedure.
- Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by their doctor and the interventional radiologist.
On the day of the nephrostomy tube insertion
Arrive at the hospital two hours before the planned time of your child’s procedure. Once you are checked in, your child will be dressed in a hospital gown, weighed and assessed by a nurse. You will also be able to speak to the interventional radiologist who will be doing the nephrostomy tube insertion and the anaesthetist who will be giving your child medication to make them comfortable for the procedure.
During the nephrostomy tube insertion, you will be asked to wait in the surgical waiting area.
Your child will have medicine for pain
Children are given medicine for treatments that may be frightening, uncomfortable or painful. This includes local anaesthesia, sedation or general anaesthesia. For nephrostomy tube insertions, most children are given a general anaesthetic.
How a nephrostomy tube is inserted
The interventional radiologist uses ultrasound and X-rays to find the kidney and insert the nephrostomy tube through the skin, aiming for the area where the urine needs to be drained. Some children need a nephrostomy tube for one kidney, others need a nephrostomy tube for each kidney.
The tube is then taped to the skin. Most children will not need stitches.
The tube is attached to a drainage bag that needs to be emptied regularly.
After the nephrostomy tube insertion
Once the nephrostomy tube insertion is complete, your child will be moved to the recovery area. The interventional radiologist will come and talk to you about the details of the procedure. The interventional radiologist will come to see your child later on to ensure the tube is working properly.
The interventional radiologist will also talk to your child's doctors about any details related to the nephrostomy tube.
Some children feel local pain or discomfort after the nephrostomy tube is placed. The tube is thin, and pain can usually be controlled by pain medicines such as acetaminophen. After a day, most children feel no pain with the tube.
Going home
The length of hospital stay will depend on your child’s overall health. Your child may go home with the nephrostomy tube in place. Your child’s nurse will show you how to care for the tube before your child is discharged from the hospital.
For more details on how to care for your child after a nephrostomy tube insertion, please see Nephrostomy tube: Care at home.
Taking out the nephrostomy tube
When your child no longer needs the nephrostomy tube, your child will not need another general anaesthetic in order to take it out. The nephrostomy tube is usually removed at your child’s bedside and a bandage is put over the site. This does not take long and should not hurt. Your child will not need any stitches.
At SickKids
At SickKids, the interventional radiologists work in the Department of Diagnostic Imaging – Division of Image Guided Therapy (IGT). You can call the IGT clinic at (416) 813-6054 and speak to the clinic nurse during working hours (8:00 to 15:00) or leave a message with the IGT clinic nurse.
For more information on fasting see Eating and drinking before surgery.
For more information on preparing your child for their procedure see Coming for surgery.