Management of Nephrostomy Care and Infection Risk
A nephrostomy facilitates access to the kidney to help drain the urine when a retrograde approach is impossible. Nurses must understand the appropriate care and the management of nephrostomy. There are various infection risk factors and other issues surrounding patients’ long-term management with nephrostomy due to the condition’s delicate nature. Since nephrostomy care management is an essential and critical element of nursing, the necessary evidence and guidance must be provided to ensure that nurses possess the relevant knowledge and skills regarding the condition. Management of Nephrostomy Care and Infection Risk
A nephrostomy is the insertion of a narrow-gauge pigtail drain tube to drain urine from the renal pelvis ureter and bladder into an external drainage bag. The nephrostomy tube is inserted under local anesthesia and is mostly sedated by a radiologist. It is conducted under computerized tomography (CT), fluoroscopy or ultrasound guidance. The main purpose of conducting a nephrostomy procedure is urinary obstruction. The major common urinary obstruction indicators include loin pain, fever, rising creatinine levels, nausea and vomiting, acute renal failure, fever, obstruction nephropathy demonstrated by imaging and urosepsis. Another reason for inserting nephrostomy tubes is diverting urine due to stenosis of a urostomy, hemorrhagic cystitis, herniation of urostomy, ureteral fistula or fissure, or following an injury to the ureter. It can be used as an intervention for delivering medications, removing stones, inserting an antegrade stent, ureteral biopsy and removing foreign bodies such as broken ureteric stents. Management of Nephrostomy Care and Infection Risk
In other cases, nephrostomies are used to conduct diagnostic testing such as ureteral perfusion tests and antegrade pyelography. They are usually temporary and removed upon the obstruction’s resolution if an internal uteretic stent can be used to bypass the obstruction or if the process has been completed. Nevertheless, there are circumstances where a nephrostomy inadvisable or impossible to bypass the obstruction, such as in retroperitoneal fibrosis or advanced cancer. In such a situation, the nephrostomy is usually semi-permanent or permanent (Doughter & Lister, 2015).
Nephrostomy Insertion Procedure
The nephrostomy tube is inserted by inserting a needle, followed by a pigtail drain following a guidewire across the external layer into the internal skin layer tissue. It then goes through the muscle layers, followed by entry into the renal pelvis through the renal parenchyma tissue (McDougal et al., 2015). A nephrostomy tube is usually affixed to a drainage bag carefully secured using sutures on the skin to drain the urine. The nephrostomy procedure can be bilateral or unilateral. Where it is unilateral, the drainage bag and the nephrostomy tube are usually on the same side as the remaining kidney drains the urine into the bladder through the ureter. A bilateral nephrostomy entails having the drainage bag with the tube on both sides with minimal urine drainage into the bladder through the ureters. In both the unilateral and bilateral cases, urine may continually drain through the ureter into the bladder. Management of Nephrostomy Care and Infection Risk
There are two alternatives to a nephrostomy: a retrograde stent insertion and a ureteroscopy, which investigates the ureter’s patency. The ureteroscopy and the retrograde stent insertion are conducted using general anesthesia with the urologist guiding and leading the medical or surgical group on the right course of action. A retrograde stent is usually more preferable if feasible for the patient because of its low morbidity rate along with its performance, which does not need a radiologist to perform a nephrostomy. Some of the cautions and contradictions associated with the procedure include the use of anticoagulants and coagulation conditions that are likely to increase the patient’s tendency to bleed.
Principles of Management and Care of Nephrostomy Patients by Nurses
There are several risks associated with percutaneous nephrostomy, and they require diligent attendance by skilled and qualified nursing practitioners. Some of the main risks include tube misplacement, severe bleeding, a vascular injury that needs embolization or nephrectomy, severe infection, tube occlusion and damage to adjacent structures, allergic reactions and death. Other aspects of nephrostomy that nurses are expected to manage to include fluid levels, infection risk and wound care, managing the tubes and bags and overseeing individual care and community help. Management of Nephrostomy Care and Infection Risk