Practice Information

Irrigation of Nephrostomy Tubes by RNs

To: Interested Parties

From: Barbara Zittel, RN, Ph.D, Executive Secretary, State Board for Nursing

Re: Irrigation of Nephrostomy Tubes by RNs

Date: May 15, 2009

The Board has been asked to opine on whether or not Registered Professional Nurses (RNs) can irrigate nephrostomy tubes.

As background information, nephrostomy tubes are typically inserted in the Operating Room or Imaging Sciences Department through the skin (percutaneously) into the kidney pelvis. Nephrostomy tubes serve to drain urine when there is an obstruction due to pathology or alterations to the normal physiologic pathway and/or to provide a direct route for delivery of therapeutic agents. Nephrostomy tubes can be temporary or permanent. The purpose of nephrostomy tube irrigation is to maintain patency of the tube, not to lavage the renal pelvis.

It is the position of the State Board for Nursing that registered professional nurses (RNs) licensed by the New York State Education Department may irrigate nephrostomy tubes under certain conditions which are provided below.

Conditions necessary for irrigation of a nephrostomy tube include:

  • A patient-specific order must be written by an authorized provider such as a physician, nurse practitioner or physician assistant that includes the type and amount of solution to be used. (Question any order that requires instillation at one time of more than 5ml of irrigation for an adult or 2 ml of irrigation for a child.)
  • Prior to irrigating a newly implanted nephrostomy tube the RN must determine confirmation of placement from a urologist or designee.
  • The nephrostomy tube should be clearly labeled.
  • Careful attention should be use not to dislodge the tube.
    Sterile/aseptic technique must be used.
  • Aspiration should not be used after installation—allow solution to drain by gravity.
  • The facility/practice must document the process for initial and annual updates in education and competency training for each RN deemed competent to provide nephrostomy tube irrigation. Such training must be documented annually in the personnel file of each RN and updated annually. Training should address proper aseptic technique, contraindications, and how to handle unexpected outcomes/emergencies.
  • RNs must be able to document initial training and annual updates of appropriate education, skill training and clinical competence. This education shall include minimally, assessment of the patient pre-procedure, precautions, contraindications, technique, and signs and symptoms of adverse reactions.

If you have additional questions, please contact Barbara Zittel, Executive Secretary to the State Board for Nursing.

Last Updated: January 31, 2013