Perma cath problems

[needlephobic]

well for the last two dialysis runs my perma cath has been acting up like clotting in the tubes not pumping right too the machine. I was told may have to take cath out which means I be dead man walking do to my needle phobia. I really don't want another cath put in. and pd is out of the question no room for the supplies. I really don't know what to do. any suggestions ? 

[greg10]

NP, Welcome back!    You've changed your avatar, that's good!

I am sorry to hear about your catheter.

The most important points about an access, whether it be a catheter, fistula or graft, are:

1. Prevent infection  - you know the drill, masks, aseptic technique, prophylactic antibiotic on the contact area.

2. Promote stable blood flow - know the reasonable blood flow, usually 350 ml/min will be a lot more gentler on the access than 500 ml/min for example.  A good diet and exercise can also improve your vascular system.

3. Prevent clots - are you taking a baby aspirin (75 to 81 mg) a day?  Ask your doctor first.  Are they using sufficient anticoagulants such as heparin for the duration of your dialysis?

All of the above can be hard to control when you are in-center and dependent on the quality of the staff and clinic.  You are also under constraint of time in the clinic - few for profit clinics really want to do slow (longer) and gentler dialysis when they get paid the same price for fast in and out jobs. 

No access will last forever, but if you try to follow some of the points above, and there may be more I left out, you should be okay.  Do you have options of doing nocturnal in-clinic or home dialysis?

[hexoffender]

Your not going to ever get as good dialysis with a Catheter than a natural fistula. Catheters clot, bind, kink, twist, and get infected at the drop of a hat. I had two replaced and got sepsis both times, and almost died from the sepsis. Not to mention how painful they are. I had much more pain from the catheters then any needle ever had a notion to be. Ditch the catheters, and get your life back.

[sullidog]

Yes, I've been through 3, you will get better dialysis with a fistula or graft.

[jeannea]

I know a guy who just gets perma-cath after perma-cath. It's not optimal but maybe it will keep you going a while.

[lawphi]

Fistula with button holes.  It is just like inserting an earring.  You can use a numbing spray until your fistula is broken in.

NxStage has 1/3 the supplies needed for PD.......... 

[GraphicBass]

Several folks in my unit swear my the numbing cream or spray.

Buttonholes are a miracle. Once established, they really don't hurt, so they're well worth doing.

Plus, without the catheter, you can take a proper shower!

gary

[needlephobic]

Button holes requires needles I am afraid of needles. The last time they tried to stick me was when my heart went running at 225 beats per min well they called for a ambulance they came and brought fire dept with them. They was ordered by er doc to start iv and give me meds. I told them not to stick me and started fighting them it took 8 of them to hold me down to get the iv in me. Been going to a Psychologist about my fear he gave me orders to tell the staff at the d center to keep me on the perma cath and that I am not ready to be stuck so looks like a long road ahead of me.

[onestronglittlelady]

If you decided to stay with a Perma Cath, make sure they are using enough heparin. After mine was replaced I found out they have a minimum amount they use at my center (to keep costs down). My dose during each session was increased after the first one failed. Also I learned my hospital uses a cheap Perma Cath the first time, if you get a 2nd one they put in the more expensive, better quality one. The first one lasted 6 weeks, the 2nd was placed the end of January this year and still going strong.

[Lillupie]

NxStage has 1/3 the supplies needed for PD..........

ARE YOU SERIOUS??? Like how many boxes a month? I was told the opposite. Honestly I wish I could do home hemo. I think I would actually seriously consider getting a fistula then if that was an option. IMO you get a better clearance with daily hemo. I wouldnt mind sitting on a machine for 2 hours or so nearly everyday.

Lisa

[rocker]

NxStage has 1/3 the supplies needed for PD..........

ARE YOU SERIOUS??? Like how many boxes a month? I was told the opposite.

Well, I'll tell you what we have.  Using the Pureflow, we get usually about 9 boxes per month.  4 of cartridges (6 per box) and 5 of magic potion, er, dialysate.  The dialysate is two bags per smallish box (maybe 2l per bag), the bags go into the Pureflow and are reconstituted into 60l dialysate.  Most people get two treatments per bag, a few people can get away with 20l per treatment and would get three treatments per bag.  We have one or two boxes of 14 1l bags of saline.

We have additional supplies stored downstairs because they don't need to be very accessible - boxes of prepared dialysate (two 5l bags per box) for emergencies or travelling - I'd say they want you to have ten or so boxes of that on hand.  And two PAK boxes, those are the filter units for the Pureflow.  Those are larger, thinner boxes - at a guess they are about 3 feet by 3 feet by six inches.

Then there are the smaller standard medical supplies - fistula needles, gauze, heparin bottles, tape, masks, gloves, etc.

I remember ages ago when he was on PD, we had boxes stacked along the walls of the bedroom after a delivery.  We don't have nearly as much now.

 - rocker