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 (Fraise and Bradley [81], E).
3. 3.Show
   Wash hands using soap and water and alcohol‐based handrub, and apply personal protective equipment.
   To reduce the risk of 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 lying on their side with their back exposed.
   To enable access to the nephrostomy site. E

Procedure

1. 7.Show
   Prepare the dressing pack on the top shelf of the trolley.
   To ensure the sterile field is ready for the procedure. E
2. 8.Show
   Clean hands with soap and water and an alcohol‐based handrub.
   Hands may have become contaminated by handling the outer packs (NHS England and NHSI [161], C).
3. 9.Show
   Clamp the nephrostomy tube.
   To temporarily cease drainage. E
4. 10.Show
   With a clean gloved hand, disconnect the drainage bag and discard.
   To allow access to the nephrostomy tube. E
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 connector hub with alcohol‐impregnated chlorhexidine wipe.
   To minimize the risk of infection (Loveday et al. [135], R).
7. 13.Show
   Attach a sterile syringe containing 5 mL 0.9% sodium chloride to the nephrostomy tube.
   To prepare to flush. E
8. 14.Show
   Unclamp the nephrostomy tube. With gentle pressure, flush the 0.9% sodium chloride into the nephrostomy tube and gently aspirate. Clamp the nephrostomy tube.
   To remove potential occlusions from the drainage channel (Radecka and Magnusson [202], E).

   To temporarily cease drainage. E
9. 15.Show
   Apply a new sterile drainage bag, and connector if required, to the nephrostomy tube, being careful not to touch the hubs. 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
10. 16.Show
    Apply a leg strap or waist strap according to patient preference to secure the bag to the patient. Be careful to ensure that the tube is not taut nor pulling at the exit site.
    To enable independent mobility and maintain patient dignity. To maintain tube security. To maintain dependent drainage. E

Post‐procedure

1. 17.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. 18.Show
   Draw back the curtains once the patient has been covered.
   To maintain the patient's dignity (NMC [178], C).
3. 19.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. 20.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