Taking Care of Your Nephrostomy Drain

Caring for your nephrostomy drainage system can be overwhelming and intimidating. Tiffany McCall, an ARA paramedic and interventional case coordinator, walks you through the steps for caring for your nephrostomy drainage catheter. She covers the equipment, inspecting your drain and dressing, draining your bag, changing your dressing, and showering with your drain.

Hi, my name is Tiffany. I’m one of the paramedics with the Austin Radiological Association. I’m here today to talk to you about your nephrostomy drain.

You’re home from the hospital or clinic. Probably pretty overwhelmed and intimidated by some of the things that have happened to you. I’m here to make this a little bit easier.

Your equipment

When you came home from the hospital, you may notice that your equipment looks a little different than mine. Different hospitals in different clinics are going to use different manufacturers. Don’t worry. Here’s what’s important.

Access to the drain is always going to be the same. It’s going to be one port that will either be connected from the drain to a catheter tube that drains into a bag, or it’ll be the same drain access site. This is your access port. It just may be capped off so that it does not drain freely into the bag.

Let’s talk about a piece of equipment that you may have gone home with that looks a little intimidating. You may have gone home with this piece of equipment between your drain and your catheter tubing. This is called a three-way stopcock. The more you use this and the more comfortable you become with this piece of equipment, the easier this is going to be for you to use. Doctors typically place this connected to the drain, and the other side connects to your catheter tubing.

The three-way stopcock may have another piece of equipment attached as well. Some doctors will attach this blue clave device. This device is going to connect where you will flush your tubing. This works the same way this access port works on the three-way stopcock. Both of these will accommodate a luer lock syringe.

When you go home with your new drainage system, you’ll go home with a syringe that will help you clear and flush your device. This syringe is called a luer lock syringe. The luer lock syringe is made so that it screws into the flush port and closes firmly. You will not need to twist this tightly. Just twist until it is firmly in place. This syringe is the saline syringe that you’ll use for flushing your catheter tubing. The syringe is also a luer lock, so it will screw into your connecting port. And again, you don’t have to screw this in tightly. Just screw until it is attached firmly.

Inspecting your drain and dressing

Every day you’re going to inspect your drainage system. Find a handheld mirror or a long mirror and use that mirror to look at your drain. There should be a little fluid in your drain. It should be free flowing. There should be no kinks and no bends in the tubing between the drain and the bulb or bag.

Inspect your dressing. You want to make sure that if your dressing is soiled, wet, or appears to be loose, that you change that dressing. When you remove your dressing, take a second and look at the skin underneath. Make sure your skin is intact. It’s normal for it to appear a little abnormal. You may have to clean that site, let the site dry completely before you recover and bandage your site.

If you have severe pain, or if you notice leakage around the drain insertion site, please contact your doctor immediately. If for some reason your drain has come out, cover your drain with your bandaging materials and go to the local emergency department. If your drain stops draining or significantly decreases in output, you’ll need to contact your doctor’s office immediately.

Draining Your Bag

After you’ve recorded your output for the day, you’ll want to empty your bag. Go to the bottom of the bag and twist your blue cap until fluid is draining. You can drain this fluid into a bowl or into your toilet. Once your bag is completely empty, twist your blue cap in the opposite direction, which closes your bag.

Remember, before and after emptying your drainage system, make sure to wash your hands thoroughly.

Changing Your Dressing

Let’s talk about changing your dressing. Your dressing will need to be changed every day or every other day. Your dressing should be changed any time it is wet or soiled or loose around the edges. When you come home from the hospital or clinic, you’re going to notice your dressing is probably a little different than what you have to work with.

Let’s talk about removing this dressing. Holding your drain cap between your fingers or with one finger on the drain cap, start pulling back on the dressing that is over the blue. Keep in mind, this can be very sticky. If you’re having trouble pulling this up, don’t struggle. Use an alcohol prep pad or dampen it so that you can pull it back just a little easier.

When you pull this back, make sure your finger is holding your drain in place. You’re going to notice there is a small length of drain outside of your body, and on top of this bandage. Pull back this outer layer to expose that small piece of catheter. The blue that this is resting on is also very sticky. You’ll want to keep your hand on your drain and pull back until your drain is free of the dressing.

Holding your drain as best you can, go ahead and start removing your outer dressing. This is the dressing that touches your skin. As you start peeling this up, you may notice that you’re leaving behind a little adhesive. That’s okay. That’s normal. As you pull this off, start removing it all the way around the drain, keeping your hand on the drain if possible, so as not to dislodge anything.

