CONTEXT AND POLICY ISSUES

CONTEXT AND POLICY ISSUES

Nephrostomy and biliary tubes are drainage catheters that are placed into the renal collecting system or biliary tree and assist in draining urine or bile, respectively. The most common indication for nephrostomy or biliary tubes is obstruction of the renal collecting system or biliary tree.¹^–⁶ Obstruction can occur for several reasons such as calculi, stones, malignancy, strictures or abscess.¹^,⁵^,⁷^,⁸ Other indications for nephrostomy tubes include access to the genitourinary system or diversion.¹

A nephrostomy tube is a catheter which is placed into the collecting system of the kidney to provide temporary or permanent drainage.⁴^,⁶^,⁹ Two different kinds of drainage systems exist: pigtail catheters which are placed under interventional radiology and wide bore catheters which are generally inserted in the operating room.⁹ The recommended time frame for nephrostomy tube changes ranges from 1 to 6 months, based on patient characteristics, with pregnant and stone forming patients requiring more frequent changes.¹^,¹⁰ Biliary tubes are catheters placed into the common bile duct (CBD) in interventional radiology.⁵^,¹¹^,¹² These tubes allow bile to drain either externally through a percutaneous drain or internally into the small intestine.⁵^,¹²^,¹³ As internal drains do not require ongoing care, they are not the focus of this review and are not discussed further. External biliary catheters may be changed every 8 to 12 weeks and prophylactic antibiotics may be used before the procedure.⁵

Complications of nephrostomy tubes include urinary tract infection which may result in hematuria, or progress to pyelonephritis, renal abscess or sepsis, a local inflammatory reaction of the skin as well as catheter displacement, dislodgement or fracture.¹^,⁸^,¹⁰^,¹⁴^,¹⁵ The risk of infection may be related to the nephrostomy tube material, with latex having the greatest propensity for biofilm production allowing bacteria to adhere to the catheter.¹ It is recommended that patients are screened for methicillin resistant Staphylococcus aureus and have a urine culture to ensure the absence of infection in the urinary tract prior to insertion.⁴ Complications of biliary tubes are similar and include blockage, infection, pain, leakage, accidental dislodgement and, if stents are present, fracture leading to intestinal obstruction or perforation.¹⁶^–²⁰

Previously, placement of a nephrostomy tube was an inpatient procedure; however, increasingly patients are having nephrostomy tubes placed by minimally invasive techniques in interventional radiology.¹ As a result, more patients may be required to care for their nephrostomy tube in an outpatient setting. Proper care of nephrostomy and biliary tubes has been proposed as a method of preventing complications. The objective of this paper is to review the literature, including evidence-based guidelines, for management of nephrostomy and biliary tubes and the impact of these management strategies on prevention of complications.

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Copyright

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/

Publisher

Canadian Agency for Drugs and Technologies in Health, Ottawa (ON)

NLM Citation

Nephrostomy and Biliary Tube Management: A Review of the Clinical Evidence and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2014 Sep 4. CONTEXT AND POLICY ISSUES.