Nephrostomy: a tube to drain a blocked kidneyNephrostomy: band gurde ko khali karne wali nali

Yeh kya hai aur kyun kiya jata hai

Gurde mein bana peshab aam tor par patli nali, ureter, ke zariye bladder tak jata hai. Agar ureter band ho jaye, jaise pathri, gilti ya soojan se, to peshab wapas chadh jata hai aur gurda phool jata hai. Agar band peshab infected bhi ho to yeh bohat jaldi khatarnak ho sakta hai (dekhein gurde ki pathri ki guide aur gurde ke dard ki guide).

Nephrostomy gurde ko seedha khali karti hai. Kamar ki jild se patli nali gurde mein daali jati hai aur peshab thaili mein nikalta hai. Yeh aksar infected, band gurde ke fauri ilaaj ke tor par kiya jata hai, ya jab band gurda uski kaam karne ki salahiyat kharab kar raha ho aur stent (dekhein DJ stent ki guide) na laga sakein. Yeh kuch arsay ya lambay arsay ke liye bhi istemal ho sakti hai jab tak rukawat ka ilaaj ho, ya pathri ke operation ke liye gurde tak raasta banane ke liye (dekhein PCNL ki guide).

Procedure se pehle

• Yeh fauri ho sakta hai. Agar gurda infected ho to pehle ilaaj (drip se antibiotics) shuru hota hai, aur nali jaise hi mehfooz ho laga di jati hai.
• Scan aur khoon ke tests band gurda dikhate hain aur gurde ki kaam karne ki salahiyat aur khoon ki ginti jaanchte hain (dekhein ultrasound ki guide, CT scan ki guide aur gurde ke function tests ki guide).
• Khoon patla karne wali dawaon, allergies (khaas tor par X-ray ke dye se) aur phephron ya saans ke masail ke baare mein team ko batayein. Apne taur par koi dawa band na karein.
• Bay-hoshi: yeh aam tor par local anaesthetic mein hota hai, zaroorat par sedation ke saath. Aap pet ke bal ya karwat par letate hain. Agar emergency na ho to khaane peene ke baare mein hidayaat par amal karein.
• Aap se razamandi (consent) maangi jayegi. Agar aap bohat bimar hain to team batayegi ke yeh fauran kyun zaroori hai.

Procedure ke dauran

Yeh procedure radiologist (X-ray ka maahir) X-ray ya ultrasound ke kamre mein karta hai. Kamar ki jild saaf kar ke sunn ki jati hai. Ultrasound aur X-ray tasveeron ki rehnumai mein patli sui gurde mein jati hai, phir taar ke upar se patli nali gurde ke jama karne wale hissay mein pohanchayi jati hai. Nali ka sira mura hua hota hai jo use apni jagah rakhne mein madad karta hai.

Nali ko taanke ya khaas dressing se jild par jama diya jata hai aur peshab ki thaili se joda jata hai. Aam tor par tees se saath minute lagte hain.

Procedure ke baad aur nali ki dekh bhaal

• Aap kuch ghante aaram karte hain, aur team aap ki nabz, blood pressure aur thaili mein peshab dekhti hai.
• Peshab shuru mein gulabi ya surkh hota hai aur aam tor par aik do din mein saaf ho jata hai. Kabhi khoon aata jata rehta hai.
• Nali ki jagah aur kamar mein dard aam hai. Aam dard ki dawayein madad karti hain.
• Nali, thaili ya dressing ko chhoone se pehle haath dhoyein. Dressing saaf aur khushk rakhein aur jaisa sikhaya gaya ho badlein.
• Thaili ko gurde se neeche rakhein aur jab do tihayi bhar jaye to khali karein. Din mein taang ya kamar par bandhi jane wali thaili istemal hoti hai.
• Nali ko khinchein ya mohrein nahi. Use is tarah jama rakhein ke woh ghasiti na rahe, aur kapray pehente waqt ehtiyaat karein.
• Flush karna: kuch logon ko nali saaf rakhne ke liye namak ke paani ki thori miqdaar se flush karna sikhaya jata hai. Sirf tab karein jab aap ko sikhaya gaya ho aur kaha gaya ho.
• Nahana: khaas mashwara poochh lein. Aksar paani se bachane wala cover istemal hota hai. Jab tak kaha na jaye tab, tub mein nahane aur tairne se parhez karein.
• Nali badalna: lambay arsay ki nali radiology team baqaida waqfon se, aksar kuch mahinon baad, badalti hai. Poochh lein ke yeh kaise tay hoga.
• Kaafi paani peeyein, siwaye is ke ke aap se kam karne ko kaha gaya ho.

Mumkina khatrat

• Aam: aik do din peshab mein khoon, nali ki jagah dard, aur nali ke aas paas thora sa peshab reesna.
• Infection: peshab ya gurde ka infection ek khatra hai, khaas tor par jab gurda pehle se infected ho. Bohat kam yeh khoon ke shadeed infection (sepsis) ban sakta hai.
• Nali ke masail: nali band ho sakti hai, mud sakti hai, ya bahar aa sakti hai. Iska hal ho sakta hai lekin fauran tawajjoh chahiye.
• Khoon behna: ghair aam tor par khoon zyada behta hai aur khoon lagwane ya doosre procedure ki zaroorat pad sakti hai.
• Bohat kam: qareebi aza ko nuqsan jaise phephre ka ghilaf, aant, jigar ya tilli, nali na laga paana, ya X-ray dye ya sedation se reaction.

