There is a muscular tube inside the body called the ureter and it drains urine from the kidney into the bladder. If the tube is blocked because of a blood clot or a kidney stone, you may need a nephrostomy. This procedure involves inserting a catheter through the skin into the kidney. The catheter will drain the urine into a bag outside the body.  

Nephrostomy procedures can also be done to give your doctor access to the urinary tract so that kidney stones can be dissolved or chemotherapy can be delivered.

During the procedure, x-ray and scanning tools will be used to guide the insertion of the catheter correctly. An OIA interventional radiologist will perform the procedure because of the expertise required in reading and interpreting the images as the nephrostomy is in process.

Nephrostomy Guidelines

When Your Procedure Is Scheduled

• Our scheduler will give you a date and time for your procedure at Overlake Hospital Medical Center. You will need to arrive at the hospital one hour before the procedure to allow the admitting and nursing staffs to get you ready.
  
• Please let the scheduler know if you take Coumadin, Plavix, Insulin or Metformin. You will need to receive specialized instructions.
  
• Please notify us if you’ve had a previous reaction to contrast dye.
  
• If you have any questions regarding your procedure, you may call us at 425-688-5507.
  
• The admitting department will attempt to call you the night before your procedure to confirm your arrival time.
  
• Please plan to leave any jewelry or valuables at home.
  
• Make sure to arrange for someone to drive you home after the procedure.

Preparation

• Do not eat for four hours before your exam. You may have sips of water.
  
• Please take your normal heart and blood pressure medications with a sip of water.
  
• You need to be at the hospital’s admitting area one hour before you procedure’s scheduled start time. This is located at the large desk at the hospital’s main entrance (across from Stanza’s Café).
  
• You will be taken down to your room where you will meet your nurse. You will be asked to change into a patient gown. An IV will be started and blood drawn for lab tests. The nurse will ask you for your medical history. If possible, bring a list of all the medications (including herbal) you take and when you take them.
  
• The nurse will also ask you about allergies. If you are allergic to radiology/contrast dye, please let them know.
  
• If there is a possibility that you’re pregnant, please let the nurse know. You will be asked to sign a form if you are a female of childbearing age (12-57).
  
• Before the procedure, the interventional nurse will meet with you and your family to review the procedure and answer any questions you might have.
  
• The nurse or tech will clean and shave, as necessary, an area around the catheter’s point of entry.
  
• You will be covered with sterile drapes from your shoulders to your feet.

What to Expect During the Procedure

• The procedure takes from 30 minutes to 2 hours. You will meet the interventional radiologist who will go over the consent form and answer any questions you might still have.
  
• An IV will be inserted so that you can receive a sedative or pain medication intravenously.
  
• The procedure is done with a fluoroscope and possibly ultrasound guidance to assist the radiologist in proper placement of the drainage catheter.
  
• The radiologist will inject a small amount of local anesthetic to the area where the nephrostomy tube is to be inserted.
  
• A needle will be inserted below the twelfth rib into the kidney. A guide wire is then passed through the needle into the kidney. Once correct placement is confirmed, a catheter is inserted over the guide wire into the kidney. You will feel a sensation of pressure as the catheter is put into the kidney. A drainage bag is attached to the catheter.
  
• During the procedure the nurse will be monitoring your heart, blood pressure and the oxygen level in your blood.
  
• The technologist will tell you to hold your breath and stay still during the imaging required for this procedure (about 10 seconds for each picture). The computerized x-ray is very sensitive to motion. The x-ray machine will move above you and come close to you at times, but it will not touch you. Pictures are taken at many different angles.
  
• Once the procedure is over you will be transferred back to your room.

What to Expect After the Procedure

• As your pain medication wears off, you may feel some soreness—especially if you have some infection in the kidney.
• Your blood pressure, pulse and puncture site will be monitored very frequently by the nurse.
  
• Depending on whether you were admitted as an inpatient or you are an outpatient, you will either be taken back to the nursing unit or you will be discharged approximately 4 hours after the procedure is done.
  
• Sometimes there can be minor bleeding from the kidney which results in blood in the urine. This should clear up within 24 hours
  
• The nursing staff will teach you about caring for the catheter.
  
• You will be able to resume regular activities after the procedure but will need to be aware of the catheter as it can “catch” on clothing, etc., and be pulled out of place.
  
• You will need someone to drive you home. 
  
• You will be given written instructions and a phone number to call if you have any questions or concerns.
  
• One of the interventional nurses will do a follow-up call the next day after your discharge. Write down any questions you might have for them.
  
• To speak to an interventional nurse, please call 425-688-5005. It is best to call between 8AM and 4PM Monday thru Friday. You can leave a message on the voicemail, and a nurse will return your call as soon as possible.
  
• If you are on Coumadin and have been told not to take it before your procedure, you need to check with your physician, and/or the Anti-Coagulation Clinic for instructions.
  
• If you an insulin-dependent diabetic, restart your regular dosing when you get home. Check your sugar regularly and if you have a concern, contact your diabetic doctor.
  
• You may resume taking all of your normal medications once you are home.