A patient has a nephrostomy tube that has been inserted because of an obstruction in the ureter. What special precautions in the care of the nephrostomy tube should the nurse implement?

Choice A rationale Irrigation of a nephrostomy tube requires extreme caution because the renal pelvis is a small space with a limited capacity of approximately 5 to 10 mL. Instilling 50 mL of fluid would cause excessive pressure, leading to tissue damage, severe pain, and potential rupture or infection. If irrigation is specifically ordered by a physician, the nurse must use very small volumes of sterile saline, typically only 3 to 5 mL, to maintain patency. Choice B rationale The nephrostomy tube is placed directly into the renal pelvis to bypass an obstruction and ensure the drainage of urine. Any kink, clamp, or disconnection can cause urine to back up into the kidney, leading to hydronephrosis, increased intrarenal pressure, and permanent nephron damage. Maintaining a closed, gravity-based drainage system without obstructions is the highest priority to prevent renal failure and urosepsis, as the kidney cannot store large volumes of urine under pressure. Choice C rationale Clamping a nephrostomy tube is contraindicated because it prevents the continuous outflow of urine from the kidney. Unlike the urinary bladder, which is designed to expand and store urine, the renal pelvis has minimal distensibility. Allowing urine to accumulate by clamping would quickly lead to increased pressure within the collecting system. This pressure causes stasis, which significantly increases the risk of ascending bacterial infections and can rapidly lead to acute kidney injury or pyelonephritis. Choice D rationale The insertion site of a nephrostomy tube must be kept clean and protected with a sterile dressing to prevent the entry of pathogens. Leaving the site open to air increases the risk of environmental contamination and subsequent infection of the tract leading directly to the kidney. The skin around the tube should be assessed frequently for signs of leakage, redness, or breakdown, and the dressing should be changed according to institutional protocols using aseptic technique.