emDocs - November 11, 2019 - Authors: Yoo M., Bridwell R and Sletten Z
Reviewed by Koyfman A and Long B
"Key Points
- The majority of nephrostomy tubes are placed for relief of urinary obstruction, and failure of catheters manifest with symptoms similar to what led to nephrostomy tube placement.
- Treat nephrostomy tube infections as complicated cystitis or complicated pyelonephritis, but avoid treating asymptomatic bacteriuria, which is common.
- Be mindful that nephrostomy tubes are often placed for obstructions caused by cancers—make sure the patient is not neutropenic if on chemotherapy.
- Obtain fresh urine from the nephrostomy tube to send off for studies, rather than obtaining urine from the collection bag.
- If an obstruction is suspected, try bedside troubleshooting with gentle irrigation of the catheter.
- Hematuria is common in the first 2 days, but always consider a vascular injury or hematoma formation if hematuria persists or re-occurs after the urine initially clear.
- In patients with decreased breath sounds or pleuritic chest pain ipsilateral to a recently placed nephrostomy tube, always consider pleural injury in your differential diagnosis."