Placing the catheter

[MooseMom]

Could y'all explain to me the whole process of the catheter placement surgery?  What happens exactly?  Same day procedure, or is an overnight stay required?  General anaesthesia or local?  How about after-care?  If all goes well, how long does it take to heal to the point where you can actually use it?  (And how much does it hurt?  That's what I REALLY want to know!!)

Thanks for your replies!

[Ginger]

It  usually is a same day surgery so you would be home the same day. There is a small (2-3 inch) incision below where the tube comes out of your abdoman.  It can be done under local or general anesthesia depends on the MD and also your choice. You will go home with dressings covering everything and these will be changed by the PD nurse or your surgeon the first time. If it is the PD nurse who changes the dressings for the first time, she/he will also begin teaching you how to change the dressing and care for the PD catheter. If all goes well, you can begin using the catheter in about 2 weeks. Your Dr may want it to heal for 3-4 weeks though before using it. How much it hurts depends on where your pain threshold is. When I had my cath inserted, I think I took maybe 1-2 strong pain pills (mostly to help me sleep the first 1-2 nights) and then just plain tylenol for a couple more days, which was enough to keep me comfortable. I am getting forgetful about the insertion surgery since it was 3+ years ago and has since been removed.
Hope this helps you a little.

[MooseMom]

Thanks for that, Ginger, and you bring up another question that has occurred to me.

I plan to go on a transplant list, and I was wondering whether or not the catheter would/could be removed.  Stupid question since of course, if you don't need it anymore, then it will be removed.  Just goes to show how anxiety can make you sorta stupid!

[Ginger]

My PD catheter was removed about 3 weeks after my transplant. Done under "happy drugs", same day surgery and minimal discomfort.  Some surgeons will remove it at the same time as transplant.

[KICKSTART]

I really dont want to put you off but if you want to know the bad as well as the good here goes .. if you dont then dont read anymore of this !!!!

I had mine done under general anesthetic and it went wrong somehow! Vast doses of Morphine couldnt control my pain when i came round . I was let home the next day but could hardly walk and couldnt straighten up , believe it or not this was because i was very FIT. It seems the stronger your stomach muscles the worse it is and after 30 years of riding horses mine were very strong! Old ladies on the other hand make a lot faster recovery!! The part of the catheter thats in your body should point downwards ..mine is lodged under my 12 rib (yes they know but havent done anything about it) and its been like that for nearly 3 yrs. Aftercare here  is always ongoing .. we always keep them covered and cleaned (which you will get training for) It is usually ready for use in about 2 weeks.
I really dont want to put you off as most folk seem to have no trouble having it done! you will have to get used to it ,which sometimes feels unsightly and not very feminine and also the swollen tummy once the fluid goes in..but at the end of the day it keeps you alive so its a small price to pay ! Hope i havent worried you , most folk breeze through it so good luck.

[Ken Shelmerdine]

Another consideration is to think carefully about which side of your abdomen you want the catheter on.
If you're only going to do manual it doesn't really matter but if later you decide you want to use the night time cycler method then you need to bear in mind which side you sleep on the most. My favoured side is my right hand side so I had my cath put on the left so I wouldn't lie on it and trap the line. Also if you start on the cycler method, take into account which side of the bed you sleep on to that of your partner. Ideally you don't want the line draping over your partner on it's way to the machine.
Best of luck 

[MooseMom]

Is there a reason that they don't just put it in the middle of your abdomen?  Why do they have to pick a side?

[Ginger]

You would not want the catheter to get caught in the zipper of your pants.

[KICKSTART]

Is there a reason that they don't just put it in the middle of your abdomen?  Why do they have to pick a side?

You wouldnt want a catheter right in the middle it would catch on everything and probably rub as well. Honestly its bad enough on the side to get comfy,( also depending on what type of connections you had to it , they would either be looped up on your stomach or reach right round to your back!)

[mariannas]

Another not-so-great-experience here...stop here if you don't want to read!




My catheter placement went, well...wrong.  Being that I am also a transplant patient my anatomy is a little different down there.  The surgeon has placed many PD catheters, but evidently never in a transplant patient because he ended up severing my ureter.  Sooooo...whether or not you've had other surgeries in the abdominal area I would recommend that you get an all-clear from a urologist first to make sure that everything's in the right place.  Basically what happened is that for two weeks after my PD catheter placement I was peeing into my stomach.  I couldn't figure out why my catheter incision was leaking so much or why all of a sudden I really couldn't pee.  It took a day of vomiting for me to realize something was really, really wrong. 

ANYWAYS...that's my story.  It was literally a one in a million chance being that there is no record of this happening to anyone else ANYWHERE.  So...there's really no chance of anything going wrong with you, but if you think your anatomy is different for some reason I recommend getting checked out.

Other than that everything went well, despite the additional trauma I healed very well and the pain was only somewhat bad.  I basically felt like I did 1 million crunches...I'd say more of an extreme soreness than pain.

[MooseMom]

Oh man, mariannas, did you get some sort of prize for being that "one in a million" case?  You would think that a surgeon who knew you were a transplant patient would assume that your anatomy was a bit different.  How boneheaded!

Did you have to have another operation to repair your ureter?  How did they discover what had happened?

I just assumed that a potential PD patient would have some sort of scan just to show the surgeon of any sort of anatomical abnormalities, especially in women...many women have uterine fibroids or dodgy ovaries.  But I guess that just makes too much sense.

