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    Percutaneous urinary procedures - discharge

    Percutaneous nephrostomy - discharge; Percutaneous nephrostolithotomy - discharge; PCNL - discharge; Nephrolithotomy - discharge; Percutaneous lithotripsy - discharge; Endoscopic lithotripsy - discharge; Kidney stent - discharge; Uteric stent - discharge

    You had percutaneous (through the skin) urinary procedures to help drain urine from your bladder and get rid of kidney stones.

    If you had percutaneous nephrostomy, the doctor inserted a small, flexible catheter (tube) through your skin into your kidney to drain your urine.

    If you also had percutaneous nephrostolithotomy (or nephrolithotomy), the doctor passed a special medical instrument through your skin into your kidney. This was done to get rid of the kidney stones.

    What to Expect at Home

    You may have some pain for the first week after the catheter is inserted. Tylenol, aspirin, or ibuprofen (Advil) may help with the pain. But your doctor may ask you NOT to take aspirin or ibuprofen because they increase your risk of bleeding.

    You may have some clear-to-light yellow drainage around the catheter insertion site for the first 1 to 3 days. This is normal.

    A tube that comes from your kidney will pass through the skin on your back. This helps the urine flow from your kidney through the catheter into a bag that is attached to your leg. You may see some blood in the bag at first. This is normal and should clear over time.

    Caring for Your Tubes and Catheters

    Proper care of your nephrostomy catheter is important so you do not get an infection.

    • During the day, you may use a small urinary bag that attaches to your leg.
    • Use a larger drainage bag at night.
    • Always keep the urinary bag below the level of your kidneys.
    • Empty the bag before it is completely full.
    • Wash your drainage bag once a week using a solution of half white vinegar and half water. Rinse it well with water and allow it to air dry.

    Drink plenty of liquids (2 to 3 liters) every day, unless your doctor tells you not to.

    Avoid any activity that causes a pulling sensation, pain around the catheter, or kinking in the catheter. Do NOT swim when you have this catheter.

    Your doctor will recommend you take sponge baths so that your dressing stays dry. You may take a shower if you wrap the dressing with plastic wrap and replace the dressing if it gets damp. Do NOT soak in a bathtub or hot tub.

    Dressing Changes

    Your doctor or nurse will show you how to place a new dressing.

    Change your dressing every 2 to 3 days for the first week. Change it more often if it gets dirty, wet, or becomes loose. After the first week, change your dressing once a week, or more often as needed.

    You will need some supplies when you change your dressing. These include: Telfa (the dressing material), Tegaderm (the clear plastic tape that holds the blue plastic ring in place), scissors, split gauze sponges, 4-inch x 4-inch gauze sponges, tape, connecting tube, hydrogen peroxide, and warm water (and a clean container to mix them in), and a drainage bag (if needed).

    Always wash your hands well with soap and water before you remove the old dressing. Wash them again before you put the new dressing on.

    Be careful when you take off the old dressing:

    • Do not pull on the drainage catheter.
    • Keep the blue plastic ring against your skin.
    • Check to see that the sutures (stitches) or the device that holds your catheter against your skin is secure.

    When the old dressing is off, gently clean the skin around your catheter. Use a cotton swab soaked with a solution of half hydrogen peroxide and half warm water. Pat it dry with a clean cloth.

    Look at the skin around your catheter. Call your doctor or nurse if there is any redness, tenderness, or drainage.

    Place a clean dressing the way your doctor or nurse showed you.

    When to Call the Doctor

    Call your doctor if you have any of these symptoms:

    • Pain in your back or side that will not go away or is getting worse
    • Blood in your urine after the first few days
    • Fever and chills
    • Vomiting
    • Urine that smells bad or looks cloudy

    Also call your doctor if:

    • The blue plastic ring is pulling away from your skin.
    • The catheter has pulled out.
    • The catheter stops draining urine into the bag.
    • The catheter is kinked.
    • Your skin under the tape is irritated.
    • Urine is leaking around the catheter or plastic ring.
    • You have redness, swelling, or pain where the catheter comes out of your skin.
    • There is more drainage than usual on your dressings.
    • The drainage is bloody or contains pus.

    References

    WolfJS. Percutaneous approaches to the upper urinary tract collecting system. In: Wein AJ, ed. Campbell-Walsh Urology. 10thed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 47.

    Curhan GC. Nephrolithiasis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 128.

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                Review Date: 9/24/2012

                Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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                St. Luke's Hospital - 232 South Woods Mill Road - Chesterfield, MO 63017 Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
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