Nephrostomy Tube Care and Maintenance

Standard Flushing Protocol

The American Urological Association recommends using normal saline exclusively for all routine flushing and continuous irrigation during procedures, as this prevents hemolysis, hyponatremia, and electrolyte abnormalities that occur with non-isotonic solutions 1, 3
Flush with 40-60 mL of warm water or normal saline as the initial approach, and proper flushing technique is more critical than the addition of heparin 2
The syringe must aspirate and flush with ease; any resistance indicates tube obstruction or malposition requiring immediate evaluation 2

Attempt flushing with 40-60 mL of warm water using gentle pressure as the first-line intervention, which clears approximately one-third of obstructions 2
Use an alkaline solution of pancreatic enzymes as the second-line intervention, which demonstrates a 96% success rate in clearing formula-related clogs and can clear an additional 50% of occluded tubes 2

For fungal urinary tract infections with nephrostomy tubes in place, perform irrigation with amphotericin B deoxycholate in conjunction with systemic antifungal therapy 2
Consider removal or replacement of the nephrostomy tube if feasible when treating fungal infections 2
If purulent urine is encountered, establish drainage immediately and administer broad-spectrum antibiotics 2

Mild hematuria is present in approximately 50% of patients after nephrostomy tube placement and is expected 4
Clinically significant bleeding occurs in less than 1-4% of cases, and most hemorrhage cases settle with prolonged tube drainage alone without surgical intervention 4
Persistent bleeding requires arteriographic evaluation for pseudoaneurysms, fistulas, or frank extravasation, which can usually be treated with transcatheter embolization 4

Most complex stones require nephrostomy tube drainage for at least 24 to 48 hours 5, 6, 7
Post-procedure tube management varies: some remove immediately, some within 24-48 hours, and some at 5-7 days depending on case complexity 5, 6, 7
In patients undergoing uncomplicated percutaneous nephrolithotomy who are presumed stone-free, placement of a nephrostomy tube is optional 1, 3

Inability to flush tube despite troubleshooting measures should prompt urgent consultation 2
Suspected pleural injury (pneumothorax, which occurs more commonly with upper-pole calyceal puncture) requires urgent consultation 4