You’ll have to forgive us. This torso does not actually have a drain in place. So you’ll notice I have white strips of tape holding the drain to the body. When you remove your dressing, you will not have these white strips of tape.

Slowly remove your adhesive. Use alcohol prep pads or warm soapy water where you need to to pull this away easily.

Once the drain is free and clear of the dressing, inspect your skin around the drain access point. If you have fluid leaking from the drain, you’ll need to contact your doctor’s office. Inspect this skin to make sure it is intact.

You can use saline and gauze to clean the area as needed, keeping in mind the saline and gauze may not remove that adhesive. The adhesive may stay with you for just a little while.

When you’re ready, take your supplies. Today, we’re going to use what you will most likely have at home. We’re going to use four inch by four inch gauze pads, and we’re going to use this plastic sheeting called a Tegaderm. Tegaderm outside of the package is just a sheet of plastic that is sticky on all surfaces. With your gauze and your Tegaderm, which we’ll remove from the packaging, use your clean hands. emember, you’re always going to wash your hands before and after changing your dressing.

Take a pair of scissors. You’re going to cut to the center of the 4×4 gauze just on one side. This allows you to place the gauze around the tube as it exits your body. Put the gauze against the drain, allowing the gauze to come together on the other side. You’ll notice that your Tegaderm is just a little bit smaller than this 4×4 gauze. Feel free to bend in the sides of your gauze to cover your drain so that your Tegaderm is able to make contact with the flesh all the way around. When you peel the Tegaderm from its backing, this entire surface is adhesive. Keeping your gauze together, lay your Tegaderm across the top of your gauze and then slowly pull the Tegaderm until it is taut and touching the skin.

You’ll want to press down on your Tegaderm all the way around your bandaging. When you feel like every surface of the Tegaderm is touching your skin, you’ll take one small piece of this white backing and you can remove that. As you go along, just press down firmly on your Tegaderm to make sure it continues to connect with your skin. Remember to wash your hands when you’re done changing your dressing.

Keep in mind, you don’t have to do this alone. If you have a friend or a partner who is able to help you, make sure that both of you clean your hands very well before changing your dressing. And you can instruct your friend or partner what to do to help you best.

This can be a very intimidating process. Changing the dressing is usually what scares patients the most, having to do this alone at home. Become comfortable with your tools. Become comfortable with your drain. Make sure you are telling whoever is helping you exactly what you want them to do so that you can work together to make this as easy as it can be. Every time you do this, it’s going to get a little easier.

Showering with Your Drain

Let’s talk about how to shower safely with your new drain. This is a huge source of anxiety for most patients. You’re told not to get your drain wet. Here’s the important part. Do not submerge your drain underwater. No hot tubs. No pools. No bathtubs for soaking. When you take a shower, you want to cover your drain.

You can do this in any number of ways. It doesn’t have to be fancy. And it doesn’t have to be perfect. Use what you have on hand. If you have cling wrap, if you have a gallon sized baggie, if you have an H-E-B bag, use what you have on hand to cover your drain to keep it clean and as dry as possible in the shower.

If you have a handheld shower head, using that can help direct the water away from your drain site. If you don’t have a handheld device, keep yourself facing your shower head and direct the water as best you can. For this demonstration, I’m just using household cling wrap. The cling wrap can go all the way around your body, making sure your drain site is covered well. And when you have it in position, take a pair of scissors and cut your cling wrap so that it fits to your body. Remember, this is not a perfect science. Water may run down your body and get under the surface of the cling wrap. Do your very best to use your hand to keep that covered.

Conclusion

I know that we’ve covered a lot of ground today. I know that if you’re not in the medical field, this is incredibly overwhelming and very intimidating. I encourage you to enlist a friend, a family member, someone you trust to help you care for your drain. I encourage you to become very familiar with the drain that’s been placed in your body – the catheter tubing, the bag, the bulb, whatever drainage system you have.

Don’t be afraid to touch your body or the drain. The more comfortable you become with this, the easier this is going to be for you. If you have questions, if you have problems, fall back on your medical staff. Contact your doctor’s office. Contact your nurse. Let them know that you’re struggling. Let them help you through this. We know you can do this.

It’s going to be a little strange at first, but you’re perfectly capable.