Nephrostomy tube
A tube draining urine directly from the kidney through the back, placed because the ureter is blocked. If it blocks or falls out, the obstruction returns - and an obstructed, infected kidney is a sepsis emergency.
Also called: nephrostomy, percutaneous nephrostomy, PCN, nephrostomy tube, kidney drain, PCN tube
What it is
A nephrostomy is a tube placed through the skin of the back directly into the kidney's collecting system to drain urine, almost always because the ureter is blocked (by a stone, tumour or stricture) and the urine cannot get to the bladder. BSIR: When the ureter becomes blocked, the kidney rapidly becomes affected, especially if infection is present
, and A nephrostomy drainage will relieve the symptoms of blockage and keep the kidney working
.
That is the whole point for the ED: the nephrostomy is the only thing relieving an obstruction. If it blocks, kinks or falls out, the obstruction comes straight back - and if that kidney is infected as well as obstructed, the result is a rapidly septic, time-critical emergency (an obstructed, infected kidney is the classic indication for emergency drainage). A fallen-out tube also loses access to a track that may be hard to re-establish. Nephrostomies are used in adults and children.
How to recognise it
- A tube emerging from the flank or back, secured to the skin, draining urine into a bag - distinct from any catheter at the front.
- A patient with known ureteric obstruction (stone, cancer, stricture) who had the nephrostomy placed to drain the kidney.
- Problems: the tube not draining (blockage/kink), reduced output into the bag, the tube displaced or fallen out, flank pain, fever or sepsis, or heavy bleeding.
What it gets confused with
A ureteric stent sits entirely inside, running kidney-to-bladder, with nothing on the skin; a nephrostomy drains out through the back into a bag. Both relieve ureteric obstruction, sometimes in the same patient. If there is an external tube on the back, it is a nephrostomy.
What goes wrong
Blocked or dislodged tube with return of obstruction
Little or no urine draining into the nephrostomy bag, new or worsening flank pain, and reduced overall urine output - the obstruction is back.
Red flag
A non-draining nephrostomy means the kidney is obstructed again. If the patient is febrile or septic, this is an obstructed infected kidney - a drain-it-now emergency. Involve interventional radiology and urology urgently; do not simply observe a dry nephrostomy bag.
Fallen-out tube (track access lost)
The tube has come out partly or completely; the patient may have the tube with them.
Red flag
The obstruction returns and the percutaneous track can close, making re-insertion harder. This needs urgent interventional radiology; do not try to reinsert a nephrostomy tube in the ED.
Obstructed, infected kidney (urosepsis)
Fever, rigors, flank pain and systemic sepsis in a patient whose nephrostomy has stopped draining or who has an obstructing stone/tumour.
Red flag
Pus under pressure in an obstructed kidney (pyonephrosis) kills quickly. Resuscitate, take blood cultures, give antibiotics, and arrange emergency decompression (nephrostomy drainage or its unblocking) - antibiotics alone do not treat an obstructed, infected system.
Bleeding
Blood in the draining urine, or bleeding at the skin site. Light bloody urine is common early after insertion; heavy or persistent bleeding is not.
Red flag
Significant or persistent haematuria, clot colic or a falling haemoglobin after a nephrostomy needs urgent interventional-radiology review (rarely embolisation).
The first ten minutes
- Check whether the nephrostomy is draining. A dry bag with flank pain means the kidney is obstructed again.
- Look hard for sepsis. Fever plus an obstructed or non-draining kidney is an emergency - blood cultures, antibiotics, fluids, and urgent decompression; do not wait on antibiotics alone.
- If the tube has fallen out, do not attempt to reinsert it - keep the patient safe, treat sepsis, and call interventional radiology urgently.
- For a blocked tube, a gentle flush may be done per local protocol, but re-access and exchange are interventional-radiology jobs.
- For heavy bleeding, resuscitate and call interventional radiology.
- Involve interventional radiology and urology for any blocked, dislodged, or infected nephrostomy.
Do not
Who owns it
Interventional radiology places and exchanges the nephrostomy; urology owns the underlying obstruction. Tell them whether the tube is draining, whether the patient is septic, the nature of the obstruction, and whether the tube is blocked, displaced or out.
Who to call
The team and the criteria are national. The phone number is local, and this tool does not know it. Find it once, now, and write it on the department's own card — that is the part no website can do for you.
- Say the device name first
- Open with laryngectomy, LVAD, shunt — the single word changes who comes and what they bring. Do not bury it in the history.
- Say what you have already established
- Whether the device is patent, whether it has been removed or disturbed, and what you have already tried. The specialist is deciding whether to walk or run.
- Ask who owns it out of hours
- Device ownership and the on-call route often differ from the implanting specialty, and it is frequently a regional centre rather than your own hospital.
- The patient's own team is a resource, not an afterthought
- Named nurse specialists, home-care companies and device helplines answer questions nobody else can, and the patient usually has the number.
When the device is not the problem
A patient with a device gets pneumonia, sepsis, pulmonary oedema and myocardial infarction at the same rate as everybody else. The device is the most visible thing about them and it attracts the whole assessment.
- The NTSP says it out loud
- The project's own manual warns that
patients with tracheostomies can become unwell with all the problems that other patients get too. It is easy to become fixated with the tracheostomy.
The same sentence applies to every device in this tool. - Clear the device, then leave it
- Establish that the device is doing its job — the stoma is patent, the line draws back, the pump is running — and then assess the patient as you would anyone else.
- The anchoring runs both ways
- The opposite error is treating a device complication as a medical illness: a blocked gastrostomy read as vomiting, a baclofen pump failure read as sepsis.
- NTSP manual — Red flags · read in full
What the patient will be carrying
Patients usually know why the nephrostomy was placed and carry interventional-radiology or urology contact details; the home-care or district nurse may manage the dressing and bag.
Scope of this page
This page covers the ED response to a nephrostomy problem: a blocked or dislodged tube with return of obstruction, the obstructed infected kidney, and bleeding. It does not teach nephrostomy insertion or exchange (interventional radiology) or definitive treatment of the underlying stone or tumour. Nephrostomies are used in adults and children; paediatric care is directed by paediatric urology and radiology.