This thing scares the crap out of me

[Desert Dancer]

So I went to unpack/flush/repack my chest catheter yesterday, as usual. I looked down at it and saw what looked like black gunk.  Hmmm. This turned out to just be tape residue on the outside of the tubing. Then I examined it a little more closely, farther down and underneath the clamps, and saw more gunk. Hmmm. I moved the clamps and - much to my horror - discovered what looks like old clotted blood jamming up both sides of the catheter. I emailed my nurses to let them know I was supposed to flush and repack but was now afraid to because of this crap in the lines. They freaked out and said, "Don't repack! Get it out! Get it out! Get it out!" I'm inclined to agree with them and as far as I'm concerned I can't get it out quickly enough, but Monday will have to do because that's the earliest appointment I could get. Now I'm completely freaked out because old gunky crap in your catheter can't possibly be good and now it's going to dwell there for another three days.

How in the heck could this have happened? I realize now maybe I should have repositioned the clamps from time to time, but even so, I've been flushing it and repacking every week so shouldn't that have been sufficient to keep the lines clean? 

[boswife]

i'd say NO apt necessary!!  Go get it done....  And thats not to scare you, just if they're telling you to GET IT OUT, i'd do it right now...  I absolutly would not wait!  Hope someone has experience with this and and calm even my worries for you now.. 

[Sluff]

I would go to the ER if need be. I don't think you would want a loose blood clot in your arteries that could travel to unwanted places or cause an infected site. You sure don't want bacteria forming in there either. I think it's pretty important. Call the Nurses back and find out what the dangers are and if it requires an ER visit. I'm not a Doctor. Let us know what you decide.

[KICKSTART]

Sorry i cant be of help because i dont get it ?  I have a tunnel line in which i expect is different from a chest cath. But even so all my changing of dressings , flushing the lines then filling up with Toralock is done at D , i personally dont have to touch my cath , although i have cleaned the lines (on the outside) of all the sticky stuff from my dressing. I would say , if you have to sort it do it straight away, a clot may damage your line , if you dont want to do it yourself go somewhere they can look at it for you.

[greg10]

So I went to unpack/flush/repack my chest catheter yesterday,... I'm completely freaked out because old gunky crap in your catheter can't possibly be good and now it's going to dwell there for another three days.

How in the heck could this have happened? I realize now maybe I should have repositioned the clamps from time to time, but even so, I've been flushing it and repacking every week so shouldn't that have been sufficient to keep the lines clean?

Don't panic. I have read that you are using NxStage and doing nocturnal dialysis.  How are you maintaining your heparin and have you had problems with clots running long hours?  You may need to adjust your heparin and also watch your hemoglobin levels if you have been injecting Epo yourself.  The lab results are often lagging and you could have a clotting problem.

If the access in your arm has matured enough and works reasonably well, you may want to think about removing the chest catheter all together.

If you have been packing the catheter yourself, have you been using adequate amounts of heparin and are the heparin 5000 units/ml?  Sometimes it doesn't matter if you use the 1000 units/ml heparin, but in some cases if clotting is a problem, you may need the more concentrated 5000 u/ml heparin.

[Desert Dancer]

Boswife: I guess I just figured that if they were so freaked about it that they wanted it out right this instant, they either would have called and told me so or called the surgery center and gotten me in the same day. All they did was give me the phone number to make my own appointment, so I took that as a sign it could wait.

Sluff: I'm not really worried about unleashing a clot, because I haven't used the catheter in a month. I was planning on going one more week cannulating myself just to be sure and then having the catheter removed anyway. My major concern is bacteria, because I unclamped both lines and when I did, Heparin came up. I clamped again immediately, but if the Heparin came up the bacteria could have gone down. Unlikely, but possible enough to really make me nervous. But you know how ER docs are; they'd insist on making their own diagnosis and would be put out at my lack of symptoms and, therefore, an emergency. Thus my hesitation.

Kickstart: Yep, I have a tunnelled cuffed catheter as well. I do all my own maintenance on it because I dialyze at home. I'm not too worried about a clot, but the possibility of bacteria travelling back down the line.

Greg10: Actually I use a Fresenius Baby K (I know, most people on home dialysis seem to be flocking to the NXstage these days - I'm an oddball). My point is, there shouldn't be a clot in there at all. Where did it come from? It didn't travel up the catheter on its own, and I've been flushing and repacking it faithfully. I just bothers me that it happened at all, and that I didn't notice it until it got to the point it is now.

[Sluff]

Good luck and keep us updated when you get seen.

[boswife]

Thanks DesertD,,,, i am a worrywort so ....well, thats what i do    Do let us know though k..