Catheter Replacement and Patients of Advanced Age

[UkrainianTracksuit]

I had a well written post but my computer decided to crash.  Let me try to pick up the pieces from memory.

I've returned to live in Russia for x amount of time.  I've been too excited about going to see the games in Sochi that I wanted to focus only on good things for the time being.  Reality doesn't work that way.  Got some worrying news I hope someone here could help...

My 88 year old grandfather has been on dialysis for 9 years.  In the early years, there were many attempts to create a fistula or graft.  All of these failed.  He has used the same tunneled catheter for 9 years as his access.  We have been extremely lucky.  I cannot express how lucky we are that he hasn't had one infection or any clotting issues with this catheter until now. 

This morning, I've just received the phone call that my grandfather has to have his catheter replaced.  The nephs weren't in so it was a nurse that informed my grandfather and father.  My parents have to have a meeting with the nephs at my grandfather's next dialysis session for more information.  I am not sure if at that time something will be booked and we will have an actual date.  Right now, all I know is that the catheter is clogging and he needs a new one.  I am extremely worried.  I knew this day would come as we know catheters are not the best form of access.

Naturally, I have great concerns about mortality.  While I was going through databases doing my own research, I came across an article that stated catheters shouldn't be used in those of advanced age.  Catheters increase the chances of mortality.  Does that refer to those starting out on hemodialysis or those facing a replacement?  My grandfather is in decent health for someone of advanced age.  He has all his marbles.  He has severe aches and pains from general life and a life career in the military.  Lately, all of his renal blood work has come back good and his blood pressure is stable.  Can we expect a successful catheter placement based upon this for someone of such advanced age?  Does anyone have any experience with a situation with someone around this age?  How did it work out?  I know it is a minimally invasive procedure but things are always higher risk with the elderly.  I myself have a tunneled catheter and wouldn't bat an eyelash in this situation if it was for me.

I am so very worried right now.  Besides that, I am feeling tremendous guilt that I left my grandfather.  I was his caregiver and since my parents relied upon me, they aren't too "in the know" about dialysis.  (Even though they had two patients in the household...)  He was so happy I returned to the mothership but at times like this, I wish I didn't have to live my own life.  Sorry, bit of a meltdown there.

[noahvale]

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[obsidianom]

The issue with mortality you are worried about is just based on issues with infection and less effective dialysis then with a fistula . However your grandfather obviously has done well for years so it is really not an issue for him. Actually for some older patients catheters are the best solution do to inability to mature fistulas or problems with grafts.
Putting in a new catheter is usually a very simple process. Here in the US we usually have interventional radiologists do it in a minor procedure room using flouroscope to visualize it. I have watched my wife have 2 cathters put in and it was a very easy procedure . It took about 15 minutes. They just used a little local anesthesia for the4 initial holes and then snaked it under the skin and into the vein . There i svery little danger in doing this.
Clotted catheter is very common. He should be fine with a new one. Dont worry.

[UkrainianTracksuit]

Hello noahvale and obsidianom,

Thank you both for your replies.  I am so thankful to have this place knowing someone could offer some insight.  I'm less worried and a little more at ease.

I made many phone calls today trying to get a bit more information.  I should have waited because we'll know more Friday.  Anyways, according to the clinic, my grandfather is in great health and a new catheter should work out fine.  Like you said, obsidianom, a clotted catheter is common and it's time for a new one.  Thank you for the information also that catheters are sometimes the better choice in the elderly.  That was a huge relief!  From what information I could get, the original surgeon will be the same one doing the procedure.  I have to say that the staff that looked after the catheter did an amazing job all of those years.  The dressing always was done perfectly and pristine.  In the beginning, since my grandfather is forever curious, we made sure that whole area was a "hands off zone".  I hope the new catheter lasts as long as this one and is as problem free.

I talked to my grandfather too and naturally, this is all that is on his mind.  The Russian Orthodox priest is coming to bless him.  I thought to myself, "Gosh, you move FAST!"  His only concern is that they'll attempt another fistula or graft.  Since the last attempts ended up in hospital stays, I understand his concern.  I told him that isn't going to happen so he shouldn't be thinking about it.  We KNOW it isn't going to happen because 1) they told him and my father 2) they told me over the phone.

Noahvale, strange question, but do you mind if I copy/translate those procedures to share with some fellow cath'd patients at my local clinic?  For the most part, we receive good care but some days, with different shifts, I wonder.  I think with a little education those patients "not so much in the know" would be dealing with less infections.  The points you gave were simple and to the point.  Thanks for the "not feeling guilt" advice and the safe Olympic wishes!  (Even if the thought of going is getting scary..)  Logically, I agree with everything you said but in my heart, I feel so selfish.  You are right; there are no guarantees in life.  With my own CKD and dialysis, life has been on hold and I'm taking a chance.   

[UkrainianTracksuit]

So, I should be having the time of my life right now but catheters are the only topic on my mind again.  Not gold medals, not biathalon, not ski jumping... just catheters.

The procedure is scheduled for Wednesday and my grandfather is really nervous.  My parents emailed me all the paperwork to explain it all to them.  The third point on the fact sheet is that someone must monitor my grandfather overnight.  One would think that wouldn't be a problem since he has two people living with him.  Think again!  My mother insists she needs her sleep and my father says he will probably need to do a night shift.  Secondly, the fact sheet said my grandfather will be kept for 4 hours in recovery to make sure everything is alright.  Why is that such a hassle to people?  How can they not spend four hours waiting?  I'm stumped, angry and all of a sudden, all these feelings of guilt come back.

With the placement of the original catheter, there were no issues of infection.  Serious infection came with fistula procedures only.  However, here I am, worried again. 

[obsidianom]

Take a deep breath and remember this is not a big deal. Catheters go in very quickly and uaually without any complications. Monitering over night probably just means having someone in the house in case it bleeds or something happens like he accidently pulls it out. I dont htink someone has to stay awake and watch him. Try and relax and enjoy yourself. This will be ok.

[UkrainianTracksuit]

Thanks again, obsidianom, for the dose of sanity.  Realistically, I know you're right.  As a caregiver who has jumped ship, I feel as though I should be there.  I think it is the loss of "control" or being on top of the situation and understanding access sites/dialysis more than my parents causing these meltdowns. 

[okarol]

Wow 88 years old and he's been on dialysis for 9 years with a chest cath?! That's remarkable!
I hope they can fix him up with a new catheter and all goes smoothly.
 

[UkrainianTracksuit]

Just a quick update: I got up early this morning to call to see how everything went.  Everything was a success!  He's complaining about his arthritis so everything is back to normal.   

Yes, Karol, it is remarkable!  The nephs have commented it was the most "trouble free" chest cath.  While my grandfather hates dialysis, it is the reason he still lives a very active lifestyle.  Flirting with the ladies at the bank, watching footy at the pub and giving barbers heck for cutting his hair too short.  All thanks to the misery of dialysis!   

[rocker]