Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [178], C).
2. 2.Show
   Screen the bed.
   To ensure patient privacy. To allow dust and airborne organisms to settle before the field is exposed to contamination (Fraise and Bradley [81], E).
3. 3.Show
   Wash hands using soap and water or alcohol‐based handrub. Put on a disposable plastic apron.
   To reduce the risk of cross‐infection from micro‐organisms on uniform/clothing (NHS England and NHSI [161], C).
4. 4.Show
   Prepare the trolley, placing all equipment required on the bottom shelf.
   The top shelf acts as a clean working surface. E
5. 5.Show
   Take the trolley to the patient's bedside, disturbing the screens as little as possible.
   To minimize airborne contamination (Fraise and Bradley [81], E).
6. 6.Show
   Assist the patient onto the edge of the bed/trolley, sitting in an upright position with their back exposed. Or, if the patient is unable to sit up, assist them to lie on their side with their back towards you.
   To enable access to the nephrostomy site. E

Procedure

1. 7.Show
   Decontaminate hands using an alcohol‐based handrub.
   To minimize the risk of cross‐infection and contamination (NHS England and NHSI [161], C).
2. 8.Show
   Keeping the drain secure with one hand, carefully remove the existing drain fixation dressing and inspect the incision site. Check the suture remains intact (if present).
   To assess skin for signs of infection, inflammation and overgranulation. The suture should remain intact to ensure the drain remains secure. E
3. 9.Show
   Pour a small amount of adhesive remover onto a gauze square. Keeping the drain secure with one hand, use the adhesive remover to remove any dressing residue from the drain tubing (check the manufacturer's guidance to ensure the adhesive remover is safe for use on a drain).
   Removing the sticky residue from the tubing minimizes the risk of infection. E
4. 10.Show
   Clean hands with soap and water and/or an alcohol‐based handrub.
   Hands may have become contaminated by handling the outer packs and the old dressing (NHS England and NHSI [161], C).
5. 11.Show
   Put on non‐sterile gloves.
   To reduce the risk of cross‐infection (NHS England and NHSI [161], C).
6. 12.Show
   Clean the drain site with 0.9% sodium chloride, working from the drain outwards. Gently remove any encrustation. Allow the site to dry.
   This is performed at least weekly to reduce the number of micro‐organisms present; to remove exudate, blood and wound debris from around the site and the device, which may be a medium for bacterial growth; and also to prevent overgranulation (NICE [174], C).
7. 13.Show
   When the site is dry, apply a sterile drain fixation dressing according the manufacturer's guidelines (e.g. Drain‐Fix or OPSITE Post‐Op Visible drain dressing). ‘Window frame’ the edges of the dressing to prevent it rucking up by using surgical tape on each edge of the dressing.
   To improve the security of the nephrostomy drain and enable patient mobility. E
8. 14.Show
   Clean hands with soap and water and an alcohol‐based handrub.
   Hands may have become contaminated by handling the outer packs and the old dressing (NHS England and NHSI [161], C).
9. 15.Show
   Gently clamp the nephrostomy tube using blunt disposable clamps.
   To prevent leakage of urine. E
10. 16.Show
    Disconnect the drainage bag, and connector if attached, from the nephrostomy tube.
    This is performed every 5–7 days or according to the manufacturer's guidelines. E
11. 17.Show
    Clean the connector hub with alcohol‐impregnated chlorhexidine wipe. Note: if a sample is required, it could be obtained at this point by unclamping the drainage tube and allowing drainage of the urine into a sample tube.
    To minimize the risk of infection. E
12. 18.Show
    Apply a new sterile drainage bag, and connector if required, to the nephrostomy tube, being careful not to touch the hubs and unclamp the drain. Urine should begin to flow.
    To enable clean passage of urine and to minimize contamination from bacteria within the drainage bag. E
13. 19.Show
    Secure the bag to the patient with a leg strap or waist strap according to patient preference. Be careful to ensure that the tube is not taut nor pulling at the exit site.
    To enable independent mobility and maintain patient dignity. E

    To maintain tube security and to maintain dependent drainage. E

Post‐procedure

1. 20.Show
   Dispose of waste in a clinical waste bag and seal the bag before moving the trolley.
   To ensure correct and safe disposal of contaminated waste (DEFRA [63], C).
2. 21.Show
   Cover the patient and then draw back the curtains.
   To maintain the patient's dignity (NMC [178], C).
3. 22.Show
   Record information in relevant documents; this should include:

   • date and time of procedure
   • procedure(s) performed
   • dressing and bag type used
   • condition of skin
   • any problems or concerns during the procedure
   • any swabs or samples taken during the procedure (e.g. exit site swab or urine sample)
   • any referrals made following the procedure
   • a review date for next dressing and/or bag change.
   To provide a point of reference or comparison in the event of later queries (NMC [178], C).
4. 23.Show
   If the patient is being discharged home, refer them to the community nurse and provide clear guidelines for equipment provision and plan for review and/or change of nephrostomy.
   To ensure continuity of care. E
5. 24.Show
   If a sample was obtained, clearly label the specimen at the patient's bedside and place it with a request form.
   To ensure correct patient's details are added to the form and the laboratory is aware of the sample type and what to test for. E