[mariannas]

Hahaha...no, no door prize here unfortunately.

Let's see...they discovered it because about two weeks after the catheter placement I started vomiting after every meal.  I didn't have a fever, but paranoia case that I am I thought I had an infection so I went to the ER.  They took labs and my creatnine was over 20!  Normally it runs around 6-7.5ish so my doctor knew something was up.  I had to have a dye scan and that's how they actually saw the damage.  A transplant urologist did the repair and now I'm good as new...almost! 

[rimbo74]

My doctor put mine on the let side even with my belly button so not to be interfered with waist issues.  My surgery was same day and was done liposcopically.  They fill your abdomen with gas so they can see what they are doing.  I was very sore for a couple of days but was able to gingerly move around. 

Removing it was nothing really for me.  The put you to sleep, make an incision in the same location as the first, then about 1 hr later your awake and ready to go home.

[KT0930]

As Mariannas said, hers was a one in a million chance...I've had two transplants, my tubes tied, a c-section, and a previous PD cath, so I've had my fair share of abdominal surgeries. My placement had no complications.

The worst pain I had was from the gas that was mentioned to inflate your belly. That tries to travel to the highest place in your body and get out, and it ended up in my shoulder (this happened with getting my tubes tied, too, that's how I knew what it was this time, b/c the nurse was clueless). They had ended my prescription for pain meds (I was inpatient) because it was over 24 hours since the surgery and I was just waiting to go home, so all I could do was sit in a chair and cry. The soreness from the surgery was nothing compared to the pain in my shoulder.

[MyssAnne]

Oh, KT, that pain in the shoulder HURTS!! I've done that too, and it seems once it hits,nothing is gonna relieve it!!! I get mine replaced next week guess I hadn't realized they use gas. Duh.  I'm a little slow sometimes!! 

[Ken Shelmerdine]

Is there a reason that they don't just put it in the middle of your abdomen?  Why do they have to pick a side?

The catheter has to teavel about 3 to 4 inches under your skin before it then goes further down into the bottom centre of your abdomen.This is so that a kind of infection buffer-zone can be created by the skin healing tightly round the catheter from  the exit site to the entrance to the abdomen. If the catheter went straight into the abdomen at the exit site, any exit site infection could travel very quickly into the abdomen causing peritonitis. That's why it's to one side. It actually enters the abdomen in the middle after it ihas tunnelled along, and just under the skin.

[MooseMom]

Oh, OK Ken.  That makes sense; thanks for the explanation!

As for the pain from the gas, I had a colonoscopy last year (one of the great things about turning 50), and I was sooooo nervous about everything from drinking that icky stuff to the procedure itself.  It was all a breeze...except for the pain under my breastbone from the gas.  OMG, that really hurt, and I had NOT expected that.  So now I know that they use gas when siting the catheter....not sure I wanted to know that, but it's probably good to be prepared!

[dlady64]

Not so great experience--may not want to read

I hesitated to respond to this post because I'm a newbie, but if I can help anyone, then...

I posted my experience of cath placement just this week.  Not sure how to link to it--think I read that admins prefer no links.  Guess you could search on my ID, dlady64, if you want to see the original post. (If someone wants to let me know the appropriate method, that would be great.)

Anyway, I normally have pretty bad menstrual pain.  Unfortunately, I'd just started my period a few days before the outpatient surgery.  The combination of gas pumped into my belly, menstrual cramps, and bladder spasms made the pain almost unbearable.  The clincher was that I had a very hard time peeing.  I ended up back in the hospital via ER.  Once they'd confirmed that there were no surgical issues (perforations, etc.), the hospital stay was just to help manage the pain.

It's been great to share this on the forum because I kept getting mixed messages from the medical staff.  The general practice doc seemed to think the pain was all in my head and I should let someone else have my bed at the hospital, but the surgeon on call confirmed that some people just experience more pain than others and that getting medical attention was appropriate.  The folks here at the forum have also been very supportive.

Hopefully, your mileage will vary.

[KT0930]

dlady, links within this site are ok. The problem with links outside of the site is that if that site goes down, then it's a dead link...no one likes that.  To get the link from your other post to this one, just go to your previous thread, copy the address that's in the navigation bar, then come back here and paste. Just like copying and pasting in any other basic application.

I've done this one for you... http://ihatedialysis.com/forum/index.php?topic=7200.0

[Slywalker]

The first catheter I had placed was not done under general anesthesia but with things like versed and other mind altering drugs.  Unfortunately I had a complication so the actual catheter was not placed.  They tore my bowel trying to place it so I ended up having minor surgery to repair the bowel.  I had to go on hemo for a month waiting for the abdomen to heal so they could try again.  Because hemo made me so darn icky feeling and tired I was bound and determined to get the PD catheter.  Second time there were no problems. 

First time the procedure was handled by a resident in a teaching hospital - he was supervised by my doc - but apparently got to far ahead of the doc and the procedure went south from there.  Had to stay two overnights in the hospital and had great amount of pain.

All in all doing PD was superior to hemo in my case.

Good luck.

sandyb

[Psim]

I just had to say again how much I appreciate everyone here sharing their experiences. It lets us following behind you know the range of stuff that can happen, so we can hope for the best but be prepared for the worst. You all make this journey so much less frightening!  to you all.