A nephrostomy tube is a small, flexible catheter inserted directly through the skin on the back into the kidney to divert urine flow. This procedure is performed when the normal drainage pathway, the ureter, is blocked by a tumor, stone, or scar tissue. If the tube stops draining, urine backs up into the kidney (hydronephrosis), increasing pressure and risking kidney damage or severe infection. Immediate action is necessary to resolve the lack of output.
Immediate Patient Troubleshooting Steps
When the tube output abruptly ceases, visually inspect the entire external system for obvious kinks, twists, or loops that could be restricting urine flow. Often, adjusting the tubing’s position on the body or within the dressing can restore drainage instantly.
Next, verify that the drainage bag is securely fastened and positioned well below the level of the kidney. Since gravity moves urine through the tube, the bag must be lower than the insertion site for continuous drainage. A change in body position, such as standing up or taking a short walk, can sometimes dislodge sediment or mucus temporarily obstructing the catheter tip inside the kidney.
If trained by your healthcare provider, you may attempt to gently “milk” the tube. This involves lightly squeezing and releasing the tubing along its length, starting near the insertion site and moving toward the bag, to break up minor internal debris. This technique should only be used if a clinician has previously instructed you on the proper, gentle method, as improper use risks damaging the tube or causing discomfort. Finally, check the dressing site to ensure the tape or securing device is not constricting the tube where it exits the skin.
Recognizing Signs of Severe Complication
While minor blockages are often resolved by simple troubleshooting, certain symptoms signal a serious problem requiring immediate medical attention. The most concerning sign is the sudden onset of a fever (over 101.5°F), often accompanied by shaking chills. These symptoms suggest the retained urine has become infected, potentially leading to pyelonephritis or a systemic infection called sepsis.
Rapidly intensifying pain in the flank, side, or lower back near the tube insertion site is another warning sign. This pain is caused by the buildup of pressure from undrained urine, which can quickly lead to kidney distress. Contact your provider immediately if the urine becomes foul-smelling, thick, cloudy with sediment, or suddenly contains a large amount of blood or blood clots.
The combination of no drainage into the bag and substantial urine leakage around the tube insertion site is particularly alarming. This indicates the tube is completely blocked, forcing urine out around the catheter. If any of these severe symptoms are present, stop all patient troubleshooting and seek emergency medical care without delay.
When and How Medical Professionals Address Blockages
When a patient reports a persistent lack of drainage, the medical team first ensures no simple external issue was missed, such as a closed stopcock valve. The primary professional intervention is a sterile flush of the tube using saline solution. This is performed using an aseptic technique and a small syringe, typically 10 milliliters, to avoid exerting excessive pressure that could injure the kidney.
If resistance is met during the flushing attempt, the professional stops immediately and does not force the fluid to prevent trauma or rupture of the collecting system. Diagnostic imaging is then used to visualize the tube’s position and the cause of the obstruction. An X-ray, ultrasound, or a specialized procedure called a nephrostogram may be used, which involves injecting contrast dye directly into the tube to outline the kidney’s internal structure.
Imaging confirms if the tube is dislodged, kinked internally, or blocked by materials like a blood clot, stone fragment, or crystalline debris. Depending on the cause and location of the obstruction, the medical team decides on the next course of action. This may involve replacing the existing tube with a new one, a procedure often done quickly in an interventional radiology suite. Restoring continuous drainage protects the kidney and prevents the development of a serious infection.