Are perm caths really that bad?

[amanda]

I have a question my husband has had a permcath in for the three yrs he's been on dialysis and the doctors and nurses say he needs to get a more permanent access because of the infection rate in perm caths but from everything we've read and heard other types of accesses have problems to.  He did have periocarditis when he was on dialysis when he was younger from bath water but he's really careful and hasn't had a problem other than the flow and he's had the catheter changed twice that helped and he gets it activased.  So I guess I just worry they want it changed because it will take less time to get him set up or something.  So I guess my question really is are perm caths really that bad?

[Marvin]

For me, perm caths were not that bad.  Over the last 13 years, I've had 14 of them (rotating between left and right sides of the chest).  I never had any problems with them (except the one that fell out -- that was scary but really nothing serious -- only bled a little tiny bit).  I never had infections.  I had to take extra, extra care when showering, and I was constantly (several times a day) inspecting them for signs of infection and for cleaning and creaming (bacitracin).  I "anchor taped" mine to my chest for extra security.  When I first started out on dialysis, I kept my first one for 18 months (I still have it in a Ziploc bag).  I've had so many because they (perm caths) became my "in between" access.  My doctors kept insisting I get a "permanent" access, so they'd put in a graft, I'd use it for a while (four grafts, one lasted a year and one got infected and was never used, the other two's usage was somewhere in between these).  When a graft would fail, clot, or stop working for other reasons, I'd get a perm cath to "tide me over" to the next one.  I've also had two Tenchkoff caths (for PD).  When I had problems with these, I'd go back to a perm cath.  I've also had two AV fistulas, so I've experienced it all.  My first choice is the AV fistula (why? less risk of infection, lasts longer for me, get better treatments with these than with perm caths, nothing sticking out of the body).  My second choice is a perm cath.  I don't like grafts at all, and they don't like me!

Right now, I'm using a fistula that I've had for a little over two years.  I had run out of places to put an access.  My current fistula is in my left forearm (the same arm that I had the infected graft that never worked -- upper arm -- and a previous AV fistula -- clotted off after my transplant -- wrist area).  My surgeon "stole" a vein out of the back of this arm, flipped it around to the inside, "stole" a vein out of my thigh to  strengthen it, and created my "magic fistula."  It runs backwards (arterial on thumb side), but it works perfectly.  If it fails before I get another transplant, I think I'll go back to perm caths and stick with them.  My only other options would be an access in my thigh, and I'm not interested AT ALL in that!

Are perm caths that bad?  No, I don't think so.  It's what you get used to, what you're comfortable with, and what works best for YOU -- that's the main thing.

[jbeany]

It's not a time issue - I don't think there's much time difference between accessing a cath or a fistula.  And if time was the issue, they would want us all on caths - no holding sites afterwards.  They push for it because of the infection risk and the blood flow rates are usually better with a fistula, so the dialysis is more effective.  There are issues with a fistula, yes, but the infection risks are much lower.