Caring for Your Nephrostomy Tube

Nephrotizing Enterocolitis (NE) is a rare but life threatening complication of endoscopic procedures involving the nephron. NE occurs when a foreign object such as bacteria or virus enters the nephrectomy tube during surgery. The infection can cause severe bleeding, shock, and death if not treated promptly. NE usually results from improper sterilization techniques used at the time of surgery.

The most common risk factors for NE are:

Failure to properly sterilize the nephron before surgery. Failure to use sterile technique during nephrectomy. Failure to clean the nephrectomy tube after each use.

Failure to remove the patient’s clothing prior to inserting the tube into their abdomen.

In addition, certain medical conditions may increase your risk of developing NE. These include:

Diabetes mellitus. Diabetes mellitus increases the risk of blood clots in the legs and lungs during surgery. If you have diabetes, it is important to take insulin immediately following surgery to prevent these risks.

Severe heart failure (heart attack). Heart attacks can occur during any type of surgical procedure including nephrectomies. In addition, patients who have had a heart attack are at higher risk for developing blood clots in the legs during and after surgery. If you have had a heart attack within the past 6 months, you may be at higher risk for developing an infection after a nephrectomy.

To prevent NE, you should immediately report to your doctor if you experience any of the following signs and symptoms following your surgery:

Fever. Chills. Unusual swelling of the surgical site.

Pain near the surgical site. Difficulty breathing. Blood in the urine.

Infections involving the nephrostomy tube are rare but can occur in rare situations. Most of these infections can be treated with proper antibiotics. However, in serious cases, additional surgery may be required to remove the infected nephrostomy tube and replace it with a new one.

Infections can be caused by bacteria, fungus, or other pathogens. The most common types of infections in this situation include:

Urinary tract infection (UTI). A urinary tract infection is a type of bacterial infection that involves the tubes and organs involved in making urine (ureters). A urinary tract infection is a medical emergency that can damage your kidneys if not treated promptly with antibiotics.

Bacteremia. Bacteremia is an infection involving bacteria in the bloodstream. Bacteremia can result from an infection in another part of the body and spread through the blood to other parts of the body. Sepsis. Septicemia is a severe condition caused by a bacterial infection in the bloodstream. Bacteremia frequently results in sepsis. Multiple organ failure. Severe sepsis can cause serious problems with multiple organs such as the heart, lungs, and brain.

Fungal infections resulting from contaminated equipment used during surgery are also possible. The most common symptom of this condition is fever.

Nephrectomy complications are rare but can be serious. Other possible complications resulting from a nephrectomy can include:

Bleeding (hemorrhage). Blood vessel damage and bleeding during surgery can cause death if not treated quickly. Blood clots (deep vein thrombosis).

Blood clots in the deep veins of your body can occur during or after surgery. Blood clots can prevent blood from reaching body parts such as your lungs, causing pulmonary embolism. If the clots reached your brain, they could cause a stroke. Fluid accumulation (edema). Accumulation of excessive fluid in your body caused by failure of the kidney’s role in processing them.

The risk of developing any of these complications is greater if you also have another medical condition such as diabetes or heart disease.

Most of the potential complications of a nephrectomy can be treated successfully if they are diagnosed in time.

1. Pain after Kidney Removal (Open)

Pain after a nephrectomy may be caused by a number of factors. These factors can include the following:

Inflammation and swelling caused by any rough handling of your kidney during the surgical procedure.

Infection in the surgical site or an infection in another part of your body that was not discovered before surgery.

Damage to blood vessels or nerves in your back as a result of surgery. This damage can cause problems with blood clotting or sensation in your legs and feet.

Your doctor will examine you to detect the source of the pain. The doctor may perform tests such as an ultrasound or a CT scan to rule out potential complications. If no serious complications are found, treatment depends on the cause of your pain.

Pain medications and changes in your diet or activities may alleviate the pain.

2. Urinary Retention after Kidney Removal (Open)

You may have trouble urinating after a nephrectomy. Pain medication can sometimes cause urinary retention as a side effect. This is treatable with fluids and medication to stimulate urination.

Changes in your diet or activities may also alleviate the problem.

3. Infection after Kidney Removal (Open)

Infections are less common after a nephrectomy when compared to other open abdominal procedures. Antibiotics will be prescribed before and after surgery to reduce your risk of infection. Trimethyltin (TMT) based ointment may be applied to the surgical incision prior to closure to prevent infection.

4. Bleeding after Kidney Removal (Open)

Bleeding after a nephrectomy can be caused by bleeding disorders or taking blood thinners before surgery. Tell your medical team if you experience any significant bleeding.

5. Thrombosis after Kidney Removal (Open)

Deep vein thrombosis (DVT) occurs when a blood clot forms in one of the deep veins in your body and then travels to your lungs, blocking blood flow. Symptoms can include swelling, redness, and pain in the area of the clot. If a clot travels to your lungs, it can cause a sudden and often fatal blockage in the blood vessels of your lungs.

Your doctor will determine if you are at risk for DVT and treat you with blood-thinning medications, compression stockings, and possibly ultrasound to help break up the clot.

6. Wound Infection after Kidney Removal (Open)

After a nephrectomy, your incision will be examined frequently for signs of infection. You may need additional medication or even surgery to clear an infection. Antibiotics are prescribed for you to take at home after surgery.

7. Pain after Kidney Removal (Laparoscopic and Endoscopic)

Pain after a nephrectomy can be caused by inflammation and swelling around the surgical site. This pain usually occurs in the first few days after surgery. Your doctor can prescribe medication to help manage your pain.

The following are some of the most common complications that may occur after a nephrectomy.

1. Bleeding after Kidney Removal (Laparoscopic and Endoscopic)

Loss of blood can cause fainting or even death. A nephrectomy does not usually result in significant blood loss. However, any injury to your organs can cause bleeding that must be stopped.

Serious bleeding may require a second surgery to stop the bleed and repair the damage.

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