Follow-up aur aage kya hota hai

• Nephrostomy aam tor par aik darmiyani qadam hoti hai. Rukawat ka ilaaj hota hai, jaise pathri nikalna (dekhein ureteroscopy ki guide) ya stent lagana, aur jab zaroorat na rahe to nali nikal di jati hai.
• Agar rukawat theek na ho sake to nali lambay arsay tak reh sakti hai aur baqaida badli jati hai. Yeh us waqt zyada mumkin hai jab rukawat kisi cancer ke ureter ko dabane se ho.
• Nali nikalne se pehle team dekh sakti hai ke peshab aam raaste se neeche jata hai ya nahi, dye ke test se ya nali ko kuch der band kar ke.
• Jaan lein kise phone karna hai. Radiology ya urology team ka phone number, aur agar ho to apni nurse ka naam saath rakhein.

Aam sawalaat

What it is and why it is done

Urine made by the kidney normally drains down a thin tube, the ureter, to the bladder. If the ureter is blocked, for example by a stone, a tumour or swelling, urine backs up and the kidney swells. If the blocked urine is also infected, this can become dangerous quickly (see the kidney stones guide and the kidney pain guide).

A nephrostomy drains the kidney directly. A thin tube is passed through the skin of the back into the kidney, and urine flows out into a bag. It is often done as an urgent treatment for an infected blocked kidney, or when a blocked kidney is damaging kidney function and a stent (see the DJ stent guide) cannot be placed. It can also be used for a short or long time while the blockage is dealt with, or to make a route into the kidney for stone surgery (see the PCNL guide).

Before the procedure

• It may be urgent. If the kidney is infected, treatment (antibiotics through a drip) usually begins first, and the tube is placed as soon as it is safe.
• Scans and blood tests show the blocked kidney and check your kidney function and blood count (see the ultrasound guide, the CT scan guide and the kidney function tests guide).
• Tell the team about blood thinners, allergies (especially to X-ray dye) and any lung or breathing problems. Please do not stop any medicine on your own.
• Anaesthetic: it is usually done under local anaesthetic, with sedation if needed. You lie on your front or side. Follow the instructions about eating and drinking if you are not an emergency.
• You will be asked for consent. If you are very unwell, the team will explain why it is needed urgently.

During the procedure

A radiologist (an X-ray specialist) does the procedure, in an X-ray or ultrasound room. The skin of the back is cleaned and numbed. Using ultrasound and X-ray pictures to guide it, a thin needle is passed into the kidney, and then a thin tube is passed over a wire into the collecting part of the kidney. The tube has a curled end that helps keep it in place.

The tube is attached to the skin with a stitch or special dressing and connected to a drainage bag. It usually takes about thirty to sixty minutes.

After the procedure and caring for the tube

• You rest for some hours, and the team checks your pulse, blood pressure and the urine in the bag.
• The urine is pink or red at first, and usually clears over a day or two. Some blood may come and go.
• Soreness at the tube site and in the back is common. Ordinary painkillers help.
• Wash your hands before touching the tube, bag or dressing. Keep the dressing clean and dry, and change it as taught.
• Keep the bag below the level of the kidney and empty it when it is about two-thirds full. A leg or waist bag is used during the day.
• Do not pull or twist the tube. Secure it so it cannot drag, and take care when dressing.
• Flushing: some people are taught to flush the tube with a small amount of salt water to keep it clear. Only do this if you have been taught and told to.
• Showering: ask for specific advice. A waterproof cover is often used. Avoid baths and swimming unless told otherwise.
• Tube changes: a long-term tube is replaced at regular intervals, often every few months, by the radiology team. Ask how it will be arranged.
• Drink enough fluid unless told otherwise.

Possible risks

• Common: blood in the urine for a day or two, soreness at the tube site, and a little leaking of urine around the tube.
• Infection: a urine or kidney infection is a risk, especially when the kidney is already infected. Rarely this becomes a serious infection of the blood (sepsis).
• Tube problems: the tube can block, kink, or come out. This can be fixed, but it needs prompt attention.
• Bleeding: uncommonly, bleeding is heavier and needs a transfusion or another procedure.
• Rare: damage to a nearby organ such as the lung covering, the bowel, the liver or spleen, a failure to place the tube, or reactions to the X-ray dye or sedation.

Follow-up and what happens next

• A nephrostomy is usually a stepping stone. The blockage is treated, for example by removing the stone (see the ureteroscopy guide) or placing a stent, and the tube is removed when it is no longer needed.
• If the blockage cannot be fixed, the tube may stay for a long time and be changed regularly. This is more likely when the blockage is caused by a cancer pressing on the ureter.
• Before the tube is removed, the team may check that urine drains down the normal way, using a dye test or by clamping it for a time.
• Know who to call. Keep the phone number of the radiology or urology team, and the name of your district nurse if you have one.

Common questions