Nursing care
Nephrostomy tube not draining: checking the system first and what the nurse should not do
Written and reviewed by Dana Whitfield, RN, MSN · 4 min read · Updated October 2026
Short answer
When a nephrostomy tube stops draining, the nurse first checks the system from skin to bag: kinks, closed clamps, a bag above kidney level and dressing or securement problems. The nurse then assesses for flank pain, fever and leakage and notifies the provider. Clamping the tube or forcefully flushing it without an order are wrong responses because the kidney may already be obstructed.
Why a non-draining tube matters
A nephrostomy tube passes through the skin of the flank or back directly into the kidney to drain urine when normal flow is blocked, MedlinePlus explains. If the tube stops draining, urine can back up into the kidney again. The client may then develop pain, infection and loss of kidney function, the same problems the tube was placed to prevent.
A sudden drop in output therefore needs prompt investigation. Possible causes include a kink, a closed clamp, a clot or debris in the tube, or a tube that has moved out of position. Low output can also reflect dehydration, so the nurse considers both a blocked tube and the client's fluid status. This page focuses on the bedside response; long-term complications are covered separately.
First action: trace the system from client to bag
Start at the insertion site and follow the tubing to the bag. Look for kinks under the client, tension at the securement device, closed stopcocks or clamps and visible clots. MedlinePlus advises keeping the drainage bag below kidney level at all times and avoiding positions that pull or kink the catheter. Correcting the position often restores flow.
Inspect the dressing. A wet dressing or urine leaking around the tube suggests blockage or displacement. Note whether the external length of tube appears longer than before, which can indicate migration. Do not attempt to push a displaced tube back in. Secure it to prevent further movement and notify the provider, because repositioning is usually done by interventional radiology.
Why the nurse does not clamp or force-flush
Clamping a nephrostomy tube blocks the only route urine has out of that kidney unless a specific order calls for clamping. When drainage has already stopped, clamping adds pressure rather than solving anything. Similarly, forceful or high-volume flushing of the renal pelvis can cause pain, push bacteria into the kidney and damage tissue.
Some tubes have orders for gentle flushing with a small, specified volume of sterile saline. The nurse flushes only when there is an order, uses sterile technique and does not aspirate unless the protocol directs it, and never forces against resistance. If gentle flushing per order does not restore flow, or no order exists, the next step is to notify the provider rather than escalate the force.
What to delegate and how to document
Assistive personnel can empty and measure the nephrostomy bag, keep the bag below kidney level and report a sudden fall in output, leakage at the dressing or new pain. They should not flush, clamp or manipulate the tube. Clear direction about what counts as reportable, such as no drainage in a set period, helps them escalate early.
Document output from each drain separately, because a client may have a nephrostomy and a urethral catheter, or bilateral tubes, and combined totals can hide a blocked side. Record the checks made, the dressing appearance, symptoms, any ordered flush and its result, and the time the provider was notified. That record helps the team decide whether imaging or tube exchange is needed.
Assess, report and work an example
Assess for flank or back pain, fever, chills, nausea, cloudy or foul-smelling urine, bleeding and redness at the site. MedlinePlus lists fever, worsening back pain, leakage, a kinked or non-draining catheter and a tube that has pulled out as reasons to contact the provider. Fever with obstruction raises concern for infection behind the blockage and should be reported promptly.
Consider a hypothetical client whose nephrostomy has drained nothing for two hours and who now reports flank pain. Options: clamp the tube and recheck in an hour; flush forcefully to clear the clot; check the tubing and bag position, then notify the provider; or encourage oral fluids. Checking the system and then reporting is safest; the other options delay care or risk harm.
Sources and further reading
MedlinePlus: Percutaneous urinary procedures - discharge. Bag below kidney level, avoiding kinks, dressing care and reporting fever, back pain, leakage, non-draining or dislodged catheters.
MedlinePlus: Percutaneous kidney procedures. Nephrostomy tube placement through the skin into the kidney to relieve blocked urine flow and risks of bleeding and infection.
MedlinePlus: Obstructive uropathy. Background on urine backing up into the kidney when flow is blocked.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our renal and genitourinary practice questions are the closest set to what this page covers.
Common questions
Can the nurse flush a blocked nephrostomy tube?
Only with a provider order or protocol, using a small specified volume of sterile saline and gentle pressure. If there is resistance or no order, the nurse stops and notifies the provider.
What should the nurse do if the tube falls out?
Cover the site with a sterile dressing, do not try to reinsert it, and notify the provider immediately. Prompt replacement may be needed before the tract closes.
Why is fever important with a non-draining nephrostomy?
Trapped urine behind an obstruction can become infected and lead to serious kidney infection or sepsis. Fever, chills or rising heart rate with poor drainage need urgent reporting.